abt chapter 5

8/17/2019 Abt Chapter 5

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ABT

Advanced only in knowing how this stuff

works and then how to work it!

By John Perone and Marina Perone

www.advancedbowen.com


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© 2008, 2009 by John Perone, MPT, BKin., RMT and

Marina Perone, RMT - All rights resered.

!o "art o# this boo$ %ay be re"rod&'ed, stored in a retrieal

syste%, or trans%itted by any %eans, ele'troni', %e'hani'al,

"hoto'o"ying, re'ording, or other(ise, (itho&t (ritten

"er%ission #ro% the a&thor)s*.

Published by John and Marina Perone

www.advancedbowen.com

Vancouver, BC, Canada

(((.adan'edbo(en.'o%2

http://www.advancedbowentherapy.com/http://www.advancedbowentherapy.com/


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Disclaimer

The material, procedures, and know-how presented in this bookare or educational and inormational purposes only. The

author!s" o this material are not dispensin# speciic medicaladvice, dia#nosis, or makin# direct or indirect prescriptions.$urther, there are no recommendations or representationsconcernin# physiolo#ical eects or any o the reported ideas,se%uences, nor is it su##ested or implied that the materialspresented relate to any ailment or have curative value. & theneed or medical attention is re%uired or re%uested, the seekeris advised to #et competent help rom their licensed amilyphysician. Those who use the techni%ues and procedures

presented within do so entirely at their own discretion andaccept ull responsibility or the use o the material.

(((.adan'edbo(en.'o%+


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(((.adan'edbo(en.'o%


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Chapter 5

Connective Tissue and The Fascial Matrix

"Fascia is the organ of posture. Nobody ever says this; all the talk is about

muscles… The body is a web of fascia. A spiderweb is in a plane; this web

is in a sphere. e can trace the lines of that web to get an understandingof how what we see in a body works." ! da #. $olf

A technical overview of Connective Tissue

Connective tissue is the most widely distributed o the our tissue types in

the body which also include muscular, nervous and epithelial tissue. &naddition to doin# what it's name su##ests, connective tissue also binds and

supports, protects, insulates, and as blood it transports substances.Connective tissue is derived rom the embryonic mesoderm cell layer.

Connective tissue has three main elements( ground substance% fibers andcells. The #round substance and the ibers make up the e&tracellular

matri& !)CM". The most important unction o the )CM is in providin#

support or our cells, distributin# mechanical stresses placed upon the bodyby movement, physical pressure and e*ternal stresses such as #ravity. &t

also provides a communication medium or the various cells within.Basically the )CM is comprised o all the e*tracellular contents within the

connective tissue, as well as a basement membrane.

The basement membrane is the structure that supports overlyin#

epithelium. )pithelium is a orm o tissue that lines the outside skin andinside cavities or lumen o our or#ans such as the lun#s, #astrointestinal,

urinary and reproductive tracts. Mesothelial and endothelial layers are

speciali+ed orms o epithelial cells and are dierential terms describin#their respective locations in the body, and what tissues they encompass.The mesothelium covers and provides protection or most o the body's

internal or#ans. The endothelium is the inner linin# o the heart, blood and

lymphatic vessels. )ssentially the basement membrane anchors theepithelium to loose connective tissue !ascia and myoascia".



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Ground Substance

The #round substance is a transparent, amorphous or unshaped #el thatconstitutes the non-colla#enous components o the )CM, includin#interstitial luids, proteo#ylcans, #lycosamino#lycans, cell adhesion proteins

and water. The #round substance varies in viscosity in dierent orms oconnective tissue, and under dierent conditions !healthy and diseased

tissue".

Proteo#lycans bind with #lycosamino#lycans !'s" which intertwine and

trap water, ormin# the hydrated #elatinous material o #round substance.These 's ill the interstitial space to act as a buer counteractin#

compressive orces to the e*tracellular matri*. These molecules bind lar#eamounts o water which creates the. yaluronic acid is the mainproteo#lycan that binds water in loose connective tissue. &t's bindin# power

is the main determinin# actor in how viscous and permeable connectivetissue is.

The #round substance, overall, provides a vehicle or the transport onutrients, #ases and metabolites between the cells and circulatin# blood.



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Cell adhesion proteins acts as a #lue attachin# connective tissue cells to

other matri* elements.

The Fibers

The ibers are the part o the connective tissue that provide support. Thereare three types o ibers/ collagen% elastin% and reticular fibers. 0 the

three, colla#en is the most abundant.

'ollagen is ibrous protein which assembles into cross-links. These ibersare e*tremely resilient and provide hi#h tensile stren#th and a stabili+in#

capacity to connective tissue.

(lastins are also ibrous proteins but instead o ormin# cross-links they are

coiled structures that allow them to stretch and recoil like rubber bands.

$eticular fibers are thinner and more ine colla#enous ibers. They are

continuous with colla#en and orm networks that surround blood vesselsand sot tissue o or#ans.

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The Cells

)ach o the dierin# orms o connective tissue have a cell type known as a

'blast' that #ives rise to it's particular orm. $or e*ample $ibroblast is the

name o the cell that #ives rise to connective tissue proper !below",

whereas osteoblasts #ive rise to bone !osteo" and chondroblast tocartila#e, etc. They secrete all the components o the )CM( the #roundsubstance and the iber characteristics o their speciic tissue. 1hen their

2ob is complete they revert to a less active state known as a 'cyte', which

maintain the health o the )CM. & the )CM is in2ured these 'cytes' revertback to their 'blast' state to repair and re#enerate the )CM a#ain.

Connective tissue houses other cells such as white blood cells !neutrophils,eosinphils, lymphocytes", mast cells and macropha#es, at cells and plasma

cells. These cells are important or deense unctions, responses to in2uries

and storin# nutrients.

Different forms of Connective tissue

The dierences in each orm o connective tissue are deined by their

secretory cell type, their dominatin# iber type and the proportion o the#round substance taken up by these ibers. The more ibrous material in

the #round substance the more dense the tissue will be.

'onnective Tissue #roper has two cate#ories/ !3" 4oose connective tissue 5

!6" 7ense connective tissue

Fascia and )yofascia are orms o loose connective tissue which cover and

surround our or#ans and muscles providin# local support. They also link upwith other pockets and ascial planes to provide #lobal support. 4oose

connective tissue is made up lar#ely o #round substance and a loosearran#ement o ibers. This allows or a reservoir o water and tissue salts

or surroundin# body tissues to be nourished by. 0ther cells also dumptheir wastes into this tissue luid-medium. &t is estimated that loose

connective tissue houses as much luid as is ound in the bloodstream.

$ascia is a somewhat le*ible ibrous membrane that bind to#ether pocketso the body containin# or#ans. Myoascia covers, supports and separates

skeletal muscles. )ach muscle iber is covered with myoascia and bundleso those ibers also wrapped in myoascia. The whole muscle is a#ain

wrapped in myoascia. Myoascia is dynamic( under strain and stress is can

increase it's density and ri#idity #ivin# muscles more support.

*igaments and Tendons are orms o dense connective tissue and as it's



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name su##ests is more dense than it's cousin, loose connective tissue. Thisis primarily because it is made up o more closely packed colla#enous

ibers which run in the same direction. The #round substance is scant andthus these tissues are poorly vasculari+ed and have less ability to stretch

and retract. These tissues need to be more dense because they need to

resist #reater tensile orces. 4i#aments link bone to bone and tendons linkmuscle to bone. 4i#aments and tendons contain many speciali+ed

mechanoreceptors which tell our body what position it is occupyin# inspace, as well as interpret inormation rom the outside environment and

communicate with our C89 to carry out #lobal and local movement

unctions.

The dense ibrous connective tissue component o the ascial matri*potentially plays a ma2or role in many patholo#ies #lobally, and speciically

in #eneral movement coordination, 2oint biomechanics, structural support

and pain interpretation and it's speciali+ed aect on movement andcoordination.

+one( speciali+ed cells called osteocytes are embedded in a minerali+ed

e*tracellular matri* and serve to develop bone. Bone is the support or ourstructure as a whole, but not the only support.

'artilage( provides cushionin# and shock absorption to our 2oints. Thee*tracellular matri* o cartila#e is comprised #reatly by chondroitin sulate.

+lood ( blood plasma is the ma2or constituent o the e*tracellular matri*.

The plasma is the medium o transport o dissolved nutrients, hormones,o*y#en and carbon dio*ide. The main cellular component are the red bloodcells.

Adipose tissue( also unctions as a cushionin# and insulatin# system or the

body, storin# ener#y in adipocytes.

s you can see connective tissue serves many purposes in the body.

Connective tissue provides support, insulates and protects or#ans, and actsas a medium or our immune systems deense pathway.

s a whole connective tissue and it's properties acts as a continuum in thebody, connectin# every structure to#ether and is the or#an o our orm or

structure.



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Overview of the Fascial Matrix

$ascia is a component o connective tissue that permeates the entire body.

&t comprises a three-dimensional matri* o structural support and is thelink between structure and unction. Collectively all the tissues o the

connective!tissue proper compromise o the fascial matrix . Thereore the

ascial matri* covers all ibrous connective tissues includin#( aponeuroses,li#aments, tendons, retinaculae, 2oint capsules, or#an and vessel

coverin#s, epineurium, menin#es, periosteum and all the endomysium andintermuscular ibers o the myoasciae. This matri* penetrates and

surrounds all or#ans, muscles, bones and nerve ibers, creatin# thecommunication pathway that links the unction o all the body's systems.

The ascial matri* has both #eneral and speciali+ed unctions in the human

body, #lobal and local i you will. The ascial-matri* system orms acomple* web, providin# stability, le*ibility and mobility. $or this reason,

there has been a wide ran#e o scientiic research into ascia within many

speciali+ed disciplines o ocus and emphasis. t the same time, ascia andit's unctions are very important to clinicians practicin# a variety o hands-

on modalities in both conventional and alternative disciplines. &n thatrespect, we elt it necessary to include an overview o ascia, it's

components and wide reachin# eects on the body and how sot-tissue

therapies can inluence this aspect o the human or#anism.

The speciics o how BT will aect and interact with the ascial matri* willbe e*panded upon in the ollowin# chapters, or now we would like to ocus

on the structure and unction o ascia as a whole.

The ascial matri* is or#ani+ed into three main layers( the supericial

ascia, the deep ascia and the menin#es. The supericial ascia surroundssubdermal tissues, muscles and 2oints, while the deep ascia surrounds and

supports the viscera. The menin#es orm the membrane system which

supports the brain and spinal cord.

$ascia is very adaptable tissue, especially supericial ascia which has more

elastic properties than the deep ascia. 7eeper or visceral ascia is less

e*tensible because o it's suspensory role in or#an support. & it becomestoo la* it can cause the or#an to prolapse, and it it's too toned then it can

restrict or#an motility. Thereore a proper balance is necessary.

$ascia is richly innervated with sensory receptors that report the presenceo pain, chan#e in movement, pressure, vibration, temperature and



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internal physiolo#y. $ascia responds to the various chan#es by contractin#,rela*in#, and chan#in# it's molecular composition by addin# or reducin#

components o the )CM. This process is known as ascial remodelin#.Trauma, strain and immobility can all have ne#ative impacts on ascia.

Therapeutic touch can also cause the sensory receptors within ascia to

respond and remodel in positive and beneicial ways. $ascia will thereoreadapt to the stresses !#ood and bad" put upon it by remodelin# itsel

accordin#ly.

1hile a #rowin# body o research on connective tissue is now bein#ocused on the speciic #enetic and molecular aspects o the )CM, the

study o ascia and it's unction in or#an and postural support has beenoverlooked or many years. 9ince the ascial matri* assists in both #lobal

and local unctions, it is a topic o study that will cross many scientiic,medical and therapeutic ields. That the ascial matri* is such a lar#e topic,

connectin# many dierent speciali+ed disciplines is likely the reason why

ascia as a whole has received very little attention. &t is so vast andinterconnected that is can easily overwhelm scientiic researchers in their

eort to divide it into small units o study. Perhaps we are not meant tostudy it in such small units, however as the scientiic model is intent on

breakin# the whole down into it's smallest understood unit, then rebuildin#

it back into a connected model, studyin# ascia as a whole may be letprimarily to the clinician rather than the scientist.

The Clinical ole of Fascia

There is an ever increasin# interest in many manual therapy disciplines inthe role that ascia plays in all sorts o musculoskeletal strain and pain

patterns includin#( postural strain patterns, low-back instability, recovery

rom acute trauma as well as chronic pain syndromes.

dynamic balance is maintained within the ascial matri* to allow it to

adapt to various activities and orces we are e*posed to. &t is this hi#hlyadaptable property in the ascia that also makes it susceptible to absorbin#

and deormin# itsel rom trauma sustained by the body. The #round

matri* can remodel itsel dependin# on the nature o the orces andbecome more or less viscous. These orces, when absorbed by the body

causin# deormations in the matri* are coined ,lesions, as touched upon inchapter :. These lesions, once set in, can cause a tensional strain to collect

around them pullin# upon the ascia as a whole !see picture below". This

can lead to increased tension in ascial planes throu#h the structure - evenon the opposite sides. This principle is one known as the tensegrity

principle. Basically what this means is that trauma delivered to the knee,or e*ample, can cause ascial disturbances as ar as the opposite shoulder,



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or even the same sided ankle. &t depends on the %uality and direction othe orce delivered to the knee, such as a tackle in ootball or e*ample,

and how the tissues respond to that orce that urther determine whatsorts o compensations the ascia will make to adapt to the lesion created.

t this point, i the tissues ability to adapt or compensate becomes

overwhelmed by the mechanical, or even physiolo#ical stress, the acial

system will respond by selectively alterin# patterns o tension and elasticityby selectively chan#in# the constituents o it's )CM. That means that

physiolo#ical processes can be initiated to lay down more colla#en cross-links which can result in reduced elasticity and shortenin# o the overall

iber len#th. This increase in colla#en bein# laid down in one area can be

met with the polar opposite happenin# in another. This is why some lesionscan be associated with hypomobility in structures in one site, and

hypermobility in structures at an opposite site. &t's a compensation



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strate#y that is desi#ned to try and allow or the problems incurred in theacial system to have a minimal eect on our movement and structure

overall. &t is not, however, a compensation strate#y that removes allpotential or dysunction.

!rimar" #esions in the Fascial Matrix

s touched upon briely above, because the ascial matri* is one

continuous structure, trauma and subse%uent i*ation in one part will causecompensations to occur throu#hout the matri*. The results can be

e*pressed as postural deviations and motion restrictions. Thereore therapydirected at the compensatory structures will be less eective than therapy

delivered at the primary lesion site.

Careul consideration and proper clinical reasonin# should be applied to allo the tissues involved, since o course our structure is interconnected.

9tructures such as or#ans, which are luid illed, may be more susceptibleto )CM chan#es in the #round substance due to their ability to absorb more

shock. These or#an structures and their ascia should not be overlooked by

the treatin# clinician. They also re%uire a distinct set o tests and methodsto uncover primary lesion that they may be holdin#. $or this reason these

areas could indeed be the site o lesions that many chronic patients suerrom.

Primary or secondary lesions are also the site where memory o trauma

can be held, which can e*plain the phenomenon o relivin# the trauma

when these tissues e*perience a release. This phenomenon is becomin#more widely accepted in conventional and alternative orms o manual

therapy.

Causes of disturbance to the facial matrix

s touched upon briely above, there are three main causes o disturbance

in the ascial matri* and they are/ !3" mechanical or physiological trauma,!6" chronic strain, and !;" immobility o ascial tissues. Primary lesions can

be created rom any o the causes above.

&n healthy ascia the colla#en ibers are cross-linked in a way that createsstability, but not at a cost to mobility. reas that re%uire less mobility

#enerally have more cross-links as do areas o repeatin# work loads. Thisis to sustain the stresses put upon these tissues. t sites which re%uire

more mobility, the cross-links will be reduced.

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Mechanical or physiolo#ical trauma, chronic strain and immobility all leadto an increase in layin# down o colla#en ibers irre#ularly in dierent

directions by ibroblasts. Colla#en binds to e*istin# proteins, makin# thecomposition thicker and less e*tensible. More colla#en in the ascia means

there will less #el and thus less water in those areas. This happens because

as more colla#en is bein# laid down, the 's slowly disappear. & youremember back, 's are responsible or bindin# water and thereore

keepin# the tissue hydrated #ivin# the #round substance it's amorphous#el %uality. 1hen 's slowly disappear less water is bound and #round

substance diminishes, and more cross-links are ormed in a vicious cycle.

s more and more cross-links are ormed, the connective tissue becomesless and less elastic. 1hile this mi#ht increase tensile stren#th it does so at

a cost to le*ibility and mobility. 8ot only has some lubrication been lost,but the sheets appear as i they are tethered to#ether, and no lon#er can

slide reely past each other. This loss o mobility causes areas to become


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not transer as much ener#y but rather absorb and dissipate the orce othe impact. Thereore, ascial tissues that become increasin#ly more dense

rom in2ury are urther susceptible to bein# in2ured. &t's a nasty viciouscycle.

host o patholo#ies can result rom ascial strains, compression andrestrictions includin#/ a mild decrease in 2oint ran#e o motion to severebindin# o muscles, nerves and blood vessels as seen in compartment

syndrome. & these problems can be interrupted lon# enou#h a reverse

ascial remodelin# occurs. This can be induced by sot-tissue release andspeciically in BT by the proper application o the


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elementary units o the materials shit rom positive to ne#ative and viceversa. That is, one side become more positively !@" char#ed and the other

more ne#atively !-" char#ed. 9o with mechanical stress the side that waspositive becomes ne#ative and the side that was ne#ative becomes

positive. 1hen the pressure is released, the ions rearran#e back to their

normal place in the material. The ne#ative and positive char#es depend onhow lon# the pressure was held and how ar it was displaced. 9o the eect

is proportional to the deormation, and the deormation depends on theamount o tension in the material bein# displaced. The pie+oelectric eect

is also dependent on the direction. 1hen material is stretched in one

direction, it contracts in the other.

!ie&oelectric Char$e (uildup

hat does this mean to living tissue

&n the past twenty years research has revealed a lot o inormation on thecomposition and the properties o connective tissue, and ascia speciically.

The luid #el has a crystalline arran#ement that is a spontaneous #eneratorand semiconductor o electricity. The entire mesh-work conducts electricity

and other orms o ener#y. These tissues #enerate electric ields whencompressed or stretched. 1hen bone, cartila#e, tendon or li#ament is

compressed or stretched, eclectic pulsations are created. The colloidal #el

component o the #round substance !proteins, nucleic acids, 's, etc" alle*hibit pie+oelectric properties and are thus inluenced by electrical ields.

9o dependin# on the direction and the duration o mechanical stress wecan create electric ields induce a chan#e rom #el-to-solid or rom #el-to-

solvent !meltin#".

Tissue loadin#, or e*ample, caused a deormation to colla#en causin# anincrease in the ne#ative char#e in the tissue that has a stron# prolierative



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eect, layin# down more colla#en and makin# the tissue more thi*otrophic.1hile this is not an ideal eect or ascia that we want to remain well

hydrated and mobile, it can indeed be a beneicial eect in other tissues.$or e*ample, in slow-healin# ractures this eect can increase osteo#enesis

!new bone #rowth". Patho#enic orces, trauma, immobility, etc, causes a

strain on ascia that creates a pie+oelectic char#e that orients new tissuealon# the char#e.

/o how is this beneficial to us as therapists and how can we use this

phenomenon to influence the reverse in tissues that have become toothi&otrophic

ood %uestion. The process works in reverse as well. Aeleasin# the acialrestrictions, or strain !usin# the


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the


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low mode !4evel &&&" where elicitation strate#ies are tau#ht to uncoverprimary and secondary lesion sites and direct the

abt chapter 5

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