Chapter 4 Myofascial Pathways – East meets West
From: Howard Evans 2009 A Myofascial Approach to Thai Massage. Churchill Livingstone, Edinburgh
Fascia is the general name for the dense irregular connective tissue layer surrounding muscles, bones, and joints. It provides support and protection and gives structure to the body. Ida Rolf says of it, ‘fascia forms an intricate web coextensive with the body, central to the body, central to its well-being, central to its performance. Clearly fascial tone, fascial span, is a basic contributing factor to bodily well-being’ (Rolf 1989, p 39).
Fascia consists of three layers: the superficial, the deep and the subserous. The superficial fascia is located directly under the subcutis of the skin. Its functions include the storage of fat and water and it provides passageways for nerves and blood vessels. In some areas of the body, it also houses a layer of skeletal muscle, allowing for movement of the skin.
The deep fascia lies beneath the superficial fascia. It aids muscle movement and, like the superficial fascia, provides passageways for nerves and blood vessels. In some areas of the body, it also provides an attachment site for muscles and acts as a cushioning layer between them.
The subserous fascia lies between the deep fascia and the membranes lining the cavities of the body. There is a potential space between it and the deep fascia that allows for flexibility and movement of the internal organs.
Myofascia extends from the deep fascia as a thin, elastic and dynamic membrane that covers, supports and separates the skeletal muscles. As endomysium it wraps and separates each muscle fibre. As perimysium it wraps each bundle of muscle fibres into a fascicle. As epimysium it wraps each muscle itself. These three varieties of myofascia each contribute collagen fibres to the connective tissue that attaches the muscle either to bone or to other muscles. These attachments may also extend beyond the muscle as tendon or aponeurosis (Tortora & Grabowski 1996, p 240-241).
Between adjacent muscles the epimysium provides a protective route for blood vessels, nerves and lymph ducts. The muscles, ideally, act as cushions for these vessels. However, the quality of cushioning depends on the tone of the muscle as well as the dynamism of the myofascial pathways. If the surrounding muscles are hypertonic they will limit the flow of blood and lymphatic fluid through the epimysium and reduce the flow to the surrounding tissue.
Andrew Taylor Still (1828-1917) who in 1874 founded osteopathy always reminded his students that the physician’s task ‘was to remove with gentleness all perceived mechanical obstructions to the free-flowing rivers of life (blood, lymph, and cerebro-spinal fluid). Nature would then do the rest’ (McPartland & Skinner 2005). Perhaps an ancient appreciation of the significance of myofascia in relation to those rivers of life was what inspired the thousands of years of research and development that has culminated in some of the traditional medical systems still available to us today.
In 1990 Dick Larson, an acupuncturist and Rolfer, wrote a paper discussing the link between the myofascial planes used in structural integration and the channels used in acupuncture and suggested that the ancient Chinese were well aware of the significance of connective tissue in the living body. According to Larson, during the Han Dynasty (206 BC – 220 AD) ‘Prince Mang ordered physicians and butchers to perform surgery on live political prisoners to measure their organs and to establish the source and route of blood vessels’ (Larson 1990, p 25).
Larson quotes the work of another Rolfer, Stanley Rosenberg, who in 1986 suggested that ‘…the acupuncture meridians are a map of the planes of fascia. By putting my hands on the meridians in certain ways (other than traditional acupressure), I can produce some predictable improvements in structure, easily and with little effort’ (Larson 1990, p 29).
Kiiko Matsumoto and Stephen Birch who have done a great deal of research into the relationship between acupuncture channels and connective tissue suggest that, ‘Perhaps the fascia, the tissues that cover and line the body and organs, have some special qualities, properties or functions that were recognised by the medical authors of the Han Dynasty’ (Larson 1990, p 26).
Fascia (or, more correctly, connective tissue) does indeed have some special qualities. The first is that it provides a physical means of communication from the outside of the body to the heart of every cell and from the heart of every cell to the heart of every other cell. Each individual cell contains a cytoskeleton that provides a framework of support, structure and communication for the various cellular and nuclear elements within. Proteins called integrins reach out from the cytoskeleton, across the cell surface to the surrounding connective tissue matrix. At the outermost layer of the skin, tonofilaments reach in from the epidermis and are attached via hemidesmosomes to the dermal connective tissue. From here anchoring fibrils link in to the connective tissue matrix (Oschman 2000, 45-47).
Another of the special qualities of connective tissue is the presence of collagen fibres within the matrix. As we have seen in table 4.1, fascia and myofascia are types of dense irregular connective tissue and as such consist mainly of randomly arranged collagen fibres within the ground substance. Collagen is the ‘longest molecule that has ever been isolated’ and is ‘stronger in tensile strength than steel wire’ (Juhan 2003, p 72), qualities ideal in its role of providing support and connectivity in the body. Collagen is also hollow, which suits its role in circulation and communication. Curiously, it is said that within the collagen tubule is not, as we might expect, lymph or ground substance but cerebrospinal fluid (Juhan 2003, p 73). If this is true it is evidence of an extraordinary communication from the ventricles in the middle of the brain to, potentially, every cell in the body.
Yoshio Manaka, who died in 1989, contributed much to our modern understanding of acupuncture through scientific research. He did not specifically refer to the connective tissue and said, ‘While we can offer no clear description of the body’s hardware, we propose that it is better to examine and define the software first (Manaka 1995, p 55). Manaka did, however, refer to the ‘X-signal system’, so called because it could not yet be fully explained, even if he considered it to be ‘the biological system that lies at the very heart of acupuncture and moxibustion theory and practice.’ He considered it to be a primitive signalling system, as yet unknown to biologists and impossible to explain with neurophysiology because, ‘it manifests and is manipulated clinically with minute stimuli or influences that cannot be clearly said to affect the nervous system’ (Manaka 1995, p 18). It seems highly likely that the connective tissue plays a major role in this system.
As modern science refines its ability to look and to listen it is discovering ever more extraordinary details about the functioning of the living body. When James Oschman talks of life energy as ‘bioelectric, biomagnetic, biomechanical, and bioacoustic signals moving through collagen fibres, ground substance, and associated layers of water molecules’ (Larson 1990, p 25) it is because each of these phenomena has been scientifically shown to be true.
Perhaps here it is worth invoking the spirit of Ida Rolf. In 1964 she started teaching her system of structural integration at Esalen and helped establish it as an important centre for bodywork. There was a growing interest there in all things Eastern including yoga, meditation, chakras, energies and auras. Perhaps Ida Rolf’s work seemed a little prosaic in comparison.
‘One morning … Ida Rolf clumped into her living room at Big Sur where about twenty of us were assembled. “Word’s going around Esalen that Ida Rolf thinks the body is all there is. Well, I want it known that I think there’s more than the body, but the body is all you can get your hands on.” – Don Johnson, The Protean Body.’ (Heller & Henkin 1993, p 83)
In Thai Massage the myofascial sen are what we can get our hands on.
Helene Langevin and colleagues at the University of Vermont College of Medicine used high frequency ultrasound scanning acoustic microscopy to study acupuncture channels and the effects of acupuncture needling. Langevin observes that ‘Acupuncture points and meridians typically are located between muscles or between a muscle and a tendon or bone’ (Langevin 2001, 2279). Again we find the connection between acupuncture channels and myofascial pathways.
In one experiment, Langevin explored a phenomenon discussed for more than 2000 years in acupuncture texts and of great clinical significance to acupuncturists. This phenomenon, known as ‘de qi’ or ‘needle grasp’, is described as a tug on the needle ‘like a fish biting on a fishing line’ (Langevin 2001, 2275). Observation showed that as the acupuncture needle is turned, collagen fibres wind around its shaft. Not only does this explain the tug on the needle but it also suggests that acupuncture achieves some of its effects through mechanical influence on the connective tissue matrix. Langevin says that, ‘The ancient maps of acupuncture points and meridians may essentially be a guide to insert the needle into connective tissue. Spreading of matrix deformation and cell activation along connective tissue planes thus may mediate acupuncture effects remote from the acupuncture needle site’ (Langevin 2001, 2279-2280).
Hiroshi Motoyama draws similar conclusions in his study of yoga practice and the Ayur-vedic nadis. He says, ‘I consider the nadis to be essentially equivalent to the meridians of Chinese acupuncture; from my research, it appears that these channels are formed of connective tissue and filled with body fluid’ (Motoyama 2003, p 43).
Perhaps one day we will construct a model with which to explain exactly how traditional medicine such as acupuncture works. Researchers like Manaka, Matsumoto, Motoyama and Langevin call our attention to the connective tissue web as an important part of that model. James Oschman gathers together the research data that shows us just how multilayered and complex is the information traveling through the connective tissue web. That web might have 72 000 pathways. It might have 350 000 pathways. It might have as many pathways as cells. In the practice of Thai Massage we have only ten sen but if these refer to myofascial pathways we have a way of understanding the physical benefits of our work on these lines.
- Rolf I 1989 Rolfing. Healing Arts Press, Rochester
- Tortora GJ & Grabowski SR 1996 Principles of Anatomy and Physiology. Harper Collins, New York
- McPartland JM & Skinner E. The Biodynamic Model of Osteopathy in the Cranial Field. EXPLORE 2005; 1 (1)
- Larson D 1990 The Role of Connective Tissue as the Physical Medium for the Conduction of Healing Energy in Acupuncture and Rolfing. American Journal of Acupuncture; 18 (3)
- Oschman JL 2000 Energy Medicine: The Scientific Basis. Churchill Livingstone, Edinburgh
- Juhan D 2003 Job’s Body: A Handbook for Bodywork. Station Hill Press, New York
- Manaka Y 1995 Chasing the Dragon’s Tail. Paradigm Publications, Brookline
- Heller J & Henkin WA 1993 Bodywise. Wingbow Press, Oakland
- Langevin HM, Churchill DL & Cipolla J. The FASEB Journal 2001; 15
- Motoyama H 2003 Theories of the Chakras. New Age Books, New Delhi