Presentation Description:

Abstract

Recent research affirms the importance of the superficial fascia in body movement. Anatomical studies performed on non-embalmed cadavers demonstrate the continuity of the superficial fascia from the subdermal layer, reaching the deep (muscular) fascia, forming a functional bridge between the skin and muscles. This structure, the Superficial Fascia System (SFS), participates in tasks such as protection, transmission of force and nociception. The mechanical disturbances of the SFS (e.g., scars) distort movements, creating dysfunctions that become pathologies. Consequently, movement is altered not only at the superficial layer, but also reaches deep structures such as muscles and joints. The Myofascial Induction Therapy (MIT) is a set of clinical applications that efficiently improve local dysfunctions by facilitating the recovery of global movement and the person's body image.

Keywords: Superficial fascia, Myofascial Induction Therapy (MIT), connective tissue, fascial continuity, extra-cellular matrix, free nerves endings.

Introduction

The skin is not just a simple and inert body wrapper nor the superficial fascia is just a fatty deposit. Rather, between both, ensembles an intricate multifunctional superficial fascia system (Pilat 2021).

Skin behavior

The skin remains in a state of continuous pre-tension. Its tensional lines are ensembled through the interrelation between elastic and collagen fibers, as well as fixed attachments between collagen fibres. Skin tensional lines, the Langer’s lines (Langer 1978), have a dynamic behavior (Bush et al. 2007) and coincide with the dominant axis of mechanical tension in the skin (Seo et al. 2013). Skillful movement of the skin facilitates efficient muscle output, pain reduction and functional improvement (Ishida et al. 2015); thereby, the skin can assist the muscular dynamics (Ottenio et al. 2015). Yoshitake et al. (2016) suggest that the skin is a main contributor for maintaining the muscle mechanical properties among tissues covering the skeletal muscle.

The skin´s proper condition of tension becomes distorted during pathological processes, as in the presence of a scar. The neuroanatomical changes relating to a scar are not simply local, but could be present also in the uninjured areas peripheral to the wound (Hamed et al. 2011) so the response to the skin injury is rather systematic. Tsukahara et al. (2012) state that these deformations on the surface (epidermis) expand and deform the underlying structures.

Superficial fascia behavior

Superficial fascia is the major anatomic structure located under the skin and firmly attached to it. It consists of horizontal membranes (stratum membranosum) connected by vertical or oblique fibrous septa – skin ligaments (retinacula cutis) – separated by adipose lobes. Along its path, superficial fascia envelops the entire body and expands, as a complex network, from the subdermal level to the deep fascia.

The most important properties of the superficial fascia are: body shape formation, connection to underlying structures (e.g., bones, deep fascia), force absorption, direct energy transfer, posture recognition and interaction with autonomous nervous system, scar formation, sensitivity to variations of temperature and pressure, heat insulation, protection of nerves and vessels (also facilitates the transit of cutaneous nerves, as well as blood and lymph vessels and may indirectly mediate blood flow) energy storing (Pilat 2021).

The densification of the extracellular matrix, could lead to loss of tissue homeostatic equilibrium by initiating remodeling - overexpression of α-actinin and actin cross-linking of fibroblasts and destabilizing the tissue architecture (Humphrey 2014). The imbalance in fascial gliding inside the superficial fascia structures, as also between the deeper structures, may promote the release of algetic substances, inducing pain, immobility, and arthrogryposis (Imagita & Sukezane 2018). Local alterations of the mechanical tissue properties may modify flexibility in neighbouring (superior or inferior) joints (Wilke et al.2019, Wilke et al. 2020).

The CNS and ANS receive most of the mechanosensitive information from the body's connective tissues (included the SFS), influencing the proprioception, nociception and interoception. Research indicates that the most intensely innervated tissues are the skin and the superficial fascia (Fede et al. 2020). Superficial fascia nociceptors (polymodal Aδ & C fibers) (Tesarz et al. 2011, Corey et al. 2011) are the beginning of a nociceptive pathway from the soft tissues to the spinal dorsal horn and probably further to higher centers (Mense 2019).

Overall objective of the workshop

The workshop provides an understanding of superficial fascia anatomy, its participation in the force transmission and the relation to the motor dysfunctions and pain. Special emphasis will be put on the outcomes of recent anatomical and biological research. A deep analysis of the anatomy and biomechanics of the superficial fascial system will be carried out with images and videos of dissections of non-embalmed cadavers. The conceptual bases of Myofascial Induction Therapy (MIT) will be introduced and the principles of clinical applications will be discussed.

Specific Learning Objectives

Define superficial fascia as the Complex Biological System.
Present the fascial anatomy bases on unembalmed cadaver dissections.
Discuss its innervation and its participation in the pain sensation.
Expose the importance of the superficial fascia in the force transmission.
Define the superficial fascia dysfunction.
Present the Myofascial Induction (MIT) Approach.
Discuss the indications and contraindications in the application of clinical procedures.
Show the basic procedures in the treatment of SDF.

Methodology

The workshop consists theoretical (slide show) and samples of procedures application.

About Andrzej Pilat:

Physiotherapist and specialist in manual therapy. Creator of the Myofascial Induction approach. Lecturer on postgraduate and master degree programs in numerous universities in Spain and other European countries, as well as in Central and South America.

Author of the book Myofascial Induction, and co-author of books and papers on manual therapy published in Britain, Spain, Italy and the USA. Director of the Tupimek School of Myofascial Therapies, Madrid, Spain. Dr Andrzej Pilat has undertaken pioneering research on fascial anatomy using non-embalmed cadaver dissections and has used his expertise as a photographer to capture the inner beauty of the body in pictures.