Stecco s Fascial Manipulation approach. Dr. Leonid Kalichman PT, PhD
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1 Stecco s Fascial Manipulation approach Dr. Leonid Kalichman PT, PhD
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3 Fascia: definition and examples Innervation of fascia Pathological changes in fascia(hyaluronic acid) Basics of fascial manipulation method
4 Fasciae (singular, fascia) are connective tissue layers and wrappings that support and surround all organs, bones, muscles, nerves, and blood vessels. superficial fascia deep fascia subserous fascia Dr. Leonid Kalichman, PT, PhD
5 Fascia is an uninterrupted three-dimensional web of dense connective tissue The soft-tissue component of the connective tissue system that permeates the human body, forming a whole-body continuous three-dimensional matrix of structural support.
6 A - epidermis B dermis C superficial fascia (and subcutaneous fat) D deep fascia (aponeurotic+epimysium) E - muscle
7 Dr. Leonid Kalichman, PT, PhD
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10 Fascia is a continues tissue that connects all parts of the body.
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14 Fascia is reach by nociceptors and mechanoreceptors. Fascia is a pain sensitive structure and involved in proprioception and movement regulations
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16 The average 70 kg person has roughly 15 grams of hyaluronic acid in the body, one-third of which is turned over every day. It is part of the extracellular matrix, a major component of the synovial fluid, and was found to increase the viscosity of the fluid. Hyaluronic acid is a component of articular cartilage and skin. Dr. Leonid Kalichman, PT, PhD
17 Dr. Leonid Kalichman, PT, PhD Recent study showed a layer of hyaluronic acid between fascia and muscle and inside deep fascia, in particular inside the loose connective tissue separating the fibrous sub-layer of the fascia. This means that the fascia thus provides an extracellular matrix that is a gliding lubricant over muscle, permitting the free contraction of muscles, but also a unique matrix for its repair and regeneration. STECCO, C., PORZIONATO, A., MACCHI, V., STECCO, A., STERN, R., DE CARO, R.. Analysis of the presence of the hyaluronic acid inside the deep fasciae and in the muscles. Italian Journal of Anatomy and Embryology, North America, 116, Nov Available at: <
18 Dr. Leonid Kalichman, PT, PhD By increasing the concentration of HA, HA chains begin to entangle conferring to the solution distinctive hydrodynamic properties: the viscoelasticity is dramatically increased.
19 HA increased viscosity and mechanorecptors
20 Dr Leonid Kalichman PT, PhD Stecco family
21 Motor Unit (Sherrington s definition): A motor unit is made up of a motor neuron and the skeletal muscle fibers innervated by axon of this neuron. The Myofascial Unit (Stecco s definition): 1. A group of motor units that move a body segment in a specific direction by activating fibres (monoarticular and biarticular) in one or more muscles 2. The joint that is moves 3. Nerve and vascular components 4. The fascia that connects these elements together Dr Leonid Kalichman PT, PhD
22 CC 1. Each Myofascial unit has its own CENTER OF COORDINATION (CC) 2. CC = Small areas on the deep fascia where the sum of tensional vectors coincide. 3. Located in epymisium Dr Leonid Kalichman PT, PhD
23 Increase of the viscosity of HA in the Centre of Coordination CC Decrease of the sliding system in the CC Improper recruitment of muscle fibres The resulting vector becomes faulty Mechanical incoordination in the joint Phase of compensation Symptoms in the Center of Perception (CP) ME LA CP
24 Friction.... Heat develops Tissue sliding improvement Perception of change in tissue mobility Patient reports pain reduction Dr Leonid Kalichman PT, PhD
25 Images of the sonoelastography state before and after fascial therapy in the L5eS1 interspace. In addition to the color scale evaluation, elasticity was quantitatively measured in the zone of interest and local elasticity demonstrated a x10 increase after fascial therapy.
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27 Performed by PTs (highly trained professionals) Science based treatment Initial research evidence for effectiveness Holistic (treat entire body, not only site of symptoms) Treat source of problem, not the site of symptoms Eliminates consequence of previous (old) traumas and surgery Very effective, especially for chronic problems
28 Dr. Leonid Kalichman PT, PhD
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