Tuesday, February 16, 2016

Fascia Fiber Direction, Myofascial Release, and Acupuncture

Fig. 1: Electron microscope view showing
the endomysial layer1 
The image to the right (Fig. 1) shows the endomysium, the )fascial compartment that wraps individual muscle fibers. A simplified schematic is shown below (Fig. 2). The cross-linking fiber direction is particularly worth noting, as this can inform clinical strategies. These strategies are especially relevant to tuina (particularly myofascial release), but can also inform acupuncture needle manipulation.2

Beginning with myofascial release, it is important to note what happens to the fibers of the endomysium as a muscle is locked into a lengthened position (locked-long) versus locked into a shortened position (locked-short).3
Fig. 2

When locked-long, the endomysium cross-linked fibers are pulled horizontally, and they become increasingly more parallel to the muscle fiber length. A slow, sustained myofascial release stroke in the direction of the muscle fiber would further move these fascial fibers into this parallel arrangement, which could ultimately be counterproductive for long-term change of the patient.

However, this same slow, sustained myofascial release stroke perpendicular to the fiber direction would result in a positive re-balancing of the fascia, which would enhance the ability of the muscle to return to its normal resting length. So, in effect, this stroke against the muscle fiber direction could be considered a tonification technique.

Fig. 3
For the locked-long muscle to optimally return to its resting length, it is important to also address its antagonist. This frequently involves muscles that are on the internally-externally related sinew channel. For instance, someone with upper cross syndrome would have an overlengthened lower and middle trapezius and rhomboids. These are part of the Large Intestine sinew channel and, in this case, would benefit from the tonification technique described above.4

However, the pectoralis minor, part of the Lung sinew channel, would be in a shortened position (excess) and would benefit from an MFR stroke in a direction with the muscle fibers; a sedating technique.4 This directional stroke would reorganize the fascia and provide the most precise communication to the tissue.

How does acupuncture fit into this? First of all, proper needling to the motor points of both the locked-long and locked-short structures would help reset the dysfunctional muscle-spindle relationship of these muscles, and the myofascial release would help reset the fascia. 

Fig. 4 Image showing collagen fibers
wrapping around the needle6 
Acupuncture needle technique can also involve moving fascia. After needling acupuncture points, the needle can be turned in one direction (just like we were taught NOT to do in acupuncture school) until the needle can no longer turn. Now the needle has wound a considerable amount of collagen fibers around it. Then, the needle can be pulled in the appropriate direction to reroute the fascia. Over time, the fascia will loosen around the needle and the needle can be removed, though it is important that you remember which direction you turned it in case there is difficulty*.5

Imagine a patient with overpronation of the foot. The peroneals are now in an overlengthened position and are pulled up fascially, much like a shirt sleeve that is pulled up on the arm. Needling the motor points of peroneus longus and brevis, winding the needle, and them pulling downward, will help reset the dysfunctional muscle and fascia. Following this with a deep cross-fiber spreading of the tibialis anterior will balance the relationship of the tibialis anterior with the peroneals. This will balance Earth (tibialis anterior/Stomach sinew channel) with Water (peroneals/Urinary Bladder sinew channel).

*This technique is best taught in a classroom setting. Please do not attempt unless you have practiced under supervision first.

References:

1. Purslow, Peter P. "Muscle Fascia and Force Transmission." Journal of Bodywork and Movement Therapies 14.4 (2010): 411-17. Web. 

 2. Spina, Andreo A. "The 'Direction' of Fascia." Web log post. Functional Anatomy Blog. 10 Mar. 2011. Web. 16 Feb. 2016. 

3. Myers, Thomas. "Lengthening Fascial Tissue: Working with the Grain." Web log post. Anatomy Trains. 25 June 2014. Web. 16 Feb. 2016. 

4. Lau, Brian S. "Anatomy of the Sinew Channels Module 2: Head, Neck, and Upper Extremities." Sports Medicine Acupuncture Certification: Anatomy, Palpation, and Cadaver Lab. Pacific College of Oriental Medicine, San Diego. Lecture. 

5. Callison, Matt. "Assessment and Treatment of Lower Extremity Injuries." Sports Medicine Acupuncture Certification. Marina Village, San Diego. 17 Oct. 2015. Presentation.

6. Langevin, Helene M. "The Science of Stretch." The Scientist Magazine. 1 May 2013. Web. 16 Feb. 2016. 

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