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Fascial Manipulation®

Origins and Background2 FM Stecco logo

Fascial Manipulation® is a manual therapy method that has been developed by Luigi Stecco, an Italian physiotherapist from the north of Italy. This method has evolved over the last 40 years through study and practice in the treatment of a vast caseload of musculoskeletal problems.

You can download a 2012, invited review article titled FASCIA SCIENCE AND CLINICAL APPLICATIONS: From clinical experience to a model for the human fascial system for background reading.

It focuses on the fascia, in particular, the deep muscular fascia, including the epimysium and the retinacula and considers that the myofascial system is a three-dimensional continuum. Initially, via collaboration with the Anatomy Faculties of the René Descartes University, Paris, France and the University of Padova in Italy and more recently with a host of different collaborations, Dr. Carla Stecco and Dr. Antonio Stecco have carried out extensive research into the anatomy and histology of the fascia via dissection of unembalmed cadavers. These dissections have enhanced the pre-existing biomechanical model already elaborated by Luigi Stecco (1,2) by providing new histological and anatomical data.

This method presents a complete biomechanical model that assists in deciphering the role of fascia in musculoskeletal disorders. The mainstay of this manual method lies in the identification of a specific, localised area of the fascia in connection with a specific limited movement. Once a limited or painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation of this precise part of the fascia, movement can be restored.

By analysing musculoskeletal anatomy, Luigi Stecco realised that the body can be divided into 14 segments and that each body segment is essentially served by six myofascial units (mf units) consisting of monoarticular and biarticular unidirectional muscle fibres, their deep fascia (including epimysium) and the articulation that they move in one direction on one plane. Numerous muscle fibres originate from the fascia itself (3, 4) and, in turn, myofascial insertions extend between different muscle groups to form myofascial sequences. Therefore, adjacent unidirectional myofascial units are united via myotendinous expansions and biarticular fibres (3) to form myofascial sequences.

While part of the fascia is anchored to bone, part is also always free to slide. The free part of the fascia allows the muscular traction, or the myofascial vectors, to converge at a specific point, named the vectorial Centre of Coordination or CC (5). The location of each CC has been calculated by taking into consideration the sum of the vectorial forces involved in the execution of each movement.
The six movements made on the three spatial planes are rarely carried out separately but, more commonly, are combined together to form intermediate trajectories, similar to the PNF patterns. In order to synchronize these complex movements, other specific points of the fascia (often over retinacula) have been identified and, subsequently, named Centres of Fusion or CF.

Fascia is formed by undulated collagen fibres and elastic fibres arranged in distinct layers, and within each layer the fibres are aligned in a different direction. Due to its undulated collagen fibres, fascia can be stretched and, thanks to its elastic fibres, it can then return to its original resting state. Given that fascia adapts to muscle stretch, it is unable to transmit force like a tendon or an aponeurosis. If these histological and functional distinctions are not taken into consideration, then one can confuse fascia with aponeuroses or, likewise, confuse the deep fascia with the subcutaneous connective tissue (superficial fascia). Subcutaneous connective tissue forms a very elastic, sliding membrane essential for thermal regulation, metabolic exchanges and the protection of vessels and nerves, whereas the deep fascia envelops the muscles, and surrounds the muscle’s aponeurosis up to where it inserts onto bone.

The above-mentioned anatomical studies have, however, evidenced differences between the deep fascia of the trunk and that of the limbs (6). The first is formed by three layers, each of which includes or surrounds different muscle groups, namely a superficial layer (latissimus dorsi, gluteus maximus, external obliques), a middle layer (serratus posterior inferior and superior, iliocostalis) and a deep layer (interspinali, intertraversarii, multifidus, trasversus abdominus). In the limbs, the deep fascia is particularly thick, resembling an aponeurosis, and well organised, connecting and synergizing the muscles of the lower limb via its collagen fibres arranged in sequences and spiral formations.
It is hypothesised, that the richly innervated fascia (7) could be maintained in a resting state of tension due to the different muscular fibres that insert onto it. Due to this optimal resting state, or basal tension, of the fascia, the free nerve endings and receptors within the fascial tissue are primed to perceive any variation in tension and, therefore, any movement of the body, whenever it occurs.
Deep fascia is effectively an ideal structure for perceiving and, consequently, assisting in organizing movements. In fact, one vector, or afferent impulse, has no more significance to the Central Nervous System than any other vector unless these vectors are mapped out and given a spatial significance. In human beings, the complexity of physical activity is, in part, determined by the crossover synchrony between the limbs and a refined variability in gestures. Whenever a body part moves in any given direction in space there is a myofascial, tensional re-arrangement within the corresponding fascia. Afferents embedded within the fascia are stimulated, producing accurate directional information. Any impediment in the gliding of the fascia could alter afferent input resulting in incoherent movement.
It is hypothesised that fascia is involved in proprioception and peripheral motor control in strict collaboration with the CNS.

Therapeutic Implications

The fascia is very extensive and so it would be difficult and inappropriate to work over the entire area. The localisation of precise points or key areas can render manipulation more effective. An accurate analysis of the myofascial connections based on an understanding of fascial anatomy can provide indications as to where it is best to intervene. Any non-physiological alteration of deep fascia could cause tensional changes along a related sequence resulting in incorrect activation of nerve receptors, uncoordinated movements, and consequent nociceptive afferents. Deep massage on these specific points (CC and CF) aims at restoring tensional balance. Compensatory tension may extend along a myofascial sequence so myofascial continuity could be involved in the referral of pain along a limb or at a distance, even in the absence of specific nerve root disturbance. In clinical practice, cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are common (8).

This method allows therapists to work at a distance from the actual site of pain, which is often inflamed due to non-physiological tension. For each mf unit, the area where pain is commonly felt has been mapped out and is known as the Centre of Perception (CP). In fact, it is important to place our attention on the cause of pain, tracing back to the origin of this anomalous tension, or more specifically to the CC and CF located within the deep fascia.

References

  1. Stecco L Fascial Manipulation for Musculoskeletal pain, Piccin, 2004
  2. Stecco L & C. Fascial Manipulation Practical Part, Piccin, 2009.
  3. Stecco C, Gagey O, Macchi V, Porzionato A, De Caro R, Aldegheri R, Delmas V. Tendinous muscular insertions onto the deep fascia of the upper limb. First part: anatomical study. Morphologie. 2007 Mar;91(292):29-37. PMID: 17574470 [PubMed - in process]
  4. Stecco C, Porzionato A, Macchi V, Stecco A, Vigato E, Parenti A, Delmas V, Aldegheri R, De Caro R. The Expansions of the Pectoral Girdle Muscles onto the Brachial Fascia: Morphological Aspects and Spatial Disposition. Cells Tissues Organs. 2008 Mar 19 PMID: 18349526
  5. PedrelliA, Stecco C, Day JA. Treating patellar tendinopathy with Fascial Manipulation J Bodyw Mov Ther. 2009 Jan;13(1):73-80. Epub 2008 Jul 26. PMID: 19118795 [PubMed - indexed for MEDLINE]
  6. Stecco A, Macchi A, Masiero S, Porzionato A, Tiengo C, Stecco C, Delmas V, De Caro R. Pectoral and femoral fasciae: common aspects and regional specializations Surg Radiol Anat 2008 DOI 10.1007/s00276-008-0395-5
  7. Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A, Macchi V, Aldegheri R, De Caro R, Delmas V. Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie. 2007 Mar;91(292):38-43. PMID: 17574469
  8. Day JA, Stecco C, Stecco A. Application of Fascial Manipulation technique in chronic shoulder pain--anatomical basis and clinical implications. J Bodyw Mov Ther. 2009 Apr;13(2):128-35. Epub 2008 Jun 24. PMID: 19329049

For a good overview article see Day JA, Copetti L, Rucli G. 2012 From clinical experience to a model for the human fascial system. J Bodyw Mov Ther.;16(3):372-80.

Publication List

For list of articles by Dr. Carla Stecco and Dr. Antonio Stecco see PubMed.

Videos

Click to review videos on the Fascial Manipulation Association's WEBSITE, video case study presentation here, or advancements in the practice and research of fascial manipulation here.

Level 1 Fascial Manipulation Course

Click Course Details for further information.

Level 2 Fascial Manipulation Course

Click Course Details for further information.

2016 Update - World Congress Presentations

Dr. Carla Stecco will be presenting at the 9th Interdisciplinary World Congress on Low Back & Pelvic Girdle Pain to be held in Singapore 31/10 - 3/11, 2016 - http://www.worldcongresslbp.com on Wed Nov 2 in the session Connecting tissues: The role of fascia in lumbopelvic pain and stability Topic: Role of fascia in non-specific low back pain
She will also  present a post-Congress workshop entitled: The Fascial Manipulation© Technique for Low Back Pain: Anatomical bases and biomechanical model
Presenter: Carla Stecco, MD (09.00 - 16.30 hrs)

Subcategories

Fascial Manipulation Level 1 Course

Fascial LR

Presented by Ms. Julie Ann Day, this 6-day course is an intensive course where theory lessons, demonstrations, and practice between participants alternate throughout the day.

2 FM Stecco logo

The course is specifically designed for;

  • physiotherapists (including final year students)
  • osteopaths
  • medical doctors
  • chiropractors
  • TCM doctors
  • podiatrists as of 2019 

Myotherapists and massage therapists that have extensive training and experience may be considered but will be required to submit a curriculum vitae detailing their additional training and experience. Send to Clinical Director.

"I have so much to say about how good and worthwhile this method and course is and how great a teacher Julie is.

The Stecco Fascial Manipulation Courses provide the physiotherapist with a detailed understanding of the fascial system. The practical component of the courses is extensive and there is plenty of time to practice palpating the fascial points and to develop the correct treatment techniques.  Julie is an inspiring physiotherapist with amazing skills and has a great teaching method.

Fascial manipulation can be applied to nearly every musculoskeletal condition that physiotherapists treat in their clinics.  It provides a framework that allows for some simply amazing results. One patient suffering from 4 years of chronic significant neck pain with limited movement (I had treated her with all the standard techniques including joint mobs, muscle releases, neural mobilisation, postural correction, stretches, and exercises – only ever achieving temporary results) regained her full neck movement with no pain after 1 treatment of a Spiral fascial point on her forearm. We were both amazed and her outlook on life is so much more positive.  I’ve been working as a physiotherapist for the past 32 years with elite sporting teams and private patients.  During this time I have palpated and seen many patients with signs and symptoms that do not fit the standard anatomical nerve / joint / muscle referral patterns.  This can now be explained by the facial system.

Add this course to your Professional Development program and you too will be inspired and able to provide an even higher standard of care for your patients."

Jim Eustace physiotherapist

Jim Eustace APAM
Practice Principal
Chair Physiotherapy Business Australia - Qld Chapter

Why chose the Fascial Manipulation Diploma?

Attending a 6-day course is a significant investment in time and finance for any busy practitioner. 

  1. Mr. Luigi Stecco and his associates present this competency-based diploma program of Level 1 (6 days) Level 2 (6 days) and Level 3 courses around the world (see other courses available in the world). To gain the complete qualification in Facial Manipulation, successful completion of both Level 1 & 2 is required. Each course is competency based and there is both an oral and written examination. Textbooks are written in 6 languages.
  2. The Fascial Manipulation Association holds an annual conference in which participants and researchers from around the world gather to discuss new findings and treatment directions.
  3. The founder of Fascial Manipulation Mr. Luigi Stecco and co-researchers have published extensively - see PubMed search
  4. In addition to these articles, textbooks are available;
    Stecco, L. 2004. Fascial Manipulation. Piccin, Italy
    Stecco, L & Stecco C. 2009. Fascial Manipulation:Practical part. Piccin, Italy
    Stecca, C. 2014. Functional Atlas of the Human Fascial System: Churchill Livingstone

On completion of this course, participants are invited to enrol in the Level 2, 6-day course. On successful completion of Level 1 & 2, participants are invited to attend the Level 3 course. It is recommended that participants complete 12 months practice before attending Level 3.

Background Information

Fascial Manipulation Level 1

While Fascial Manipulation is mainstream in Europe, it is less well known in Australia (opportunity to get ahead of the crowd in offering and understanding tissue from a new perspective). Here are several resources to provide background information.

  • Fascial Manipulation background paper 
  • Introductory video produced by students describing, the Facial Manipulation Method here,
  • Video case study presentation here
  • Fascial Manipulation Description
  • Advancements in the practice and research of fascial manipulation here
  • Fascial Manipulation Association's website,

Textbooks

Textbooks can be sourced from here scroll to Fascial Manipulation and from here.

Fascial Manipulation Level 2 Course

Presented by Ms Julie Ann Day, this 6 day advanced course is an intensive course where theory lessons, demonstrations, and practice between participants alternate throughout the day. Fascial Manipulation Participants Level II Sydney 2015

The course is specifically designed for;

  • physiotherapists (including final year students)
  • osteopaths
  • medical doctors
  • chiropractors
  • TCM doctors
  • podiatrists as of 2019

and that have passed their Level 1 course.

In the Level II course of Fascial Manipulation© participants expand on their understanding of the biomechanical model to treat patients with multi-segmental dysfunctions more efficiently.

Level II will focus on the role of Centres of Fusion as part of the biomechanical model, and how the CF form the Myofascial Diagonals. Elements of evolution and comparative anatomy studies will be discussed to assist the evaluation of adaptive compensations within the fascial system. The involvement of fascia in motor control will be looked at and the Assessment Chart used in Fascial Manipulation© will be updated with new elements. Myofascial Spirals will be presented to complete understanding of complex movement patterns and mechanisms.

Treatment demonstrations and student practice will highlight this course and the comparative assessment of Centres of Coordination and Centres of Fusion, Assessment Chart analysis, clinical reasoning, hands-on skills, and treatment strategies will be emphasized.

Participants MUST provide proof of successful completion of Fascial Manipulation Level 1 before applying for Level 2. Please email a copy of your certificate to AAP Education Course Director.

"I have undertaken both the Level 1 & 2 courses in Fascial Manipulation and am intending to take the Level 3 in Italy later this year. I have found this treatment method to be very beneficial and a great adjunct to integrating into my other physio skills and treatment methods. The greatest parts about Fascial Manipulation is that it allows a methodical approach to assessing the person as a whole and integrating previous injuries/imbalances into treating the current presenting issue for the patient and it works fast if it is the right technique for the problem.jo hadley physioterapist

Learning Fascial Manipulation requires an initial investment in learning a new way of understanding the importance of the fascial system in our bodies and how it can effect both local and distal structures and then in learning a new way of assessing and looking at the body and learning where the FM treatment points are and how to implement this new approach. Six days for each course seems long but it also is such an intense course that 6 days sometimes feels too rushed.

I highly recommend learning Fascial Manipulation as I feel it is an important missing piece to treating the whole person."

Jo Hadley

On successful completion of Level 1 & 2, participants are invited to attend the Level 3 course.

Participants will learn to evaluate musculoskeletal dysfunctions, with specific reference to the human fascial system, and to apply the Fascial Manipulation technique as taught by Mr. Luigi Stecco. Lessons include anatomy and physiology of the fascial system, explanation of the biomechanical model used in application of this technique and the anatomical localisation of key fascial points. The evaluation of musculoskeletal dysfunctions from anamnesis to hypothesis to verification and treatment is emphasized, together with the methodology of treatment and treatment strategies. 

Textbooks

Textbooks can be sourced from here scroll to Fascial Manipulation and from here.

Fascial Manipulation 2 - Perth

In the Level II course of Fascial Manipulation© participants expand on their understanding of the biomechanical model to treat patients with multi-segmental dysfunctions more efficiently. Level II will focus on the role of Centres of Fusion as part of the biomechanical model, and how the CF form the Myofascial Diagonals. Elements of evolution and comparative anatomy studies will be discussed to assist the evaluation of adaptive compensations within the fascial system. The involvement of fascia in motor control will be looked at and the Assessment Chart used in Fascial Manipulation© will be updated with new elements. Myofascial Spirals will be presented to complete understanding of complex movement patterns and mechanisms.

Treatment demonstrations and student practice will highlight this course and the comparative assessment of Centres of Coordination and Centres of Fusion, Assessment Chart analysis, clinical reasoning, hands-on skills, and treatment strategies will be emphasized.

This 6-day program is divided into 2 blocks of three days.

Early bird discount of 10% will be applied during Checkout until 1/10/2018

An AAP Education Accredited Course. AHPRA CPD 48 hours.

Event Date Fri 26 Apr, 2019
Event End Date Thu 02 May, 2019
Available place 8
Location SCGH - Physio Department

Ticket Information

Ticket Type Price Available place
AAP Education Member

Includes free lifetime AAP Education membership

$2,300.00 2
APA Member $2,300.00 4
Fascial Manipulation 1 - Perth

Fascial Manipulation® is a manual therapy method that has been developed by Luigi Stecco, an Italian physiotherapist. This method has evolved over the last 40 years, through research, anatomical studies and clinical practice for a wide variety of musculoskeletal problemsb and focuses on the fascia, in particular the deep muscular fascia. Lessons include anatomy and physiology of the fascial system, explanation of the biomechanical model used in application of this technique and the anatomical localisation of key fascial points. The evaluation of musculoskeletal dysfunctions from anamnesis to hypothesis to verification and treatment is emphasized, together with the methodology of treatment and treatment strategies.

Early bird discount of 10% will be applied during Checkout until 1/10/2018

This 6-day program is divided into 2 blocks of three days.

An AAP Education Accredited Course. AHPRA CPD 48 hours.

Event Date Fri 10 May, 2019
Event End Date Thu 16 May, 2019
Available place 5
Location SCGH - Physio Department

Ticket Information

Ticket Type Price Available place
AAP Education Member

Free lifetime membership + benefits with course

$2,400.00 0
APA Member $2,400.00 3