Fascia as a Sensory Organ
Fascia as a sensory organ; what does this mean to an MFR Therapist?
All of us were taught about the nervous system in our qualification training. But, often anatomy and physiology (A&P) were taught as stand alone systems where their integrated workings were lost. This, for many of us, resulted in an inadequate translation of how systems influence each other both in health and disease. To be fair, massage therapies span a huge range of application and those specialising in therapeutic well-ness full-body massage, in my opinion, only need to understand A&P to assess risk and contraindications. For those training at sports massage (probably level 4+), the skill set is different as the whole idea of the qualification is to work with injuries (and pain) promoting a return to pain-free active lifestyle (or sport). Here, A&P is relevant to providing the best evidence informed practice with more in-depth appreciation of tissue damage, repair and what we can do to assist recovery through a variety of modalities.
However, there is an increasing need to appreciate what’s called the ‘mechanism of action’. This is what actually happens when we touch; what changes are made to the human body when we apply our hands-on modalities?
What do I mean when I say ’changes to the human body?’ This is where the nervous system is an ideal place to start and is something that I've been focusing on in our recent social media.
So, what do I mean when I say ‘fascia as a sensory organ?’
You will have all heard about the 5 senses, taste, sight, hearing, smell and touch. You may have been taught about the integumentary system, that is the skin, hair, nails and exocrine glands. Mostly, you may have been taught about the skin as that's what we physically touch in all manual therapy. You may have been taught that the skin is a sensory organ because it senses, or discriminates against, different types of touch. A long and light nurturing massage effleurage stroke is determined by different nerve receptors embedded in skin than those which determine cross-fibre friction and, the physiological changes as a result of those different styles of touch are different too.
However the skin is not the only tissue with embedded nerve endings called receptors. The nervous system is a 2-way street. When impulses are generated from the periphery outside of the brain and spinal cord, such as in touch from manual therapy, they move along nerves as action potentials (electrical signals) towards the brain, this is called afferent signalling. Hence the term ‘affective touch’ as it has an affect on the body. When impulses are generated from the brain and spinal cord and move out to the periphery along nerves, they have an effect on the body such as moving a joint. This is called efferent signalling. Simply put, affect is to influence change in the body and effect is a response due to change. If we have this 2-way street of both afferent and efferent processing, it can't be done by the skin alone. Every tissue type, organ, bone and vessel are innervated. Even nerves have their own nervous system, called nervi nervorum. This means that all information about your internal and external environment is sent to your brain via nerves. This obviously includes the fascial system. All fascia is innervated and can discriminate changes to its structure. This is called mechanical loading, hence the term mechanosensation.
According to Dr Helene Langevin,
‘connective tissue functions as a body-wide
mechanosensitive signaling network’
Robert Schleip PhD has also discussed the mechanosensitive qualities of the fascial tissue for 2 decades (here, here and here). Yet, probably due to the complexities of understanding and teaching the nervous system, most therapists struggle to use this information adequately in practice perpetuating inappropriate claims as to why their therapy works. Let's not get me started on that right now! Fascial fallacies abound but, this is probably due to lack of good teaching.
Below is a slide from one of my presentations in our Certificate in Integrated Myofascial Therapy (CiMFT). I introduce mechanosensation and how touch discrimination can be used to offer insight into how MFR may affect the body via the nervous system. Not only that, understanding the anatomy of fascia and its innervation can help you to choose appropriate MFR techniques resulting in a better and more productive treatment session. The claims that fascia stores trauma memories and we ‘release’ scar tissue is outdated. Claims that MFR has thixotropic and piezoelectric effects and that it breaks cross-links and scar tissue up is the old paradigm (belief) becoming less and less likely to be the case. The new paradigm centres round fascial innervation and the autonomic nervous system where what's called ‘top down’ processing (from the brain to the body) plays a vital role in understanding pain and how touch therapies may promote this quality.
Interestingly, this slide is adapted from Schleip in the article I have hyperlinked above but, my comment of ‘50% respond to firm touch and pain’ in the bottom right hand corner - needs refinement. No nerve receptor senses pain. Pain is a construct, a feeling and some argue that it’s a perception derived from brain processing. Hence the slide would be better to say ‘50% respond to firm and noxious stimuli’. Noxious stimuli is something injurious to the body where the experience of pain may be the result of brain processing to alert you to the injury and to protect it from any further harm.
Most literature discusses the skin as being the largest sensory organ.. However, fascial anatomy research is disputing this as it is now suggested that the fascial system contains approximately 250 million sensory nerve endings whereas the skin is said to have only 200 million nerve endings. Interestingly, it is also suggested that some of the sensory nerve endings in the fascial tissues, the free nerve endings (FNE) respond at lower thresholds than the same FNE in the skin. In other words, it takes less stimuli for them to respond.
This suggests that touch, including MFR, could stimulate millions of nerve endings sending signals to the brain and a ‘top down’ process occurs that helps to reduce the experience of pain and promote a sense of well-being.
But, we need more than this to really appreciate what’s happening. In my slide above you will see different types of receptors that respond to different stimuli. In the yellow text, I describe what types of stimuli these receptors respond to. Does that offer clues as to what techniques you may want to use to build awareness of body areas when you are doing MFR? Additionally, free nerve endings promote interoception. See the slide below again from CiMFT.
Promoting interoception with clients is a valuable tool. This means to dialogue with them and engage them in the entire treatment session building rapport and trust. Interoception is the sense of self. Encouraging clients to feel what's happening as a result of your skilled MFR touch, helps top-down processing and ultimately plays a valuable role in a pathway back to health.
If you have never trained with MFR UK, we have in-person MFR workshops and also online courses. CiMFT is our most popular training programme. It is a 200-hour qualification (in-house) that offers over 45 MFR techniques, numerous presentations as well as text theory in downloadable workbooks. This means that you can download all the workbooks and read on the go. The online components are the videos to supplement your learning. We also have our own app so that, if you choose, you can watch all the videos on the go too. CiMFT also has 2 x 2-day in-person workshops to refine your skills. More on CiMFT here. CiMFT is ideal for you to start your MFR journey from either massage or sports/remedial massage. The huge benefit of CiMFT is that you get valuable and practical skills and knowledge to become a qualified MFR Therapist providing individual and bespoke treatment sessions. CiMFT is also applicable if you have some MFR skills and want to take them further. This is especially beneficial if you have been introduced to MFR in a 1-day training or as part of your core qualification.
If you are looking for in-person workshops and are either new to MFR or want to expand current skills, you can attend MFR Upper Body and MFR Lower Body workshops. These are part of CiMFT but can be purchased as individual workshops. You can also upgrade to CiMFT to get the entire package (conditions apply).
Pelvic Balancing Pro is a 50-hour online MFR course for therapists who already hold MFR insurance to practise. This amazing course teaches pelvic assessment, easy and effective MFR techniques and the use of pelvic positioning blocks as an extra pair of hands to help improve pelvic and low back function resolving back, pelvic and lower limb pain. Grab this amazing course here.
BUT - if you want to try before you buy - we have 2 FREE MFR courses on our home page. They provide 5 techniques each, 10 in total. That’s MORE than a 1-day MFR training and they are totally FREE. Experience MFR, see how easy techniques are and learn from me directly. Get the FREE courses here - 5 Powerful MFR techniques and 5 Powerful Pelvic Balancing Pro techniques.
There is definitely an ‘out with the old and in with the new’ attitude across the profession especially with mechanisms of action. Question what you were taught and it's maybe time to update the outdated!!
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