Fascial Manipulation®

Fascial Manipulation® is a manual therapy method that has been developed by Luigi Stecco, a physiotherapist from the north of Italy. This method has evolved over the last 40 years through study and practice in the treatment of a vast caseload of musculoskeletal problems.

It focuses on the fascia, in particular the deep muscular fascia, including the epimysium and the retinacula and considers that the myofascial system is a three-dimensional continuum. Initially via collaboration with the Anatomy Faculties of the René Descartes University, Paris, Franceand the University of Padova in Italy and more recently with a host of different collaborations, Dr. Carla Stecco and Dr. Antonio Stecco have carried out extensive research into the anatomy and histology of the fascia via dissection of unembalmed cadavers. These dissections have enhanced the pre-existing biomechanical model already elaborated by Luigi Stecco by providing new histological and anatomical data.

This method presents a complete biomechanical model that assists in deciphering the role of fascia in musculoskeletal disorders.

The mainstay of this manual method lies in the identification of a specific, localised area of the fascia in connection with a specific limited movement. Once a limited or painful movement is identified, then a specific point on the fascia is implicated and, through the appropriate manipulation of this precise part of the fascia, movement can be restored.

Fascial Manipulation® is effective in treating the most common conditions therapists see in their practice on a daily basis. Fascial Manipulation ® is backed by substantial scientific research and you can view the recent article entitled “Fascial Manipulation® for chronic specific low back pain: a single blinded randomized controlled trial” by Branchini et al. by clicking the here. This article demonstrates the importance of the pathology of the fascia in a specific low back pain and the effectiveness of Fascial Manipulation® in the reduction of symptoms.

The Fascial Manipulation® Certification Program is an intensive hands-on series taught by Dr. Antonio Stecco and Francesco Pacenza. It combines theoretical lectures, demonstrations, and practicals throughout each course day.

Participants will learn to evaluate musculoskeletal dysfunctions with specific reference to the human fascial system, and to apply the Fascial Manipulation® method as created by Luigi Stecco, PT. Lectures include the anatomy and physiology of the fascial system, an explanation of the biomechanical model used in application of this technique, and the anatomical localisation of key fascial points. Emphasis will be placed on the evaluation of musculoskeletal dysfunctions (from history taking, to a hypothesis, to a verification and treatment) together with a methodology and strategy for treatment.

The complete programme consists of two levels: Level 1 Fascial Manipulation® and Level 2 Fascial Manipulation®. Successful completion of Level 1 is required before attending Level 2. Candidates will be required to complete a multiple choice theory exam at the end of each level.

The Level I Fascial Manipulation® course consists of two three-day courses that need to be taken together to assure a good understanding of the underlying biomechanical rationale and for mastery of the techniques. The course will include the following:

• basic principles of Fascial Manipulation®, including an introduction to fascial anatomy, and the biomechanical model employed in this method
• the myofascial units that form the myofascial sequences of the upper limbs, trunk, and the lower limbs in the sagittal and frontal planes will be presented
• the Assessment Chart used in Fascial Manipulation® will be reviewed in detail
• physiology of the fascial system and the assessment and treatment of the myofascial units for the upper limbs, trunk, and the lower limbs in the horizontal plane.
• on completion of the second weekend all participants will be capable of utilising the Assessment Chart for a 3D examination of the human fascial system
• proficiency in the comparative examination of Centers of Coordination will be stressed, as well as streamlining of treatment strategies
• multiple choice theory examination to appraise the level of understanding and skill level

Fascial Manipulation® Level I Course Objective
The primary objective is to develop an understanding of the Centers of Coordination (CC) that are responsible for the normal function of related monoarticular and biarticular muscles. By the end of the course, clinicians will:

• Learn anatomy and physiology of the fascial system
• Learn how to evaluate myofascial planes: upper and lower extremities, spine
• Determine functional testing of areas of complaint.
• Develop skill and understanding to assess abnormal functional findings with fascial points of involvement to restore normal function

The Level II Fascial Manipulation® course will allow participants to expand on their understanding of the biomechanical model to treat patients with multi-segmental dysfunctions more efficiently.

As part of the learning process, Level II students will be required to present Assessment Charts of cases treated after Level I for discussion.

The course will include the following:

• a focus on the role of Centers of Fusion as part of the biomechanical model and the formation of Myofascial Diagonals
• elements of comparative anatomy studies will be introduced to assist the evaluation of adaptive compensations within the fascial system
• the involvement of fascia in motor control will discussed and the Assessment Chart used in Fascial Manipulation® will be updated with new elements
• introduction to Myofascial Spirals to complete understanding of complex movement patterns and mechanisms and the latest fascial research projects will be presented
• numerous treatment demonstrations and practice will highlight this course as comparative assessment of Centres of Coordination and Centres of Fusion, Assessment Chart analysis, clinical reasoning, hands-on skills, and treatment strategies will be emphasised

Fascial Manipulation® Level I Course is €1,350.00 with an early bird rate of €1,100.00 available.

Course fees are inclusive of course notes and a copy of the new Fascial Manipulation, Practical part, first level 2018, Second Edition, STECCO LUIGI – STECCO ANTONIO.

The Fascial manipulation® courses require prior qualification and is open to:

• physiotherapists 
• osteopaths
• medical doctors
• chiropractors
• neuromuscular therapists
• physical therapists
• sports therapists (BSc)
• sports medicine practitioners

Other qualifications may meet the eligibility requirements. If your area of expertise is not listed here please contact us on 01 882777 to check eligibility.

The science behind Fascial Manipulation ®
By analysing musculoskeletal anatomy, Luigi Stecco realised that the body can be divided into 14 segments and that each body segment is essentially served by six myofascial units (mf units) consisting of monoarticular and biarticular unidirectional muscle fibres, their deep fascia (including epimysium) and the articulation that they move in one direction on one plane. Numerous muscle fibres originate from the fascia itself and, in turn, myofascial insertions extend between different muscle groups to form myofascial sequences. Therefore, adjacent unidirectional myofascial units are united via myotendinous expansions and biarticular fibres to form myofascial sequences.

While part of the fascia is anchored to bone, part is also always free to slide. The free part of the fascia allows the muscular traction, or the myofascial vectors, to converge at a specific point, named the vectorial Centre of Coordination or CC. The location of each CC has been calculated by taking into consideration the sum of the vectorial forces involved in the execution of each movement.

The six movements made on the three spatial planes are rarely carried out separately but, more commonly, are combined together to form intermediate trajectories, similar to the PNF patterns. In order to synchronise these complex movements, other specific points of the fascia (often over retinacula) have been identified and, subsequently, named Centres of Fusion or CF.

More about fascia….
Fascia is formed by undulated collagen fibres and elastic fibres arranged in distinct layers, and within each layer the fibres are aligned in a different direction. Due to its undulated collagen fibres, fascia can be stretched and, thanks to its elastic fibres, it can then return to its original resting state. Given that fascia adapts to muscle stretch, it is unable to transmit force like a tendon or an aponeurosis. If these histological and functional distinctions are not taken into consideration, then one can confuse fascia with aponeuroses or, likewise, confuse the deep fascia with the subcutaneous connective tissue (superficial fascia). Subcutaneous connective tissue forms a very elastic, sliding membrane essential for thermal regulation, metabolic exchanges and the protection of vessels and nerves, whereas the deep fascia envelops the muscles, and surrounds the muscle’s aponeurosis up to where it inserts onto bone.

The above-mentioned anatomical studies have, however, evidenced differences between the deep fascia of the trunk and that of the limbs. The first is formed by three layers, each of which includes or surrounds different muscle groups, namely a superficial layer (latissimus dorsi, gluteus maximus, external obliques), a middle layer (serratus posterior inferior and superior, iliocostalis) and a deep layer (interspinali, intertraversarii, multifidus, trasversus abdominus). In the limbs, the deep fascia is particularly thick, resembling an aponeurosis, and well organised, connecting and synergizing the muscles of the lower limb via its collagen fibres arranged in sequences and spiral formations.

It is hypothesised, that the richly innervated fascia could be maintained in a resting state of tension due to the different muscular fibres that insert onto it. Due to this optimal resting state, or basal tension, of the fascia, the free nerve endings and receptors within the fascial tissue are primed to perceive any variation in tension and, therefore, any movement of the body, whenever it occurs.

Deep fascia is effectively an ideal structure for perceiving and, consequently, assisting in organising movements. In fact, one vector, or afferent impulse, has no more significance to the Central Nervous System than any other vector unless these vectors are mapped out and given a spatial significance. In human beings, the complexity of physical activity is, in part, determined by the crossover synchrony between the limbs and a refined variability in gestures.

Whenever a body part moves in any given direction in space there is a myofascial, tensional re-arrangement within the corresponding fascia. Afferents embedded within the fascia are stimulated, producing accurate directional information. Any impediment in the gliding of the fascia could alter afferent input resulting in incoherent movement. It is hypothesised that fascia is involved in proprioception and peripheral motor control in strict collaboration with the CNS.

Therapeutic Implications
The fascia is very extensive and so it would be difficult and inappropriate to work over the entire area. The localisation of precise points or key areas can render manipulation more effective. An accurate analysis of the myofascial connections based on an understanding of fascial anatomy can provide indications as to where it is best to intervene. Any non-physiological alteration of deep fascia could cause tensional changes along a related sequence resulting in incorrect activation of nerve receptors, uncoordinated movements, and consequent nociceptive afferents. Deep massage on these specific points (CC and CF) aims at restoring tensional balance. Compensatory tension may extend along a myofascial sequence so myofascial continuity could be involved in the referral of pain along a limb or at a distance, even in the absence of specific nerve root disturbance. In clinical practice, cases of sciatic-like pain and cervicobrachialgia without detectable nerve root irritation are common.

This method allows therapists to work at a distance from the actual site of pain, which is often inflamed due to non-physiological tension. For each mf unit, the area where pain is commonly felt has been mapped out and is known as the Centre of Perception (CP). In fact, it is important to place our attention on the cause of pain, tracing back to the origin of this anomalous tension, or more specifically to the CC and CF located within the deep fascia.

John Sharkey, Clinical Anatomist and NTC Director says…
​​I feel privileged to say that I have worked with Dr. Stecco over many years and on both sides of the Atlantic producing articles and working in the dissection room investigating and exploring human fascia. The Stecco family, father Luigi (Physiotherapist), daughter Carla (Professor of Anatomy) and Antonio (doctor) have contributed to our appreciation and understanding of fascia following years of research resulting in countless papers and studies and a number of historical books on the topic. This unique research and rich understanding of the anatomy of fascia and its role in common painful conditions has led to the development of Fascial Manipulation ®. I am very proud that Dr. Stecco has chosen NTC as the exclusive training provider to deliver this course in Ireland. I strongly endorse the course and encourage therapists of every stripe to participate.