~ by Melinda Cooksey, MS, PhD, Co-Founder ALC
The past few decades have been exciting for the Field of manual medicine. This new- found attention to the mechanical domain will continue to foster profound changes in how gross anatomy is taught, how future clinicians are encouraged to think and hopefully in how the public will be encouraged to imagine their own physical/ mechanical adaptability, resiliency and potential. In the mid-/late- 1800s A.T. Still, the founder of osteopathy, wisely and proliFically spelt out the importance of a whole-body, mechanical and holistic focus in medicine. He is quoted …
“To find health should be the object of the doctor. Anyone can find disease.” It is indeed difficult today to find academics or professionals that would want to dispute his words, but for well over a century this was not so.
As our Western culture moved more toward a focus of industrial era ‘parts’ that all had ‘functions’ and all added up to a well-oiled ‘machine,’ we became saturated in a health system that looked specifically at naming symptoms and treating those symptoms and parts to add up to healing. While there have been huge leaps in faith and understanding since the National Institutes of Health began recognizing and funding complementary and alternative approaches in the late 1990s, it has only been since 2007 that manual medicine has begun to have its own international research community. In 2007, the first International Research Congress on Fascia was held at Harvard. In the decade since, interest, knowledge and forward progress have been exponential.
A theme that this tugs at is, with all the modalities and proprietary, trademarked clinical certifications that are available to massage therapists, movement therapists, physical therapists and bodyworkers; how is one to decide which are valid? Which are helpful? How does a patient with an injury, ache or chronic pain know what modality is right for them or helpful at all? A Cochrane Collaborative tool was applied to randomized trials within the field of manual medicine (this is a tool for assessing the risk of bias) and found manual therapies, when used alone, are only moderately beneficial. Furthermore, the specific modalities are more alike than unique and, in general, are statistically indistinguishable from one another. This is a big deal statement! Mechanical domain therapies are relatively similar to each other and when used without other domains present are only moderately helpful. This gives us loud reason for pause to look at the current trends in teaching and providing
these therapeutic interventions to the public. To close the 2015 Fascia Research Congress, the scientific chair Serge Gracovetsky stated …
“Clinicians are treating patients based upon their school of thought or modality of certification instead of basing their care upon the pathology of the patient.”
While this statement might leave one with a large question hanging, ‘so what do I do now?’ “Where do I seek training?” Or, “how do I find a good practitioner?” The undercurrent it provides means that over the next few decades, we will be producing new generations of manual therapists, osteopaths and bodyworkers that will have more sound knowledge. Instead of working off protocols and other’s taught techniques, future clinicians can draw from academic knowing to treat their patients based upon their best application of that knowledge and integration with other relevant domains of integrative care.
Fascial research, specifically, has been a profound contributor to the rapid advancements in our knowledge and interest in mechanical domain therapies. This has been a tremendous professional joy for me to watch unfold. It has been a sincere gift of timing for me personally to be where I was, and am, along the timeline. In the late 1990s when I was in graduate school, I had a very hard time convincing the department of Anatomy and Medical Education at OSU that fascia was a valid area of study. It was the ‘stuff’ that we threw away during a dissection, not the ‘stuff’ graduate degrees where made of. But as my professional career has moved on, the field of fascia has exploded. And, it is such an exciting place to be!
Fascia is the scaffolding that supports our posture and streams together our movements without our conscious input. In fact, we have absolutely no conscious control of our fascia at all! In the embryo, fascial precursors migrate out very early (around 20 days of development) and sets up ‘guide wires’ and containers for future muscles, bones, nerves, blood vessels, organs etc. to travel along to find their future homes and set up shop within. It becomes a dynamic, 3-dimensional matrix of support, geometric efficiency and tensional integrity (or tensegrity as we call it) that underlies all of our movement, resiliency and adaptability.
Because of its nature, it is very unique to each of us. It has come to be the way it is because of the life we live within it, what we have asked from it over time and the patterns we have relied on to live out life. Furthermore, it has amazingly elegant electrical features that beg fascinating questions about its role in the increasingly credible field of energy medicine. Because of this, fascia is also uniquely challenging to treat with a protocol, or technique or hand placement in mind for the therapist.
Fascia has been re-categorized as a system of the body, like your skeleton, muscles, nervous system, respiratory system, etc. It is no longer the ‘stuff’ we ignore, fail to name and disregard. It is the newest frontier of manual medicine. Fascia has become a leading interest in biomechanics and cell biology as the knowledge of its importance and impact to the other bodily systems comes flooding in. This gets us
much closer to being able to discover paths toward healing, instead of naming and treating the symptoms of disease as A.T. Still alluded to nearly 150 years ago.