Fascial manipulation of the lower limb. (Stecco Method_®)

What is Fascia?

Fascia is a band or sheet of three-dimensional connective tissue, primarily made of collagen it surrounds every tissue, muscle, tendon, nerves, blood vessels and organs of the body. It encompasses every part of the body connecting the surface of the skin to the deeper structures within. You can often see fascia when preparing a joint of meat. It’s the white `caul like` covering, similar to a spider’s web that is present when cutting through the meat.

It is truly an amazing structure that has gone relatively unrecognised in the medical world until Luigi Stecco discovered its use in the 1970’s. It is with his continued work with his children Dr Antonio and Dr Carla Stecco advancements in fascia function that the `tensional network` of human fascia is now beginning to be fully understood along with the treatment method to relieve painful symptoms in the body that densified fascia can cause.

Fascia classification

Superficial fascia

Superficial fascia is located in-between the superficial skin and deep adipose (fatty) layers of the skin layer in nearly all regions of the body, it is more adherent to the skin than to the deep fascia. Due to its elastic properties it can stretch to accommodate weight loss and gain that a person may go through and resume its normal level of tension afterwards.

Deep fascia

Deep fascia is the lowest layer of the skin and made up of many layers of collagen fibres that slide over each other. Hyaluronic acid is produced in the deep fascia which allows the layers to glide over each other. The deep fascia surrounds the individual muscles and also divides groups of muscles into fascial compartments. Which is perfect for the force transmissions of movement and at the same time be an excellent shock absorber for the body.

What does fascia do?

In a healthy state the fascia is relaxed and flexible - allowing easy movement of the limbs and body without any restrictions however when the body has sustained an injury, overuse or surgery , the fascia can often become densified , thickened and when in this state, the layers of collagen fail to glide over each other and become stiff, painful and quite disabling in some cases.

Fascia enables the body to be flexible, strong and resistant to over stretching, it has its own nerve, circulatory supply and lymphatic system and carries messages to the brain and other parts of the body, a messenger system if you like! Considering the fascia has been ignored for all this time it is now considered to be the richest sensory organ in the body enabling it to be a very effective communications system within the body.

What are fascial restrictions?

Fascial restrictions do not show up on any diagnostic images and painful restrictions of the body go undiagnosed. The painful area of fascia densification can be transferred into the next adjacent structure, as the fascia can have a “domino effect” so the area of fascia that is densified and stiff doesn’t always present with pain in that area, so it is up to the practitioner to locate and treat the actual source of the problem.

What causes restricted fascia in the body?

• Surgery can affect the fascia by creating scar tissue which is inflexible and restricting, movement is then limited. The nerve and circulatory vessels are affected and the lymphatic drainage is impaired, which can be why areas of the body carry fluid retention and can appear swollen.
• Overuse of a part of the body causes the fascia to be restricted and can be very uncomfortable upon movement, evident at marathons when the runners have finished and are struggling to move- even to walk home.
• Fractures due to impact injuries – a broken bone has healed but the area around it is still sore and movement is limited for a much longer time beyond the expected recovery time.
• Poor posture caused by lack of stretching and exercising causes the fascia to stiffen and restrict the movements of the surrounding joints.
• Immobility for any reason causes the fascia to densify and then the body becomes stiff with difficulty in regaining movement.

What can a Podiatrist trained in Stecco Fascial Manipulation do for you?

Podiatrists are registered to practice from the waist downwards establishing any restrictions in the fascia that may be present. From this movement verification process, we can assess which plane of movement may be affected - this is confirmed by palpating specific fascial points that are restricted and densified in the lower limb or pelvis. Once this is established the practitioner’s elbow or knuckles are used to melt the densification of the fascia and restore normal tension and movement.

Before carrying out a Biomechanical assessment on my patients in clinic, I always recommend a fascial and joint mobilisation assessment first. The reason for this is - fascial manipulation and joint mobisation may be enough to resolve that patient’s problem or after the fascial manipulation the patient’s gait has changed sufficiently that the orthotic prescription would be a different one prior to manipulation.

Taking time to stretch after the treatment is beneficial in keeping the movement in the fascia, add on treatments may be needed or a single treatment may be enough to resolve the problem.

If you are not sure this treatment is applicable to you then just book into clinic on a normal appointment slot and come and have a chat to me as I could talk all day about fascia, it is totally fascinating subject! I appreciate it can be difficult to comprehend initially but it really does work.

References:

1. The Fascial Manipulation Technique and its Biomechanical model: A guide to the Human Fascial System. Carlo Stecco MD and Julie Ann Day PT
2. A practical guide to Fascial Manipulation Tuulia Luomala PT and Mika Pihlman PT
3. Fascial Components of the Myofascial Pain Sydrome Antonio Stecco, Marco Gesi, Carla Stecco, Robert Stern.
4. Fascial Manipulation Practical Part | Level one Luigo Stecco PT and Antonio Stecco MD