The fascia, with both its macroscopic and microscopic structure, is the map that can help to orientate any research into the origin of locomotor apparatus’ disorders. This book, which is the outcome of thousands of treatments carried out over the last twenty-five years, provides the necessary guidelines for reading this map. Up until now, perhaps due to its intrinsic complexity, the role of the fascia has been relegated to that of containment.

The book illustrates:

• The connections of the fascia with muscles, bones, articulations and nerves (anatomy of the fascia),

• The coordinating function of the fascia with regards to all components of the locomotor apparatus (physiology of the fascia),

• The way to manipulate densified or condensed fascia in order to restore it to its physiological state (treatment of the fascia).

This new vision of the anatomy, physiology and histology of the fascia allows one to have an effect on soft tissue dysfunctions in an efficient and long-lasting manner.

This book specially imported from Italy is in Hard Cover, 252 pages, and 188 colour illustrations.

What is Fascial Manipulation?

The logo of Fascia Manipulation shows a correct posture with the alignment of the head and the scapula with the vertebrae.

Fascial Manipulation has been brought to focus through many years of study and clinical practice by Luigi Stecco, an Italian physiotherapist and it is now being practiced by a growing number of therapists in Europe.

Theoretically it is based on anatomical aspects of the fascia :

 1) The continuity of fascia throughout the whole body, from superficial to deeper myofascia (epymysium, perimysium, endomysium).

2) A certain capacity of the epimysial fascia to perceive and consequently “direct” movement through it’s proprioceptive elements

3) When traumatized, irritated or inflamed the fascia loses it’s characteristic elasticity forming granulation tissue (neocollagen)

It is also based on anatomical aspects of the musculoskeletal system:

 1) Muscles are surrounded by epimysial fascia and are also divided by fascia into myofascial units. Each myofascial unit contains muscle fibres that when they contract move the corresponding joint in only one direction (ipsodirectional fibres). Many muscles are made up of more than one myofascial unit as they have the capacity to move a joint in more than just one direction.

2) In a healthy state part of the fascia slides freely over muscles and part has certain fixed points of anchorage or bone “insertions” via tendons, ligaments and intramuscular septum.

3) For each myofascial unit it’s possible to localise a specific small area of it’s fascia (called Centre of Coordination or CC) where the tractions of the various muscles of the MF unit converge and which, when inflamed, blocks or limits movement at the corresponding joint.

Taking into consideration the above concepts Fascial Manipulation consists in manual techniques applied to these Centres of Coordination in order to free the fascia of any neocollagen tissue. The rise in temperature caused by manual friction dissolves the neocollagen formations restoring tissue elasticity and joint range.

Prior to initiating any treatment an accurate analysis of all impeded movements indicates the most appropriate myofascial unit (and thereby it’s specific CC) to be treated. This assessment procedure which involves both a subjective and an objective examination also provides the basis for an immediate evaluation of treatment effectiveness, allows for treatment planning and is a vital aspect of a successful treatment.

This technique which has been clinically tested over the last 20 years is proving to be a useful in Orthopaedics, Rheumatology and Neurology.

Fascial Manipulation analyses muscles from a functional viewpoint rather than from their external structure:

• It assembles unidirectional motor units (mono and biarticular fibres) into myofascial units,

• It describes the precise location of the centre of coordination (CC) of each myofascial unit,

• It highlights the correspondence that exists between each cc and the respective trigger points and acupuncture points of each muscle.

In the first part of this book the relationship of the endomysium, perimysium and epimysium with the deep fascia is analysed; this analysis is extended to all of the 84 myofascial units (mf) in the human body. It is the continuity of the fascia that regulates and coordinates the tensioning of the muscles spindles and Golgi tendon organs located within each of these mf units.

In the second part the macroscopic structure of the fascia is analysed. The intermuscular septa form compartments that surround the unidirectional muscular chains or myofascial sequences. The mf sequences that control movement on one spatial plane are all connected together by the fascia, allowing for synchronised maintenance of the body’s verticality.

The third part of the book highlights the arrangement of the endofascial collagen fibres. There are longitudinal fibres arranged according to the traction of the mf sequences as well as spiral form fibres, which have assumed this type of arrangement due to traction of the oblique muscle fibres involved in complex motor activities.

This volume not only presents an in-depth analysis of the fascia but also offers useful indications for identifying the origin of its dysfunctions. A particular method of data collection that can provide immediate indications of the points to be manipulated is proposed.

• If pain is present in only one body segment then identification of the exact part of the joint where the disorder is manifest will indicate the dysfunctional mf unit.

• If pain is present in a number of segments and analysis demonstrates that their distribution corresponds to a particular spatial plane, then treatment aims at re-equilibrating postural alignment.

• If the pain is poorly defined and exacerbated by complex motor activity, then the particular mf spiral, which is dysfunctional during that specific motor activity or gesture, is identified and treated.

These innovative theories are supported by many citations from anatomical texts in order to highlight the marvellous structural design that exists within the fascial system.

Fascial Manipulation for Musculoskeletal Pain presents to all people dealing with Rehabilitation a new therapeutic tool which gives very good results for the treatment of musculoskeletal pathologies. Such pathologies usually involve joints, nerves, muscles, yet a proper therapy should first of all focus on the most malleable tissue: the fascia. Fascial manipulation is indeed the best treatment for the rehabilitation of patients affected by myofascial pain and fribromyalgia, which are the most common impairments reported by patients to Rheumathologists.

Sport physicians, Bodyworkers, Massage Therapists and Physical Education Teachers as well take often care of athletes suffering from musculoskeletal recurrent diseases. In this book they will find the necessary know-how to efficiently take care of the underlying myofascial structures. By knowing the origin of the problem, they’ll be able to give proper instructions to modify the athletic gesture and prevent recurrences.

As Acupuncture researchers have found, there is a parallelism between the meridian path and the nerves, veins, and lymphatic vessels paths. The Author’s innovative proposal in Fascial Manipulation is that each space direction corresponds to a meridian. Hence the motor impairment towards a certain direction can be a guide to locate the blocked point to treat.

Last but not least Family Physicians, who are daily confronted with patients suffering from musculoskeletal pain, will find in Luigi Stecco’s book the opportunity to go beyond the usual radiological exams and drug prescription by inserting also manipulation in their therapeutic approach.

Few books achieve the fond hopes of their authors and their admirers.This is just one that succeeds, making a genuine and profound contribution to the fields of biomechanics, orthopedics and rehabilitation. It moves with easy grace from any topic to its neighbor, shedding warmth and life to them all.

As one who has experienced both the high and low points of medical writing and editing over several decades, I see in these pages a true work of genius. It deserves a very wide readership and enthusiastic application of its lessons.

John V. Basmajian Professor Emeritus in Medicine, McMaster University, Hamilton, Ontario, Canada

Very impressive, an analytical masterwork, Luigi Stecco’s findings on coordination centres will be of strong interest. This work will be a great stimulus for investigations in all kind of rheumatic diseases.

Prof. Dr. Hartmut Heine Institutsleiter, Anatomisches und Klinisch-morphologisches Institut, Universität Witten/Herdecke

A new and valid interpretation of the function of the muscular fasciae as a part of locomotor organisation, based on both practical and rational aspects. Clearly written and easily comprehensible. A useful book for all those who are involved in rehabilitation.

Prof. Ivano Colombo, Milano

An admirable book with a different approach.

Prof. K. Lewit, Central Railway Health Institute, Prague

• Fascial Manipulation website http://nuke.fascialmanipulation.com/
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