Latest / The STA Clinician Podcast / Ep.258 'New Perspectives On Fascia' with Dr Claire Melanie Boucher and Dr Kyra De Coninck

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Ep.258 'New Perspectives On Fascia' with Dr Claire Melanie Boucher and Dr Kyra De Coninck · The STA Clinician Podcast

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You're listening to the Sports Therapy Association podcast, putting evidence
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back into soft tissue therapy.
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Okay, and we're live. Apologies for a slightly late start. We were sitting there ready.
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It's just the program starts, it kicks in and I get a countdown and it doesn't go in. so I was here.
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Please don't think I'm being insulting to you by making you wait three minutes. But anyway, we're here.
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We're live. It's episode 258 of the Sports Therapy Association podcast.
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My name is Matt Phillips, creativerunchecklive.com. And as always,
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this episode is being recorded live on the Sports Therapy Association YouTube
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channel and Facebook on a Tuesday night at eight o'clock.
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So I'm so excited about tonight's show. It's on a topic that I absolutely love
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and I have loved for years.
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It probably set my career really as putting the evidence back into running or
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putting the evidence back into soft tissue therapy.
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It was one of the topics that was so, so hot back in 2012, 2013. It really was amazing.
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And it's still a topic that is being discussed today, but in lots of different ways.
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So in this episode, New Perspectives on Fascia, I'm absolutely thrilled to be
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joined by two leading researchers in fascia from the University of Kent, Dr.
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Claire Melanie Boucher, lecturer in sport, exercise and rehabilitation sciences, and Dr.
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Kira DeConnick, senior lecturer, School of Sport and Exercise Sciences.
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Before I bring up my wonderful guest tonight, then as always,
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I must thank my guests from last week.
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We had a great episode. I always say it was a great episode, but it really was.
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It was a chance for us in episode 257 to look back and reflect on the STA and
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Hands On Hub conference that happened on the 20th and 21st of September.
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Feels like a lifetime ago.
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But we looked back in collaboration with the ST School and we talked about it.
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And we looked at what went well, what could have been a little bit better.
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And we're so excited about planning for another one.
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But as part of that, and this is where you, the listener and colleagues of listener, we need your help.
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I did mention that there is a questionnaire that we created.
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And it's a questionnaire where we invite all of you listeners and colleagues
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to basically answer these questions about what do you want from a CPD conference?
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Because we kind of said last week that the success of the conference and the
2:27
feedback we got was simply because we gave the people what they wanted.
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We listened to you guys and we did mix it with some kind of education-based
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approaches and things and helping you guys be the folks of attention instead
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of the speak on the stage, but it went so well.
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So it works. Guess what? If you listen to somebody, then you can actually help them.
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Who would have thought us being clinicians and that? so if you do have time
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then please go to the home page of the ST school or go to the home page of the
2:53
sta.co.uk and you'll see a QR tag on there or a little button to click if you
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prefer that and you'll find a questionnaire it really won't take more than four
3:03
or five minutes to fill out.
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And that is the way we can help you and put together a follow-up conference
3:09
somewhere in the UK so we'd love yeah please please do contribute it really helps us help you,
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right then to tonight's show very excited to bring up my guests in this episode
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entitled new perspectives on fascia dr claire melanie boucher and dr kira de conic.
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You're listening to the sports therapy association podcast putting evidence
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back to soft tissue therapy,
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good evening dr claire boucher and dr kira
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de conic oh the name is just rolling off my tongue now not one mistake no
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i'm so glad we had that
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30 minute training beforehand just to practice the names thank
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you for your time welcome pleasure to be here particularly kira
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de conning because this is your first time on the show and so you
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had no idea claire's just gone yeah come on it'll be okay and and
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you said and you said yes you must trust claire wonderfully which
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is nice to see i always say this i'm hoping i
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mean claire you've been on the show before and you spoke at therapy expo and i'm
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sure a lot of sta members remember but i'm
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hoping that there's people who are listening now with a
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couple of thousand we get downloaded who have never heard of either of you i'm
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sure they've heard of fascia but hopefully they don't know you because otherwise
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what's the point we're just an echo chamber so well hey you are in my mind yeah
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you're my go-to fascia people so yeah if you could yeah what a great label you
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can your work is done yeah exactly Exactly.
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Matt Philipson from Munchet Live said. But yeah, so if you could,
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although I'm sure it gets longer and longer each time you have to do it with
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the amount of work and research and things that you've done,
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but a little introduction,
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a little elevator talk on how you got into fascia and what you do with fascia now.
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Shall we start with Dr. Claire Boucher?
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All right. I was going to say Kira could go first, so I guess I'm up.
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So, yeah, I'm Dr. Claire Melanie Boucher, Claire.
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And I stumbled into fascia, which you may have heard me talk about before,
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in that I vocationally was working in exercise referral, working with lower
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back pain, working in various different kind of health and fitness environments.
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Had never heard of fascia, never came up. I think at one point it may have been
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a little tiny anecdote in an anatomy drawing, but that was it.
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Finished my undergraduate degree, sport and exercise science,
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was looking for masters and PhD opportunities with back pain,
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lying on the soap with my legs in the air and saw a Twitter post back in the
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day that was Kira advertising a PhD looking into the thoracolumbar fascia and
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back pain and my brain went what?
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What is this? Why do I know nothing about this? And that was pretty much what
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I messaged Kira and then here I am.
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So my kind of interest I suppose fell into it through using
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movement and exercise to help people and
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then realizing okay well massage and all the things I'm doing connect
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up with it so that's how I got here that's wonderful
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when was that again when was that twitter post what year were
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you talking about 2018 I think I
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saw the post and I started the phd 2019 so yeah
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I'm not on twitter anymore I've just
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started using it again because i've got a newfound interest in
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communication skills and behavior skills and
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a new course and stuff so i've just made a little group of brand
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new people now just to follow them because you know you can create those groups and
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just just follow them and actually you know what it reminds me of the
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good old days on twitter when you could actually follow some people and get some
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good information i almost feel like doing a follow friday again or
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something just uh like we did like a decade ago when we
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actually wow you know remember that's amazing it was so cool now linkedin i've
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got i've got all the good people over there i'm in my little bubble yeah and
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that's it's good as well that's true okay well thank you very much for that
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uh detail and you did do your phd didn't you there under the watchful eyes of
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dr kira de connie because you've done it already.
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And and since then you're very much involved with now you've
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got undergraduates of your own haven't you and you're helping them yeah so
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yeah i'm still at kent i'm lecturing i am still ongoing
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writing up my phd while i've written it but to try and get it published takes
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ages especially when you're teaching at the same time but i'm working on that
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and yeah i've got some new research projects i'll give them a shout out katie
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and daisy no idea if they're listening they should be because they're doing
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a study on fascia which they started training last week well that's exciting Well,
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we'll turn that into a little soundbite and then they can put that on their CV.
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Wonderful. Okay. Thank you very much for that. So, yeah, the person who made Dr.
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Claire Boucher's future as it is now, which I'm sure she would thank you for. Yeah.
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How did you get into fascia then, Kiva? How did that happen?
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My journey started a long time ago.
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I used to run a sports injuries clinic and was part of a multidisciplinary group
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of practitioners and I ended up with a lot of patients who just couldn't find
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any answers anywhere else.
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So these were people who had been suffering with chronic pain,
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both athletes and non-athletes, people who may or may not have been injured
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a very, very long time ago, but were really suffering with chronic pain,
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with recurrent pain, with intermittent pain.
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And I started looking into the nervous system and it's really the frustration
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of the kind of theories and ideas and concepts and frameworks that were available and courses,
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CPD courses that were available at the time,
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working with chronic back pain and chronic neck pain, for example,
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that didn't really answer the questions that I had.
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And I noticed that some people just working, working on their bodies,
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their bodies just felt so different.
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So some people, it felt really spongy and very soft and I could just go into it. People in pain.
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Other people, more or less the same pain as they
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presented to me and talked to me about their pain, their bodies felt very different.
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It's very dry, very stiff, not a lot of movement in there.
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Now, both of these people, whatever what was going on underneath their skin was very different.
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However, they presented with more or less the same symptoms.
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So that really got me thinking.
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And then it was complete serendipity. I was on,
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this was in the 1990s and I went on
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a really early kinesio tape course because again my athletes
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get babbling on about about this colored tape
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that they'd seen their you know famous athletes wear
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and could I use this and of course I have been
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using elastic taping and mechanical taping
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and and and taping to enhance movement we didn't call it kinesio tape and it
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didn't have fancy colors But we were using that concept of actually moving the
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skin above and putting that little bit of tension on the skin.
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And things seemed to shift.
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We didn't really know much about it. So I really wanted to go and do that kinesiotape
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course really to prove my athletes wrong.
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Because I felt at the time that it was snake oil, that it was commercial exploitation.
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And so I went on it. And I started using it and noticed that,
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yes, when you are putting tension on the skin, is that me? That is me. I'll say it's me.
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Putting tension on the skin and
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keeping that tension there for a sustained period seemed to shift things.
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It made movement easier. It reduced pain in some people in some circumstances.
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On one of those kinesio tape courses, they showed us using ultrasound.
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So they put the tape on, they put the scanner on, and then you could actually
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see the tissues underneath the scanner were moving without us touching anything.
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I thought, wow, maybe I could use this to try and look and see what's going on underneath the skin.
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And at that time, I was starting to read Helene Langevin's work.
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I went to visit her. I showed her the ultrasound techniques that I had developed
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in the meantime and really started to develop this more and more.
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And then I had the opportunity to apply for a PhD. I did my own PhD whilst I
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was already teaching sports therapy and sports rehabilitation at the university.
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So really, these things were happening in tandem.
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And then, as you mentioned, there was this kind of explosion of this really
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early fascia ultrasound research.
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Munich kind of came to a halt. But I carried on asking questions and trying
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to figure out what exactly was going on.
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Because we know that things happen.
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Things change for some people in Korea.
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For some people with movement restrictions is whether we use manual therapy,
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whether we use exercise, whether we use taping, whatever mechanical force we
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apply, something, something, something happens.
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So, but one of the really big issues for us still at the moment is to visualize that.
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That is still a really big problem. So I think the gap for me that it's still,
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we need to breach is the difference between what therapists,
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whether they are rehabilitators, whether they're exercise specialists.
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Whether they're massage therapists, yoga teachers, Pilates teachers, notice a change.
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When you put a mechanical stimulus in there, something happens.
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We still don't really know how to visualize that and how to measure that and
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really to be taken seriously or to be incorporated into other really big scientific
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fields, we need to visualize it.
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We need to have biomarkers. We need to have very clear frameworks to say,
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okay, this is what a healthy fascia looks like, and this is what a pathological
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fascia looks like. We still don't really have that.
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That doesn't mean that fascia doesn't play a role just means we haven't quite
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developed the tools in order to measure those changes.
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I know I'm veering off a little bit, not really talking about me,
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but that's how I, what still, you know, gets me up and go to work every day.
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And that's what's been such a pleasure, for example, working together with Claire
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on her program, because she really pushed it forward.
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And she started to look at fascia and movement and fascia and exercise and okay we.
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You know, we know that things don't happen quickly. The turnover of collagen
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changes within the hyaluron, the extracellular matrix, the fluid part of fascia.
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Those changes take time.
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So we've looked and tossed and turned and measured fascia in so many different
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populations under quite a few different circumstances.
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I then had another master's student who then looked at very,
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very short term, a little bit of flexion.
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We tried to see whether we could see any changes between pain population and non-paid population.
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And with each study and each student that I work with, we moved forwards.
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Very, very slow. It doesn't mean that it's not worthy of investigation.
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It is, but we still need to develop the tools. So from that super excitement,
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way back in 2009, 2010, we sort of thought, oh, by now we'll have all the answers.
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And we don't. We're still working it out.
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Yeah. What we do have is people from very different scientific areas are now
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becoming interested in our seeing connections.
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They might not call it fascia, but that's basically what they're working with.
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And that's really exciting.
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I feel like you pretty much summarized my talk at the therapy expo there through
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my every question I was like well we don't know but yeah I think I think it's
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really important because it is it is easy to polarize this area.
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And I do think it's very, very important that whether you're a massage therapist,
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whether you're a Pilates teacher or yoga teacher or an exercise coach,
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that you understand that this tissue is ubiquitous.
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It is absolutely everywhere. It is like a second skin underneath our skin.
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It is very closely related to our immune system. And it has a role in fluid dynamics.
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It has a role in pain. it has
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a role in movement so it interacts and
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it communicates with so many different systems yet
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it's very very slippery it just
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keeps slipping through our fingers because we still can't quite measure it what
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standard measurements in in imaging in musculoskeletal research is is mri we
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we still can't really measure ultrasound is still much much better at visualizing.
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Compared to MRI, for example.
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I think that's just kind of, you're probably gathering from listening.
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Kira and my kind of, well, our heads and the way we think about things,
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the way we teach, the way we research is trying to find, okay,
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well, we don't think this is everything, but it's connected, right?
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And we always think about fascia as that connection, it's that whole body,
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and it interplays with everything.
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You know, we're not saying it connects everything equally, but it's involved, right?
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It's somewhere there, it's doing something, and we're still us
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and all the older wonderful or fessier researchers are trying to put
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those dots together and go ah that's it and
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i still think it will happen at some point we'll find that that's how it connects
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and we're all at a party i swear all over the world but we
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know it's connected somehow and it's just trying to fit that together and see
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how and why and where my mind i compare it i compare it a lot with for example
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ligament research or cartilage research if you think about what cartilage research
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was like say 50 years ago.
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It was a little kind of discounted cartilage.
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And we still don't really understand, for example, why cartilage injuries are
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so painful, yet there are no nerves in there.
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There's no neural inputs into cartilage, yet it really, really hurts.
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So there is again that communication system.
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So I think I'm a very patient person.
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I think you need to be as a researcher and you
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need to keep chipping away at it but that doesn't mean
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that there is nothing nothing to discover and we
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haven't quite turned the stone over and kind
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of seen seen the treasure but we are chipping away
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at it because we know that there that our answers are
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somewhere somewhere in there specifically for
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those type of conditions that are still so
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difficult to treat and that we try
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and do our best and help people but are
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still very very difficult because it's not just
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purely muscular it's not just purely psychosocial it's
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not just purely the nervous system it works
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together it's not just purely training and strength it's it's fascia touches
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on on all of those elements makes it a nightmare to do research but it's of
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course very fascinating and It's an absolute treat for sports therapists,
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for rehabilitators, exercise specialists, and massage therapists.
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Because practitioners work with all of those systems together.
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Probably, they may or may not realize it, but certain changes that people can
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feel, therapists can feel underneath their hands, or can see in terms of changes
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of range of movement, changes in agility, changes in responses.
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Absolutely out there and those changes
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are there because it's different systems interacting
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with each other i love that
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i love the way you both present it for anyone listening to the podcast you've missed
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13 minutes of smiles whilst talking about fascia and you both of you had smile
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from ear to ear you haven't stopped because it's it's so infectious because
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you're obviously so passionate about it and you've had like a 24-hour day of
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not stop non-stop education and stuff so no it's It's wonderful hearing everything you've said.
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And I love, thank you so much, Kira, for the timeline you gave.
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It was so interesting hearing how, I think for me personally.
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My confirmation bias is just hearing that you came from a skeptic's point of
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view with like Kinesio tape and stuff and other types of tape,
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where you're like, hold it, I'm just going to do this because I know it doesn't work.
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And then you start looking into it. And that's such a healthy thing to hear.
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I think it's needed so much 15 years later when,
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like you say, it has become very polarized like everything else in society
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and people have given up on it so yeah very exciting
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i just want to say sherry phelps good
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to hear first time listener little shout out first time watching an sta
20:16
live hi from podium therapist thank you sherry it's interesting
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as well and i'm sure it's because of the passion you're delivering is i i get
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to see like the youtube listeners and normally they go up and they go down again
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everybody who's joined is just like stuck and glued and they're like oh hold
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on you know so it's it's what we need i think but the topic that can be so volatile
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and people switch off so quickly and don't kind of make the effort so.
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Right then. Early on, there was a lot of misinformation.
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And I think lots of different modalities really latched on to that very,
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very early research where myofibroblasts were involved,
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where the nociception and the relationship between fascia and pain,
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the relationship between cannabinoids and fascia.
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The fluid dynamics and fascia.
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So there was all this really early cell-to-cell communication within fascia,
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changes in collagen turnover.
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There was all that really exciting, very new, early research.
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And I think lots of modalities kind of thought, this explains what's happening.
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You know, Bowen's therapy, lots and lots of visceral manipulation.
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Lots and lots of different kinds of therapies.
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Understandably wanting to have
21:30
a framework theoretical framework to justify
21:34
and to explain and to make sense of what they could feel was happening underneath
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their hands and then it kind of stopped because the research could never provide
21:47
evidence that that is what's happening in those therapies because it is so,
21:52
so difficult to actually justify that because so many different systems are involved.
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And, you know, is it the tone of our voice by which we talk to people?
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Is it the amount of time that we're listening to people?
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Is it the pressure that we're putting on the tissues?
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Is it the amount of dehydration and then rehydration of the tissues?
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There are so many different elements at play now
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the beautiful thing is that therapists so
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many therapists seem to know instinctively what
22:26
somebody might need now it's it's it's up to the science in a way to catch up
22:32
with that and to try and and make sense of of what happens and to find the tools
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for doing that that's still really in its infancy,
22:43
both in terms of the visualization of fascia and the biochemistry.
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The cell-to-cell communication, the role of inflammation in fascia.
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There are still so many elements of change that therapists just work with as a matter of normal.
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This is normal for many therapists that they see these things change.
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But in scientific investigation, we can't just...
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Rely on case studies and case series. This is a great starting point,
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but then we need to look and look a little bit deeper.
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Literally underneath the skin, to try and look, to try and understand what is
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a healthy fascia and what is a pathological fascia and how does that differ in the body?
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How does it differ across the age of people as well, for example?
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This always links with how, I think I
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know it's how me and Kira and I think a lot of other lecturers teach
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and talk to their students is we're always asked by students
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by our patients you know well what's the best massage
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I can have what's the best exercise I can have what's the
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best and the answer is pretty much always
24:01
well there's not which one are you going to do regularly there isn't
24:04
a best size fits all it's going to come down to what are
24:07
you going to keep doing what are you going to enjoy doing what are
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you going to put that effort in even when you're tired and that's
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what I'm always trying to come back to you know is ultimately in terms
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of fascia we don't have anything more concrete
24:20
than do what's good for your body you know like we know
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movement is good but we can't say doing this particular method
24:26
is the best one because it might well work but
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we don't know if it's better compared to a hundred other
24:32
versions it's just what are you going to keep doing and that
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is what I'm always coming back to is that we haven't
24:38
found anything that's the best yet but we know that things
24:41
are working so let's keep doing it keep moving and adapting to what you're finding
24:46
when you're treating these patients if it's working for them keep going because
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it's doing it you know and everyone's so individual and so different that that's
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what we want right they're going to keep coming back to you as that therapist
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as your researcher as your.
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Physio as your scientist piece personal trainer whatever it is if it's working
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and if it's working it's because you're doing something right for that person and that body and that.
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Individuality is something we really have to I think dive into which makes it
25:14
hard for research But in terms of us doing work with patients, it works, right?
25:19
Yeah, it does make it harder for researchers, doesn't it? Because that's another
25:23
problem. Is it the classic way of conducting research?
25:26
Go back to guys just doing research on guys. I mean, that's a classic one,
25:29
isn't it? Where there's a slight kind of omission there.
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But it is tricky. It's getting a bit better. Look, hey, we've got both of you on the show.
25:37
20 years ago, we wouldn't have allowed women to talk about fascia.
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So it's fantastic. Oh, come on, Matt. It's only 50% of the population that's missing.
25:45
It's so... Yeah, exactly. And we can mansplain it.
25:50
Anyway, so I'm interested then, we call this new perspectives on fascia.
25:54
So you've laid a wonderful perspective on the idea that we don't know everything,
25:59
but we mustn't dismiss everything.
26:00
But if we can look now at maybe a
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couple or two or three things which you think clinicians should be
26:06
taking on board to update their perspectives on fascia things
26:09
which maybe you think people got wrong whether it's they're overdoing
26:13
it on something old which is kind of moved on from
26:15
or maybe they're underdoing it because they think that oh there's
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no point touching this i can't affect fascia what what
26:21
what do you think we should talk about two or three things oh i mean we sort
26:26
of started i sort of started on movement there so perhaps we start there in
26:30
that i think the issues when i have discussions with someone that comes up to
26:35
me and goes oh fascia and i'm like yeah did a whole phd on it it's a real thing.
26:41
They're usually just but but we don't know what's best you
26:44
know and that is the one that comes up a lot and it's trying
26:47
to remind i suppose people that we
26:51
do we have found research that so things are changing you
26:54
know we have we i my phd is still not published but
26:57
the intervention i did but i had lower back pain
27:00
i did lower back pain classes for six months i did it all online
27:03
because it was COVID era and they had a reduction in
27:05
pain you know so we didn't see any significant changes
27:08
in fascia it changed but it wasn't didn't cross
27:11
that magic number I think we needed more than six months but that's
27:14
another whole problem but their pain reduced so
27:18
maybe we need to look a bit more broadly and go okay
27:21
well what do we know works you know we've got
27:23
loads of evidence that looks at how muscle adapts
27:26
to different types of exercise and I'm talking cardiovascular I'm talking
27:30
strength talking flexibility again that there's no one size fits all we know
27:34
it works with bones we know it works with ligaments think about injury rehab
27:37
you know we know that these things are working and it's trying to get that thought
27:43
out of people's heads that are of a well I can't do anything it does take a
27:47
long time and I'm not going to argue that it doesn't.
27:50
If you get people into those habits of those movements and those
27:53
massages and whatever it is you're doing that are we know
27:56
mobilizing we know they're encouraging those multi-directional movements
27:59
across the body that's going to hopefully make those
28:02
lifelong changes and then they might still be doing that six 12 months
28:05
from now and then we start to see the fascia change so
28:08
that's something I think it needs to
28:10
shift back because it was you must do this exercise and
28:13
this will make fascia work and then that that didn't kind
28:16
of follow through so then it became it won't do
28:19
anything that aims at fascia because they won't do anything and so we've gone
28:22
one end to the other whereas i want us in the middle somewhere i
28:26
want us to middle and work between both and see
28:29
what happens and if you agree disagree kira i think you're
28:31
going to agree yeah i think i think
28:34
really it's about from from a
28:37
fascia practice point of view needs a
28:40
very different approach to fascia research so
28:44
for fascia practice what is important is that
28:47
you understand which layer are you
28:50
working with i think what's really interesting
28:54
is that we're becoming more and more interested in
28:57
the superficial layer it's basically the
29:00
space between the dermis the epidermis the fat those fat lobules they sit inside
29:08
pockets of dense connective tissue within that dense connective tissue there's
29:14
a layer of superficial fascia now on the.
29:18
Thousands of scans that claire and i have been
29:21
doing we can see we can measure and
29:24
we can see distinctive different patterns
29:27
of that superficial fascia whereas traditionally
29:31
in fascia ultrasound research the emphasis
29:35
was on the deep fascia for example the
29:37
thoracolumbar fascia that that thick pad that
29:41
kind of diamond shaped thick connective tissue
29:44
pad in the in the lower back where when you
29:47
put the scanner on there you can get somebody to
29:50
do a superman type of movement and you can see all these
29:53
layers sliding sliding over again so the
29:56
original thinking was oh well actually that's really where the where where the
30:01
answers lie now we've been scanning people for you know thousands of different
30:06
scans yet the changes that we see is not in that deep fascia but it's in the superficial fascia,
30:14
where that superficial fascia is very organized in some people and very,
30:19
very disorganized in other people.
30:22
Sometimes the disorganized fascia is indeed in people with lower back pain.
30:29
Sometimes the really disorganized fascia is in people without pain.
30:34
It might be a precursor, it might not. We need to do follow-up studies in order to find out.
30:40
Now, as a therapist, as a fascia practice
30:44
it is important to have
30:47
the conscious intention to understand
30:51
that when you are doing a fascial technique
30:54
or when you are using plyometrics or when you are stretching or when you are
31:00
doing a whatever whatever training you might be doing when you're doing strength
31:04
training for example so to to think about the relationship between these different
31:10
layers and, for example, the muscles.
31:12
As Claire mentioned, a lot of the facial techniques are.
31:17
Sometimes claim that they
31:19
are only addressing the fascia in
31:23
my book it's not really possible so when
31:27
we're talking about strengthening you are looking
31:30
at strengthening those the muscles
31:33
but you are also looking at changing that relationship right creating less stiffness
31:40
less adhesions less densification or doing the opposite actually trying to get
31:46
to get that fascia to tighten up a little bit because that will enhance that force transmission.
31:53
So I think there are two things in fascia practice is to understand that relationship
31:57
between the fascia and the muscles.
31:59
We can't really separate them. They act together. They slide over each other.
32:05
They either don't slide over each other and move as one unit.
32:10
And then that relationship between it might not be the deep fascia.
32:15
So it might not be those really, really deep treatments that are necessary.
32:19
It could be that actually very light touch or a different input,
32:25
maybe more of an interplay between the nervous system and the fascia and the fluid.
32:31
That's what might be necessary. So I think we're still at the stage where very, very deep treatments,
32:37
that's what might be needed, or more lighter and a more superficial and very
32:44
light touch, that might be what's needed.
32:49
Okay. Got some great questions coming in on basis of what you've said.
32:52
So you ready for questions here?
32:54
And we've got some good questions in the house. So that was like a little warning here coming on.
32:59
Let's go. So, Cecily Hislop, first of all, I'll bring it up on the screen for
33:01
people who are watching on YouTube.
33:03
Cecily says, so to put it in a blunt terms, classic Cecily, how can touch massage affect fascia?
33:10
Particularly in the US, you'll hear the term melting fascia, which makes me cringe.
33:13
So what does actually happen? Many thanks, smiley face.
33:17
Yeah, I also don't like the melting. You can't melt it. It's part of your body.
33:21
We don't want it to disappear.
33:23
We just want to mobilize it. I mean, we know from when we're doing massage treatment,
33:28
if I'm ultrasounding at the same time, you can see how the muscles and the fat
33:33
and the fascia all kind of go.
33:36
It's the same when you do anything. If you touch something, everything interplays.
33:40
So the way I see it is we're not melting it.
33:43
We're just trying to mobilize. and linking back
33:46
to what Kira said there really when people are saying they're
33:49
just targeting fascia no you're not you're targeting skin you're targeting
33:52
muscle you're targeting everything and that's not a bad thing we
33:55
can't separate it we're not trying to we're trying to move everything we're
33:59
trying to get everything moving and mobile because we all know you've got anything
34:03
if you've got DOMS and you can barely move everything feels wrong you do the
34:07
penguin waddle out the gym don't you know and it's like if I could just get
34:10
that all to move properly it's not a problem so I think
34:14
you can we can see it under ultrasound we can see the
34:17
kind of changes that we're putting that pressure on as
34:20
we're moving up and down the body with those massage strokes we're not melting
34:24
it we're just trying to get it more supple more mobile we're just trying to
34:29
get it to do something because sometimes it can get very sticky and you can
34:33
looks like cotton wool sometimes under ultrasound which i should have brought
34:35
some scans in we could bring them over to you matt but.
34:38
You've done a great job describing it so but have you
34:41
seen then the different types of touch and strokes do affect
34:45
the fascia in different ways is
34:48
that just or does it is it random no we
34:51
haven't the changes so just to go back
34:54
to Cicely's question about melt I also
34:57
think that concept of melting is probably not
35:00
meant literally I think it's a concept whereby a very light touch or a very
35:08
prolonged stretch similar to yin yoga for example these very prolonged stretches
35:14
give the sensation of release hmm,
35:18
that release in that short period of time is probably not going to be that deep fascia.
35:25
When you do dissection, you have to take a very, very fresh scalpel in order
35:30
to separate that deep fascia from the muscles.
35:34
In order to kind of look at that relationship between the intramuscular fascia,
35:41
the perimuscular fascia, don't want to get too technical about it,
35:45
but it is basically everywhere.
35:48
So, melting it or stretching it is probably not what's happening.
35:55
But people doing these techniques feel different. They feel great.
36:01
So, what might be happening is that it's actually an interplay between fluid changes and fascia.
36:08
Or it's an interplay between the nervous system and fascia. Because,
36:13
of course, stiffness in muscles, and you mentioned Dom's earlier,
36:18
that pain in muscles is not just the muscle fibers.
36:23
It's the nervous system. It's the immune system. It's the fluid system. It's inflammation.
36:29
So could it be that these very slow, very prolonged stretches somehow have the
36:36
neurological effect, which reduces pain, which then allows us to move a little bit more freely?
36:42
Now, that doesn't mean that those techniques don't work, but they might not
36:47
just be working on the fascia.
36:49
And that's why I think people have this immediate release.
36:53
Whereas if it would be working only on the fascia, you would have to hang there
36:59
for a very long time, or you would have to kind of stretch, stretch for an incredibly long time.
37:07
Yet when people do those techniques, They feel the release immediately.
37:11
So in my mind, it's a different system.
37:14
It doesn't mean that we have to disregard fascia.
37:19
There are still adhesions within the fascia. There are still densifications.
37:23
There are still changes. But maybe we need to address those changes by working
37:30
with different body systems, like the fluid system, like the immune system,
37:35
like the nervous system.
37:37
So that's what I think is happening there. How about...
37:43
Because one of the reasons that I think fascia courses lost favor with maybe
37:48
some of the scientific community was the really painful techniques,
37:52
like the picking up the skin and the rolling.
37:54
And I've been on courses back in the day where it was a case of the person underneath
37:58
just had, we were doing it on each other and it was so painful.
38:00
I can't remember what it's called now, but literally lifting up the skin and picking it up.
38:04
And it was all very structurally based. We were told what you're actually doing
38:07
here is you're separating the fascia and that you're lifting it up.
38:09
And it was so painful and you had massive red marks afterwards. And
38:12
that was used as evidence that something's happening the fact that it was like absolutely and
38:15
that is exactly what you were doing so you were breaking up
38:19
that superficial fascia you were releasing an awful lot of inflammatory cells
38:24
you were causing bruising i mean i was covered in bruises myself and i did those
38:29
courses and and again this this idea of it's it produces so much pain therefore it must
38:38
good for us it's that loop it's that experience of pain and then of course the
38:44
reduction in pain and then maybe or maybe not a little bit easy of movement once that that bruising.
38:53
But that skin rolling and that picking up
38:56
and kind of tugging at the skin that's that's
38:59
exactly what what we were doing we were breaking up
39:03
that that that those very very delicate
39:06
almost like a honeycomb of of
39:09
tissues for how long was that
39:12
a difficult question was it is it a temporary thing like any structural effect
39:15
it did have would it as soon as they stand up and start moving around and
39:18
go back to how it was or do you think there was any therapeutic benefit in terms
39:21
of loosening things up it depends on what you do afterwards so if once you once
39:27
you kind of have that have that release as such with those very very painful
39:32
deep techniques if people then went back to not moving their bodies,
39:38
Everything probably just went back again.
39:42
If that would then allow people to start moving a little bit more,
39:46
like go maybe for a walk or to do some exercise and to enjoy exercise or to
39:53
have a continuation of movement and exercise, sure.
40:00
So if it's like a gateway towards another change, absolutely.
40:04
But just of its own to having to keep going back for those very very painful
40:12
treatments I yeah it wouldn't be my first choice.
40:16
The kind of argues that is it necessary to like
40:19
the way we teach both Kira and I teach massage to
40:22
our students we teach them in the first year then we follow up
40:25
with a follow-up course later in their degree we're always
40:28
telling them to stay within certain pain ranges because one they're
40:31
learning we don't want them to hurt each other but we don't
40:34
want them to go out and cause loads of pain to people because it doesn't always
40:37
make sense if you're someone's doing a really painful treatment to
40:40
you I bet you you're bunching up your shoulders you're probably clenching your
40:43
fists you're gritting your teeth and actually well how is that
40:46
helping you to relax those muscles that your whole
40:49
body system it's causing the opposite effect so it's
40:52
yeah the one the one
40:55
kind of situation is for example in post-surgical
40:59
fibrosis particularly around the knee around
41:02
the elbow around the shoulder when you're working with those
41:05
joint capsules sometimes a very
41:08
deep a very acute stretch or
41:11
manipulation can help as long as people then carry on moving moving those joints
41:18
and and and keeping and keeping active so there are situations where i think
41:24
those very deep techniques which can be painful are really really useful,
41:29
again, as long as it's followed up.
41:32
How does this, because back in the day, it was the Chowdhury paper,
41:36
2007, I think, which kind of took, people took great delight in quoting,
41:40
you know, how much, how many Newtons it took to deform fascia by 1%.
41:44
I think it was on nasal fascia and stuff.
41:46
And on paper, it showed that whatever you think you're doing to fascia, you're not.
41:51
But you're suggesting that with the picking up of the skin, we are actually
41:54
kind of changing the state of the fascia.
41:57
There's two different things. That picking up of the skin and tugging at the
42:00
skin and the skin rolling, where we were told at the time, look,
42:05
this is where it's very, very dense and this is where it's adhered and so on.
42:09
A lot of that is just different thicknesses in layers of fat between the skin and the muscles.
42:16
And that differs all across the body. And that's important that that differs.
42:21
So, for example, over the hamstrings, it's meant to be tight.
42:25
Over the shoulder, it's a little bit less tight. So a lot of those differences are functional.
42:31
But what I think we were doing is we were changing that relationship of that
42:37
very, very thin, that honeycomb superficial fascia right in where the fat lobules sit in.
42:46
We were changing that. We weren't changing the deep fascia because you can't
42:50
really do that. So, again, when we talk about fascia, that goes back to my earlier
42:55
point about nomenclature and about what it is that we're calling.
43:01
Really, we shouldn't just be talking about fascia. We need to talk about,
43:05
are we talking about the superficial fascia, the honeycomb network,
43:09
or are we talking about the deep fascia?
43:12
Are we talking about visceral fascia? Are we talking about intramuscular fascia,
43:17
the fascia inside the muscles? So.
43:21
All those different layers and different areas of the body require a slightly
43:26
different approach, depending on what the role of fascia is.
43:31
Is it to aid gliding? Is it to help force transmission?
43:35
And should it be stiff so that it can aid that force transmission between muscles,
43:42
for example? So I think it is different.
43:44
And with the post-surgical fibrosis, I think that relationship between skin,
43:50
joint capsule, ligaments, tendons, fascia, it is all collagen.
43:57
It is all connective tissue.
43:59
It has a slight, slight contractile ability, but its main function is very,
44:06
very different from, for example, muscles.
44:08
So it requires a different technique and
44:12
sometimes shifting shifting that
44:15
capsule or it might be that what we're
44:18
doing is again talking to the nervous system and it
44:21
might be that you know certain end plates kind of
44:23
switch and turn from nociceptors to mechanoreceptors which is blows my mind
44:29
i think it's absolutely incredible that our body can do things like that It
44:33
might be that we're putting different inputs into those nerve pathways and that that aids that easing.
44:43
So again, it takes us back to the idea of melting fascia.
44:47
We might be talking to the nervous system, which will then allow a little bit
44:54
more sliding or allow a little bit more movement with reduced pain.
45:00
That does sound like a important avenue to
45:03
go down because like again i think people still
45:06
taught like cross friction and the whole kind of like syriac's method
45:09
and the idea that by really putting two things
45:11
in the other and really pushing you are breaking stuff down and and over
45:14
and again back in the day i remember like with achilles tendon opposite
45:17
and things we were told kind of yeah and it's so
45:20
painful but i guess yeah it's
45:24
just trying to move away from that idea james has kind of
45:27
asked a great question james morgan from barefoot physio along the same lines
45:31
james says so what's the premise of specific changes that's a fascia with regards
45:36
to pain is it possible to be specific how do you separate fascia from inputs
45:40
to the nervous system and the contextual factors that go along with the patient's experience.
45:45
It's quite a lot in there isn't it you can rely on james morgan to uh come up
45:49
with a yeah it's not going to be an extended episode for an hour do stay with
45:53
us good one james yeah what what can you comment on that.
45:58
I mean, for me, it's with difficulty. That's the answer to that question is
46:01
because anything with people, we're alive, we're living, we're doing,
46:06
we're breathing, we feel things, you know, how can we quantify it?
46:10
And that's something we are, well, I think we'd be asking that question for an eternity,
46:15
if I'm honest, because how can we, you know, and it's trying to think of it
46:19
in all of those avenues is something that's important to me,
46:22
because that patient experience might not be, I might be scanning you on an
46:26
ultrasound and going, well, actually, it looks like a patient.
46:28
Fine but it's not if you're in pain and
46:30
you've had issues you've got nothing coming up on your
46:33
x-rays or mris you know whatever it is but if it looks
46:36
fine but it's not something's happening
46:39
right and it's that patient experience is what
46:42
we're trying to get to the bottom of and at the moment the honest
46:45
answer is we don't have a go a way to do
46:48
that we don't i'd like us to one day i'm
46:51
not even sure we will i think i'll be researching this forever
46:54
and trying to work it out and i'm not unhappy about
46:57
it you know because i want to i want to find out more i want to
47:00
get more into it but it's really hard to be specific and how to separate because
47:05
we can't separate it it's connected to everything we're we're one thing but
47:09
are we closer to a way of saying that this person has got a problem or an issue
47:14
that is because it's fascia orientated not really.
47:19
We still don't have, because one of the problems is that we still can't,
47:24
we still don't really know what the biomarkers are and how to visualize and
47:31
how to image and how to measure and what the parameters are of a healthy fascia.
47:36
We still, and those early studies, which mentioned all 25% of people with chronic
47:43
lower back pain, you know, their thoracolumbar fascia is 25% thicker.
47:48
Now, when we did our studies, we didn't find that at all.
47:52
Subsequent studies didn't find that at all. And it might be that what was being
47:57
measured was the dense connective tissue, but also the fluid and the superficial fascia.
48:03
And in those days, we didn't really distinguish between we either discounted
48:08
the superficial fascia, was discounted in research papers, or it was kind of locked in together.
48:14
So again, that's, you know, what you mentioned, the specific changes to fascia
48:20
with regards to pain, we still can't separate that.
48:23
But that doesn't mean that we don't consider it or that we don't take it into
48:30
account. It's not because we can't diagnose it as such at the moment that we discount it.
48:37
So, for example, the fascial connection between different muscle groups,
48:41
the connection between the muscle, the musculotendon unit, the attachment onto
48:47
the bone, those are real.
48:49
Those are real anatomical structures that I don't think anybody is questioning.
48:54
Now, when we are looking at how to separate fascia from input to the nervous
49:01
system, there is a really interesting study at the University of Auckland.
49:07
And what they did was they tried to visualize fascia in MRI scanners.
49:14
It's very, very difficult. They tried it with contrast fluid.
49:17
It's really, really difficult to look at what is fascia, what is fat.
49:22
It all comes up as white. It all looks the same.
49:27
Then what they did is they stimulated the fascial layers with an acupuncture needle.
49:34
And all of a sudden it started lighting up
49:37
and they could see and they could see the difference
49:40
as to where the fat was and where the fascia is so
49:44
these are really really early studies so
49:46
we are at a really early stage whereby we
49:50
are putting a stimulus into the
49:53
fascia now whether that's lighting up because of
49:56
that mechanical stimulus or whether that's lighting up
49:59
because of the neural input we still
50:02
don't really know again other studies are.
50:05
Finding out the difference between very superficial
50:09
this is on the the cheek of a mouse very
50:13
very superficial stroking and looking
50:16
at which which neurons are are
50:19
lighting up and then applying a deeper pressure
50:22
just with like a you know the thing you clean your
50:25
ears with and then a deeper pressure
50:28
kind of going into this is being imaged at
50:31
the same time this is on a sedated but
50:34
but live mouse so not not a cadaver
50:37
and and a deeper pressure and then
50:40
when you look at which neurons are are being activated it's a very very different
50:45
pattern so we're only at the very early stages whereby we can visualize and
50:51
measure what happens to the nervous system when we do very light touch and it's
50:56
a very different pattern than when we apply a deeper touch.
51:00
So that goes a little bit towards answering your question on inputs to the nervous system.
51:07
And then the last point of your question for me rounds the circle. And that is those.
51:15
Psychosocial context of pain and
51:19
and restrictions and and holding on and for me
51:21
that's a really exciting area whereby we put together the the mechanical inputs
51:28
the psychosocial changes and the the structural changes and for me the answers
51:36
lie in all three all three of those things.
51:40
And that is what therapists have been working with in a holistic manner.
51:46
So rather than separating them, I think it is about bringing those systems together
51:52
and from a theoretical perspective is to understand the interplay between all of those systems.
52:00
Now, for Claire and I, this is not something that we do at the level of research that we're doing.
52:07
We are still trying to figure out the best medical imaging techniques in order to measure pixels,
52:16
in order to look at changes in fluid, in order to look at changes in the shapes
52:21
of the fascia that we are imaging.
52:24
So we are still very much working with ultrasound and fascia.
52:29
At the same time, conceptually, we are very aware that this is not just structural changes.
52:36
It's the nervous system And of course, the socioeconomic and the psychosocial
52:42
circumstances of somebody who is in pain.
52:46
Getting on the structural side, sorry, jumping one more. So our lab's not,
52:51
it's me and Kira currently, small lab, little undergrab students.
52:54
And we're working on this bit by bit.
52:56
But I mean, fluid is something that we're very interested in.
52:59
And we are currently a bit limited with how we can get in there and all the rest of it.
53:02
But the research coming out from Carla Steco and Katarina Fedde are really looking into,
53:06
and that's the past what past five years or
53:09
so it's really started growing and growing what is that fluid
53:12
made of exactly what is in there how is that starting to
53:15
be different in different kind of age ranges that
53:18
like Carla did one that looked from pre-birth and all
53:20
the like there's been various different bits that are coming out that's very
53:23
much new in terms of fasia research that's trying
53:27
to get us to get that little bit more understanding and I
53:29
think what we're all doing is trying to just find that little bit
53:33
more so then we can build it build it build it and it's like we're
53:35
playing with lego the whole time and we're still trying to get to
53:38
the okay well we know this but it
53:41
doesn't quite make sense here okay what if we put this in what if
53:43
we put that in and build that kind
53:46
of picture and say the new research that i've got my new student team which
53:50
kira is helping me out as co-supervisor as well we're looking at how fascia
53:54
changes under ultrasound the same technique we've been doing so it's it's the
53:58
same thing still but okay well how does that change through the menstrual cycle
54:01
because we haven't looked at that yet you know What is different? What are we building?
54:05
And it's all trying to find new bits because we can't.
54:09
There's only so many of us we can only do so much but i think every
54:12
researcher is coming across it in a different angle and we're all trying
54:14
to work together i suppose to try
54:18
and find these answers so we can get a little bit closer to quantifying
54:21
more things and the connection between them but it's really hard as you said
54:27
it's stressed so we're gonna have to do i mean i'm saying we have to it'd be
54:31
lovely to have you back for part two because there's so many more questions
54:34
but i'm interested with this episode we've talked about some of the new perspectives
54:38
on fashion And it's so exciting to hear what you're working on.
54:40
And what are some of the take-homes for clinicians then in terms of,
54:45
thanks to the new perspectives you've talked about and ones which we probably
54:49
haven't even mentioned,
54:50
what do you think the modern clinician should be doing or even shouldn't be
54:55
doing in order to make the most of what could be happening?
54:59
We don't know exactly what's happening yet, but just to make the most of potentially
55:02
affecting the fascia and helping.
55:04
I mean my number one will be talk to
55:07
your patient and see what what are you doing what
55:10
are they saying is working for them what is improving it
55:13
be that movement be that massage be that various different
55:16
techniques mobilizations whatever it is and
55:19
go from there make those notes of what works for that person it
55:22
probably won't be the same for that next person and going back
55:25
to trust your gut you know you can read a hundred different journal articles
55:28
and i encourage you to your like new research is great
55:31
but actually applying it is sometimes missing in
55:34
the research you know we're trying to do that in our avenue but not
55:36
everyone is because not everyone can be a researcher and a practitioner because
55:41
we're all too busy for that so it's trying to find.
55:43
You know okay well how can I get that and put it into mind
55:46
what is working that I'm doing that might interplay and I
55:49
think having that open mind that okay
55:52
well it's working I might not know exactly why but it's
55:56
working so that's my big take home okay
55:59
so that's let's just are you okay for time by the
56:02
way it's nine o'clock i don't know whether okay for another
56:05
five ten minutes because i want to want to give people kind of three things
56:08
to take home so even though we don't
56:10
know how things are working and we are getting closer by the
56:13
sounds of it which is thanks to people like yourself in order
56:16
to successfully potentially help somebody
56:19
with a fascia situation even though we can't label it then it really
56:23
is a case of working in a patient-centered model
56:26
where you're asking what works for them and then the chances are
56:29
by giving them maybe a technique which you've poo-pooed in the past like
56:32
bowling or whatever it is if that's working
56:36
for them and it's giving them results then kind of believe your gut and stick
56:39
with that that's kind of the take-home message you've got from you know a lot
56:44
of the research you've done keep going with what your patient says is better
56:46
because it is very much an individual thing and one day well maybe we'll know
56:50
why ah that's why that worked for that patient and why it didn't work for the other one.
56:53
But at the moment, it's just let
56:54
the patient guide you because we haven't really got an explanation yet.
56:57
Yeah, absolutely. And I think not to put your eggs all in one basket and to
57:02
be very open-minded and not to think that because something worked with one person,
57:09
that therefore this is the technique that you now identify yourself with and
57:14
this is now something that you apply to absolutely everybody.
57:17
So it is still very much a case of very individualized approach.
57:23
And then I think to really think of fascia as something that works together with other systems.
57:30
It's not something that just functions on its own.
57:34
I think that's really important. So not to disregard muscles,
57:41
not to disregard the immune system, not to disregard the fluid system,
57:45
not to disregard movement and strength, and that these all work together.
57:52
It might be that actually preparing the body for, for example,
57:57
strengthening or for agility,
57:59
that actually these fascial techniques might really help to prepare the body
58:04
to be better equipped to cope with rehabilitation,
58:09
to cope with maybe those deeper techniques, to cope with strength training or
58:15
whatever, or biometrics or whatever it is that you need to do with your patients.
58:21
So I think fascia can be a very helpful framework to think about restrictions, to think about pain,
58:30
to think about densification in certain areas of the body, to work with those,
58:35
to then prepare the body for further treatments.
58:39
Okay. And one more. What else would you like therapists to be taking?
58:44
Like I haven't got enough of me, but what else do you think?
58:46
To be really, really patient.
58:48
Remember, connective tissue is very, very different from muscles.
58:53
Muscles, you can feel when you put a mechanical stimulus into it,
58:58
you can almost feel that change.
59:02
With fascia, it takes time.
59:05
The collagen turnover is very, very slow. So I would say, particularly with
59:09
people with very chronic pain, is to be patient, to work very incrementally,
59:16
and then to look at how the patient responds.
59:20
Is to allow for that work to settle in and not to always expect short-term outcomes.
59:28
But people know this.
59:30
Well no i think i think i think by poo-pooing
59:33
kind of fascia techniques then people
59:36
are moving away from those slow kind of hold your
59:39
hands on there and imagine i remember i was given the kind
59:42
of idea of a it was like a pound coin melting in
59:45
a tub of margarine and just giving it that moment and if
59:48
you think well is anything actually melting under my hands then probably
59:51
not and you think i'm not gonna do this anymore but like you say
59:54
you could be affecting the fascia doing this but
59:57
it for a different reason recognition we actually don't know yet yeah
1:00:00
so if you keep trying these techniques on
1:00:03
your individual don't go in there with a i know how to sort you out see if it
1:00:07
feels nice to them see if it helps with their movement and stuff and then keep
1:00:10
going with that because that could be because we're working with yeah different
1:00:14
and also those i don't think those techniques need to be thought of as a standalone
1:00:19
technique no i see them very much as an entry.
1:00:24
Into other things that people can do themselves in their own lives.
1:00:29
You should not have to go and have, you know, facial treatments for the rest of your life. No.
1:00:35
Though lots of different professions will come and shoot me now.
1:00:39
I'm going to hit you with one hard question now. I think it's a hard question, but I hear it a lot.
1:00:43
And I'm interested on, because there's two of you. I wouldn't do it if there's
1:00:46
one of you, because there's two of you now. You can take this now.
1:00:49
And it is from Mr. James Morgan again, a barefoot physio.
1:00:52
And I hear this a lot. So here we go. James says, if it's a frictionless interface,
1:00:57
then how can you create any significant structural change?
1:01:01
Well, we haven't yet. We're still trying to get that significance.
1:01:06
But what we're looking at is that it's going to take a very, very long time.
1:01:10
And I think, I mean, the study I did, well, my main bulk of my PhD was a six-month study.
1:01:15
And it was exercise rather than massage things. Obviously, you could argue perhaps
1:01:19
a hands-on would have had a faster approach.
1:01:21
But we saw changes, but they weren't statistically significant.
1:01:25
But we saw reductions in pain. And those people
1:01:28
were saying and telling me from these discussions I managed
1:01:31
to walk my dog for a mile and they're like I haven't walked more than 10
1:01:34
meters in years and it was just like that's amazing
1:01:37
you know and I they're still in contact with me on Facebook we still check
1:01:40
in so we don't quite know how to make that significant structural change yet
1:01:46
I don't yeah yeah I would also I wouldn't really call it a frictionless interface
1:01:52
because it's not it's not frictionless that gliding is not endless Yeah,
1:01:58
so there are restrictions within the interface and some of those restrictions
1:02:04
are actually really important and should not be broken down.
1:02:07
But at other times, when it causes pain and when it causes a reduced range of movement, for example,
1:02:14
then maybe some fascial work could actually ease that movement and increase
1:02:20
range of movement, even if it's temporarily, to then allow that rehabilitation to take place.
1:02:27
So, this is a really important point.
1:02:31
Significant structural change. So, we don't see any significant structural change
1:02:37
as a result of a short-term mechanical input.
1:02:42
Be that massage, be that grustin, be that whatever.
1:02:46
So, what we do see is...
1:02:50
Some changes in fluid, but that deep fascia does not change.
1:02:57
We don't see change. We see some changes, some changes in the superficial fascia,
1:03:02
but not in the deep fascia.
1:03:04
And that's what gets me thinking, then it's obviously what we are seeing,
1:03:08
because I do not want to trivialize a patient's experience.
1:03:12
They experience a reduction in pain. They experience an increase in range of movement.
1:03:17
We cannot discount that. But that might not be because we made a structural
1:03:23
difference to the fascia.
1:03:25
It might be because we are changing the neural input into the fascia.
1:03:32
Okay. I think it's more along those lines.
1:03:36
But we do not have any evidence that what we are doing is structurally changing the deep fascia.
1:03:46
Wonderful great answer i was worried about that one but it dealt with it wonderfully
1:03:49
no it's great don't be worried about any question well no i haven't spent time
1:03:53
with you before kira so now i know that you're you know you're hard as nails
1:03:56
like claire so yeah i should have guessed,
1:03:59
in our pre-talk we kept talking about the importance of touch as a massage therapist
1:04:04
and as anyone treating people and i think that still comes back in here is you
1:04:07
know one of the take-homes again don't be afraid of touching your patients They generally like it.
1:04:13
They generally find it helps them understand what's going on and helps them feel better.
1:04:18
I think anything that we can do to get people moving is good and is beneficial.
1:04:27
And what we're trying to understand is what this connective tissue,
1:04:33
what the role is. Yeah, absolutely.
1:04:37
So we're not looking at, you know, smoothing out your fascia or untangling your
1:04:43
fascia or anything like that.
1:04:46
Those short-term changes are probably quite temporary.
1:04:54
They could be very significant to get somebody moving or to get somebody to
1:04:59
experience a pain-free movement, which is incredibly important as a starting point.
1:05:05
Definitely, yeah, in terms of behavior change. I mean, some people hate that
1:05:08
idea of, what was the phrase which was going around?
1:05:11
I think it was something to do with a window, opening a window or it's a window of opportunity.
1:05:16
That was the one that got really kind of slagged off by a lot of other kind
1:05:19
of who would call fascia people fascists when it was that kind of era.
1:05:23
But there is windows opportunity i don't think it's a
1:05:26
we're coming around now and understanding all the principles of coaching
1:05:28
and behavior change and person-centered care it's a beautiful
1:05:31
analogy the opening window we don't literally mean you're opening a window but
1:05:35
that's really sums up in this person's life where they've never been able to
1:05:38
lift up their grandchild or being able to do something really meaningful if
1:05:42
they can do it that afternoon who knows how that's going to knock on effect
1:05:46
of what they could believe they can do and witness they do so.
1:05:50
That's exactly what i what i remember
1:05:53
talking to claire about when we were doing the statistics
1:05:57
and statistically there was no difference then
1:06:00
when you look at the experience of these of the six months of training and that
1:06:05
that that that was life-changing incredibly very very meaningful and now we
1:06:11
need to figure out whether it also had an effect on on the connective tissue
1:06:17
because it also, you know, such a long, long intervention.
1:06:21
Great stuff. Okay, right. I'm very conscious of the time. Cecily Hislop sums
1:06:24
it up very nicely in saying, thank you both.
1:06:27
This may sound daft. Never, Cecily. Never accuse you of being daft.
1:06:30
This may sound daft, but I feel quite reassured from your answers.
1:06:33
There's such a mind-filled information out there that a simple clarification
1:06:36
is needed. Well, that's nice. That's our goal, isn't it?
1:06:39
Just to make therapists feel assured. I just want to give a little shout out
1:06:45
for anybody who is interested in fascia research and finding out more about it.
1:06:51
There is the Fascia Research Society.
1:06:54
So check out, there's going to be webinars, there's going to be lots of things coming up.
1:06:58
There's going to be a research cafe as well. So lots of things are coming up.
1:07:02
Have a look at our, on our social media.
1:07:05
Over the next weeks, we'll have more information.
1:07:07
We'll make sure that link, what is the best link for that? We'll make sure it
1:07:10
goes into the show notes. But where should people go if they're listening now
1:07:13
and they're ready to go? What should they go to?
1:07:17
Fasciaresearchsociety.org. Dot org. It's a dot org. Okay. We'll make sure that
1:07:20
goes in the show notes. Brilliant.
1:07:21
That's very exciting to hear. It is such an interesting topic.
1:07:23
I'm so glad it's coming around like a corner now and coming back and linking
1:07:27
with other research with the touch and the difference between light and,
1:07:31
you know, deeper touch and everything. So very exciting.
1:07:35
Thank you so much, you guys. Really, really appreciate it. The way you present
1:07:38
the information as well is so, so beautiful. So I really appreciate the time you've given us.
1:07:42
And thank you, everyone. All right. Are you sure? I never got that impression.
1:07:47
I've never seen two people smile.
1:07:51
Fascia, fascia. I'm trying to think whether you can, yeah, you can say fascia
1:07:54
with a serious face. It is possible. I thought maybe it was a fascia,
1:07:56
but you can, you can say fascia.
1:07:58
Say it with a big grin as well. You can.
1:08:01
Definitely. It seems a much happier word. I'm so glad, Ceci,
1:08:04
that's really summed it up nicely as well, because that is our goal on the STA
1:08:07
podcast is to, you know, try and help you amazing, empathetic people.
1:08:12
Continue your job because if you don't have that confidence in yourselves very
1:08:16
difficult to help the person underneath you you know very difficult
1:08:19
to guide them and walk next to them if you if you're not sure of yourself
1:08:22
so it's really nice to hear cecily and maybe
1:08:25
that will open a window opportunity now and and
1:08:28
make you to allow you to do great things tomorrow and then change someone else's life
1:08:31
so really good feedback thank you cecily right fantastic
1:08:35
we will be here next week and just
1:08:38
to let you know if you're listening to the podcast uh we'll be
1:08:41
here on what date we can talk about November the 14th at
1:08:44
eight o'clock we'll be on the Sports Therapy Association YouTube channel
1:08:47
and Facebook page with our guests will be Jenny
1:08:50
Burrell who a lot of you have done courses and you know Jenny fantastic
1:08:53
educator founder of Burrell Education a lot of people you
1:08:56
know through courses of that to do with women's health fitness and wellness
1:08:59
Jenny Burrell's also creator of Holistic Core Restore
1:09:02
which is a program designed to enhance pelvic floor and core health
1:09:05
through movement-based exercises and Jenny's also very
1:09:08
much involved with coaching and self-care and which is
1:09:11
such a hot topic for clinicians as well to look after yourselves because it
1:09:14
is a it is a career and a which you can really burn out so easily giving all
1:09:20
of your all to everybody else so one way of avoiding that is just just the way
1:09:26
you approach it you haven't got the responsibility of fixing this person.
1:09:29
Giving it to them let them talk they figure out what
1:09:32
what the way is to help them and that takes that responsibility off you and
1:09:36
you're going to get better results so we'll be talking about all sorts of things
1:09:39
like that with jenny next week so if you are listening to podcast and you fancy
1:09:43
joining us live because you thought yeah i want to i want to hear some of this
1:09:46
i want to ask some people questions then uh yeah just come along to youtube
1:09:49
or facebook at eight o'clock on tuesday.
1:09:51
Until then thank you once again to dr claire voucher thank you claire thank
1:09:55
you thanks for having her.
1:09:56
And also to Kira, Dr. Kira de Conink. Thank you very much. Thank you so much.
1:10:01
One thing I wanted to ask you is some of the questions. I haven't been able
1:10:05
to read all of the questions, but there's some really great questions.
1:10:10
Would you like me to answer some of them in writing and then you can post them?
1:10:14
That'd be amazing. I mean, they'll be on YouTube and I always encourage listeners,
1:10:17
if you listen to podcasts and you want to leave a question, go to YouTube and
1:10:20
put it in the comments there and I do monitor them and then I can send them in a nice,
1:10:24
easy to read format because i know claire and kira are
1:10:27
super super busy but yeah i'd love to that'd be amazing of
1:10:29
you if i can send them to you i know nikki had a couple of questions and a
1:10:32
few people so some of those questions and we'll
1:10:35
give people some papers that they can they can go and read and yeah so kind
1:10:40
of you i saw nikki was after the one with the mechanoreceptors so we'll give
1:10:43
her that yeah nikki says great tuesday night geeking guys gracias and nikki
1:10:49
says yes please yeah we will come back to it and maybe who knows maybe we'll
1:10:52
have a part two because there's so much what we could have talked about. Right.
1:10:55
Look at that. 9.15. I'm sorry. I'm sorry. I kept you for 50 minutes longer.
1:10:59
I'm going to close it down. Thanks, everyone.
1:11:01
Take care of each other and take care of yourselves. We'll see you hopefully very soon.