Fascial Manipulation

Origins and Background

2 FM Stecco logo

Fascial Manipulation® (FM) 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 problems.

FM 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.

"As a sole practitioner, I totally understand the hurdles faced by physiotherapists in Australia looking for 'quality' Continued Professional Development. I try to not only look at the cost and time missing from work which is an added expense but I try to look at emerging trends from Europe and the UK / Ireland where I have worked and trained. That is how I came across Fascial Manipulation and I have now completed level one and level two approximately two years apart.

Julie Ann Day is one of the most approachable, generous, knowledgeable and professional presenters I have had the pleasure to learn from in my 20+ years. Besides evidence-based studies (just look for any studies with the search words fascia+Stecco + Julie Ann Day) plus amazing anatomical knowledge in Carla Stecco's fascial anatomy book, I can truthfully say Fascial Manipulation has been a great benefit to my practice and to me continuing to be passionate about what I can treat and positively influence in the body. Fascial manipulation sits alone or can be integrated into your existing skill set which in my case includes dry needling along acupuncture guidelines and the previously named Integrated Systems Model by LJ Lee.

I feel we as Australian physiotherapists, need to be progressive with our manual therapy skills as well as the academic development of our profession. I am currently nearly finished the first year of my Masters of Sports Physiotherapy (which will probably take me the maximum time to complete) but it is my 'hands-on' ability to assess and treat and rehabilitate that keeps my practice full with clients that spread the word and provide my next new patient. I don't advertise. My advice is to get on board the 'fascial knowledge train'."

Aideen Osborne

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

Stecco L Fascial Manipulation for Musculoskeletal pain, Piccin, 2004
Stecco L & C. Fascial Manipulation Practical Part, Piccin, 2009.
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]
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
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]
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
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
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 background reading, you can download an invited review article titled FASCIA SCIENCE AND CLINICAL APPLICATIONS: From clinical experience to a model for the human fascial system

For a 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.