Fascial Manipulation is both a diagnostic and manual therapy technique developed by Luigi Stecco in Italy over 40 years ago. Dr. Carla Stecco and Dr. Antonio Stecco have continued their father’s research via dissection of un-embalmed cadavers to enhance the pre-existing biomechanical model. The focus of this model is primarily on the deep muscular fascia, or the layer just above the muscles that allow them to slide and move easily. This model looks at the musculofascial (myofascial) system as a three-dimensional continuum where tension often comes from multiple body segments away. Some examples of this can include pain in the knee coming from a lack of sliding or gliding of fascia in either the foot or hip. This can happen all over the body.
This method focuses on identifying specific areas of the fascia and its association with a specific limitation of movement. These points on the fascia are identified through palpation, then with appropriate manipulation, proper movement can be restored.
With this method, the body is divided into 14 segments and each body segment is divided into six myofascial units supporting the three planes of movement of the body. Myofascial insertions extend between different muscle groups to form sequences of different movement patterns in the body. Specific points called Centers of Coordination (CCs) are points where myofascial vectors converge for these movement patterns. Areas where the three planes come together are formed for more complex movements called Centers of Fusion (CFs), usually near joints or over a retinaculum like the one that covers the carpal tunnel.
Tension is removed from the larger musculoskeletal system based on findings of both CCs and CFs, usually a distal to proximal approach, to balance the area of limited movement and/or pain. The space between the layers of fascia is filled with a matrix that acts as a lubricant to allow sliding and gliding of the fascia and normal movement of the affected muscles. If this lubricant gets imbalanced due to trauma or local inflammation it can densify, becoming more adhesive, causing tension in that area. If enough of these points densify the tension increases over a larger area leading to Centers of Perception (CPs) that cause pain.
Deep massage or shockwave treatment over these points aims at restoring tensional balance, often working at a distance from the actual site of pain. Cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are commonly treated with this method. This method makes sense of treatment for TMJ to plantar fasciitis, tennis elbow to adhesive capsulitis of the shoulder, as well as most back pains and carpal tunnel syndrome.
References:
Pawlukiewicz, M., Kochan, M., Niewiadomy, P., Szuścik-Niewiadomy, K., Taradaj, J., Król, P., & Kuszewski, M. T. (2022). Fascial manipulation method is effective in the treatment of myofascial pain, but the treatment protocol matters: A randomised control trial—preliminary report. Journal of Clinical Medicine, 11(15), 4546. https://doi.org/10.3390/jcm11154546
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