Welcome to an exciting new field in musculoskeletal therapy: the fascinating world of fascia. Fascia forms a continuous tensional network throughout the human body, covering and connecting every single organ, every muscle, and even every nerve or tiny muscle fiber.

This manual  provides practical indications to facilitate the treatment of the fascia. This text is the fruit of an ever-growing number of requests, from students attending Fascial Manipulation© courses for a unified text. It describes the topographical location of all the points, the respective movement tests and the modality of treatment for each point. In order to manipulate the fascia it is essential to know the exact location of the points, to perform the movement examinations correctly and to position the patient appropriately for each treatment.

This new book will help all of those engaged in learning the method of Fascial Manipulation © to obtain satisfactory results in their clinical practices, as well as improving comprehension of the anatomical substratum of the superficial, deep and epimysial fascia because, as we like to say, only a knowledgeable hand is potent or “Manus sapiens potens est”.

This new book published 2009 is specially imported from Italy, is in Hard Cover, full colour, 364 pages, with more than 200 colour photographs.

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.

Foreword by Robert Schleip

The Stecco family, two of which are authors of this book, have become a driving force in this new field. Their first book Fascial Manipulation for Musculoskeletal Pain already attracted worldwide attention, and was quickly passed around from one myofascial therapist and bodywork instructor to another. It was therefore not a large surprise that their presentation at the Harvard Fascia Congress in 2007 was honoured with a special award for its scientific quality and depth of implications. I have no doubt that this new book, which not only deepens the theory and anatomical details of the first book but also presents a precise description of their therapeutic technique, will have a major impact upon the whole field of manual therapy.

The authors present a novel model concerning the contribution of fascia to neuromuscular coordination through a specific topography of centers within the fascial network (centers of coordination, centers of perception, and centers of fusion). While this is a completely new model, it is presented in a very convincing manner. The evidence given in this book in support for this intriguing model, covers not only corroborating phylogenetic and neurophysiological details, but includes thousands of hours of anatomical cadaver research, performed by the original founder of this approach, Luigi Stecco, as well as his daughter Carla Stecco MD and son Antonio Stecco MD. Their diligent cadaver studies have resulted in several new anatomical discoveries and descriptions, published in peer-reviewed scientific anatomical journals. Anybody who has followed the emerging new publications on fascia in the scientific literature in the last few years will have noticed these important contributions. This family team has studied fascial morphology and topography in detail, which is not only impressive but also resulted in the novel descriptions and findings that support the new model for neurofascial coordination presented in this book. While these findings add great

One of the treasures of this book is the large number of cadaveric photos showing topographical anatomy details of fascia. These are extremely well done and display some local properties that have never been described in such detail.

If you are a beginner within the field of physiotherapy (or orthopaedics, rehabilitation, movement therapy, etc), be prepared that this is not a book to skim over lightly while watching TV. It is a gold mine of condensed information. If you mistakenly skip over a sentence, it may easily occur that you will miss this information later, when trying to understand the logic of the following pages, as there is not much redundancy in this book. Yet I give you my word that even most experts in this field will look at and read this book with immense excitement and a state of joyful discovery. While other books have been written on fascia from several different angles, this one clearly sets a new standard. My congratulations to the authors for completing the most valuable and richest book that has ever been published on fascial manipulation; and also to you, dear reader, for having chosen this very book in order to learn more about a truly fascinating tissue and its manipulation.

ROBERT SCHLEIP PhD Director, Fascia Research Project Ulm University, Germany

• Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . 1

• Basic Principles . . . . . . . . . . . . . . . . . . . . . . . 3

• Superficial fascia . . . . . . . . . . . . . . . . . . . . 5

• Deep fascia . . . . . . . . . . . . . . . . . . . . . . . . 7

• Epimysial fascia . . . . . . . . . . . . . . . . . . . . 12

• Physiology of the fasciae.. . . . . . . . . . . . . . 13

•  

• Part I: The centres of coordination

• Chapter 1 – Fascial Manipulation . . . . . . . . . 19

• A - Fascial control of segmental movement 19

• The myofascial unit . . . . . . . . . . . . . . . . . . 19

• B - Fascial control of posture . . . . . . . . . . 25

• The myofascial sequence . . . . . . . . . . . . . . 25

• Chapter 2 – Treatment of the CC. . . . . . . . . . 31

• A - Compilation of an assessment chart for segmental treatments . . . 31

• B - Compilation of an assessment chart for global treatments . . .  35

• Fascial manipulation - Indications and Contraindications . . . . . . 37

• Chapter 3 – Mf Sequence of antemotion . . . . 39

• Mf units of the trunk . . . . . . . . . . . . . . . . . 40

• Mf units of the lower limb . . . . . . . . . . . . . 50

• Mf units of the upper limb . . . . . . . . . . . . . 56

• Example of treatment . . . . . . . . . . . . . . . . 64

• Chapter 4 – Mf Sequence of retromotion . . . . 65

• Mf units of the trunk . . . . . . . . . . . . . . . . . 66

• Mf units of the lower limb . . . . . . . . . . . . . 76

• Mf units of the upper limb . . . . . . . . . . . . . 82

• Example of treatment . . . . . . . . . . . . . . . . 90

• Chapter 5 – Mf Sequence of mediomotion . . 91

• Mf units of the trunk . . . . . . . . . . . . . . . . . 92

• Mf units of the lower limb . . . . . . . . . . . . . 102

• Mf units of the upper limb . . . . . . . . . . . . . 109

• Example of treatment . . . . . . . . . . . . . . . . 117

• Chapter 6 – Mf Sequence of lateromotion . . . 119

• Mf units of the trunk . . . . . . . . . . . . . . . . . 120

• Mf units of the lower limb . . . . . . . . . . . . . 130

• Mf units of the upper limb . . . . . . . . . . . . 137

• Example of treatment . . . . . . . . . . . . . . . . 145

• Chapter 7 – Mf Sequence of intrarotation . . . 147

• Mf units of the trunk . . . . . . . . . . . . . . . . . 148

• Mf units of the lower limb . . . . . . . . . . . . . 158

• Mf units of the upper limb . . . . . . . . . . . . . 165

• Example of treatment . . . . . . . . . . . . . . . . 173

• Chapter 8 – Mf Sequence of extrarotation . . . 175

• Mf units of the trunk . . . . . . . . . . . . . . . . . 176

• Mf units of the lower limb . . . . . . . . . . . . . 186

• Mf units of the upper limb . . . . . . . . . . . . . 193

• Example of treatment . . . . . . . . . . . . . . . . 201

•  

• Part II: The centres of fusion

• Chapter 9 – Fascial Mobilisation . . . . . . . . . . 205

• A - Fascial control of segmental motor schemes . . . . . . . . . . .  . 205

• The centre of fusion . . . . . . . . . . . . . . . . . . 208

• B - Fascial control of global complex movements . . . . . . . . . .. . . 210

• The myofascial diagonals . . . . . . . . . . . . . 211

• The myofascial spirals . . . . . . . . . . . . . . . . 213

• Chapter 10 – Treatment of the CF . . . . . . . . . 221

• A - Assessment chart compilation for segmental treatments of CF  221

• B - Assessment chart compilation for global treatments of CF . 223

• Chapter 11 – Retro-latero centres of fusion . . 229

• CF of the upper limb . . . . . . . . . . . . . . . . . 231

• CF of the trunk . . . . . . . . . . . . . . . . . . . . . 238

• CF of the lower limb . . . . . . . . . . . . . . . . . 245

• Example of treatment . . . . . . . . . . . . . . . . 251

• Chapter 12 – Retro-medio centres of fusion . 253

• CF of the upper limb . . . . . . . . . . . . . . . . . 256

• CF of the trunk . . . . . . . . . . . . . . . . . . . . . 262

• CF of the lower limb . . . . . . . . . . . . . . . . . 269

• Example of treatment . . . . . . . . . . . . . . . . 275

• Chapter 13 – Ante-latero centres of fusion . . 227

• CF of the upper limb . . . . . . . . . . . . . . . . . 279

• CF of the trunk . . . . . . . . . . . . . . . . . . . . . 286

• CF of the lower limb . . . . . . . . . . . . . . . . . 293

• Example of treatment . . . . . . . . . . . . . . . . 299

• Chapter 14 – Ante-medio centres of fusion . . 301

• CF of the upper limb . . . . . . . . . . . . . . . . . 303

• CF of the trunk . . . . . . . . . . . . . . . . . . . . . 310

• CF of the lower limb . . . . . . . . . . . . . . . . . 317

• Example of treatment . . . . . . . . . . . . . . . . 323

• Chapter 15 - Synoptic tables . . . . . . . . . . . . . 325

• CF and CC . . . . . . . . . . . . . . . . . . . . . . . . . 327

• Comparative movement verifications . . . . 339

• Parallelism with acupuncture . . . . . . . . . . 355

• Conclusion

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.

For the first time all of the so called "pressure points", many acupunture points, trigger points, and tender points throughout the body are explained in relation to the function of the fascial system. Luigi Stecco, PT, has treated these fascial points for years and now with the help of his daughter Carla Stecco M.D. who is a premier fascial researcher, corroborates the points with cadaver studies of the fascia. We no longer have to manually treat a point just because it is tender. We can now correlate the point with functional testing of what they call myofascial units. After treatment of each of these fascial restrictive points within the unit a practitioner can retest the movement to see if the painful loss of movement has improved. 
I have been using this fascial technique and have noticed remarkable results.

Warren Hammer DC

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