T. Myers: Anatomy Trains. Lateral myo-fascial force transmission. Fascial tissues. Peter Huijing Vrije Universiteit, Amsterdam. Huijing & Baan 2003

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1 Fascia is Alive Active Contractility and Sensory Innervation of Human Muscular Connective Tissues Robert Schleip PhD Fascia Research Project, Applied Physiology, University of Ulm, Germany 1. Fascia as a tensional network 2. Fascia as a sensory organ 3. Fascial tonicity 1

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3 Fascial tissues Epimysium & aponeuroses Superficial & deep fascia Perimysium & septi Endomysium Lateral myo-fascial force transmission Peter Huijing Vrije Universiteit, Amsterdam Huijing & Baan 2003 T. Myers: Anatomy Trains 3

4 Vleeming A, 1995 Barker P Tensegrity Architecture Elastic recoil function of fascial elements Classical model: muscle fibers shorten New findings: muscle fibers don t shorten; usage of fascial recoil Fukunaga

5 Using muscles for adjusting the ideal prestiffness (and resonsance frequency) for maximum energy storage of fascia 1. Fascia as a tensional network 2. Fascia as a sensory organ 3. Fascial tonicity Fascial mechanonreceptors Already postulated in 1899 by A.T. Still 5

6 Presence of intrafascial mechanoreceptors Stilwell 1957 Sakada 1974 Vshivtseva 1988 Yahia 1992 Stecco 2006 Localisation Sensitivity Effects Overview at Simplification: The three Italian brothers and their little sisters Golgi Paccini Ruffini Interstitial Sisters Golgi Paccini Ruffini Interstitial Sisters 6

7 GOLGI Respond to stimulation with a decrease in muscular tonus Passive stretching does not excite GTOs Jami L 1992 Golgi tendon organs in mammalian skeletal muscle: functional properties and central actions. Physiol Rev 73(3): E. Lederman: Foundations of Manual Therapy GOLGI Myotendinous junctions & attachment areas of aponeuroses Ligaments of peripheral joints Joint capsules 7

8 GOLGI Therapeutic stimulation: Slow, deep stretching close to the attachments maybe combined with AMPs (active movement participations of client during manipulation) Golgi Paccini Ruffini Interstitial Sisters PACINI Sensitive only to rapid pressure changes 8

9 PACINI Deep capsular layers Spinal ligaments Myotendinous junctions PACINI Proprioceptive feedback for movement coordination Stimulation by practitioner tends to increase local proprioceptive attention and self-regulation PACINI high velocity adjustments sudden pressure release techniques vibratory tools rocking, shaking, rhythmic joint compression 9

10 Golgi Paccini Ruffini Interstitial Sisters RUFFINI Specially responsive to: tangential forces (shear) RUFFINI Stimulation results in: an inhibition of overall sympathetic activity 10

11 RUFFINI Ligaments of the peripheral joints Dura mater outer capsular layers RUFFINI Slow melting pressure with lateral shearing. Golgi Paccini Ruffini Interstitial Sisters 11

12 Composition of a motor nerve INTERSTITIAL (Type III & IV) 50%: high threshhold Other 50% are responsive even to very subtle stimulation. INTERSTITIAL (Type III & IV) Most abundant receptor Found almost everywhere, even inside bones. Highest density in periosteum 12

13 INTERSTITIAL (Type III & IV) Strong stimulation can increase vasodilation and plasma extrusion Also used for interoception (plus proprioception?). Can function as mechanoreceptors and/or nociceptors. Receptor sensitivity is frequently modulated by neurotransmitters. INTERSTITIAL (Type III & IV) Work on periosteum, interosseous membranes, and other fasciae connected with bones. Intention of re-sensitizing interstitial mechanoreceptors. Look for autonomic reactions widening of breath & eyes, but not yet any withdrawal responses. Golgi Paccini Ruffini Interstitial Sisters Schleip

14 1. Fascia as a tensional network 2. Fascia as a sensory organ 3. Fascial tonicity Introduction Pathological fascial contractures facilitated by myofibroblasts M. Dupuytren Kloen 1999 M. Ledderhose Hasegawa et al Frozen shoulder Bunker & Anthony 1995 Peyronie s disease Hypertrophic scar Nodular fascitis Club foot Desmoid type fibromatosis Knuckle pads Myofibroblast development Adapted from Tomasek et al

15 Histochemistry Histological examination Immunohistochemistry Monoclonal antibody against α-sm-actin SS-lig. L2 L4 F.lata Digital quantification ppm of surface portion F.plant. 32 humans (25M, 7F, 17-91yrs, Ø47±23yrs) Density of myofibroblasts in human fascia IH for α-sm-actin (15 photos per sample. Monte Carlo method for choice of locations) Plantar fascia. Male 57 yrs. Digital quantification 100 of stained µm areas. 565 ppm Typical lumbar fascia 15

16 Frozen lumbars? Signs of injured lumbar fascia? L2 lumbar fascia. Male 19 yrs. 100 µm Lumbar fascia., male 19 yrs High density of contractile cells in perimysium Tonic Phasic Pharmacological stimulation Adrenaline 16

17 Control tissue Mepyramine Hypothesis: general joint mobility related to MFB density Dupuytren contracture Average Systemic hypermobility Remvig L, Schleip R (unpublished) 17

18 THANK YOU Werner Klingler MD Adjo Zorn PhD Stefanie Rankl Anne Klein 18