It has been a couple of months since the AAMT national conference rolled into Hobart and while this article was originally written to update those that were unable to attend, the ongoing developments since then are also worthy of discussion.
The conference kicked off to an exciting start, with a thought-provoking presentation by John Sharkey in the main auditorium, with around 200 avid listeners. His talk was entitled “From Research to Chaos, From Outdated to Updated.” John engaged all his listeners right from the start, he addressed the topical issue of research into fascia and anatomy and all of the challenges and implications.
Regardless of what you may think about the topics of fascia and anatomy, John’s presentation definitely makes you question some of the fundamentals of anatomy and biomechanics and how this can relate to massage, exercise and the very basis of human movement.
John raised the subject of the use of language and terminology in the massage industry and the negative impacts on clients and their treatment outcomes, this was an eye opener for some and a welcome statement to others. Many in the crowd became intrigued when John spoke about the science behind pain and how this is linked to the language we use.
John asked everyone to consider what the body is constructed of and challenged us to think about what we actually know about tissues in the body. He explored the science behind Fascia, recognising there is a continuity of tissues and no layers in the body, just a continuum. He highlighted examples of “epic fails” in science, such the myth that the ITB (iliotibial band) can be stretched. John suggested that we avoid using the term “stretching” and consider lengthening or gliding of our tissues. Stretching tissues is what happens in sprains and strains, in other words, tearing, so instead we should use words such as “lengthen” and “mobilise” tissues. He brought in more examples of scientific evidence describing trigger points, for John, trigger points are an important part of dysfunction within the Biotensegrity structure of the body.
The BioTensegrity model, was introduced and explored in depth in John’s workshops on Translating BioTensegrity into Clinical Practice. The overall message John delivered was a powerful one and it was a thoroughly enjoyable and engaging presentation, which set the standard for the quality of the conference.
Is the BioTensegrity Model a Complete Game Changer?
Short answer? Possibly. The simple point that John made was that we have long viewed the human body as a system of levers. This is sometimes referred to as rigid body mechanics. The problem is that we have made a huge assumption that the body truly acts in this manner. One of the issues surrounding rigid system analysis of human movement is that it can’t equate for how the body handles heavy loads. The human body, as we know, is capable of lifting huge weights, with world record deadlifts going beyond weights of 500kg and bench press in excess of 300kg. The issue with rigid body systems is, this would mean that some areas of the body are required to handle literally tonnes of force, which is beyond the capacity of the human body. The internal abdominal pressure alone would cause the body to explode.
Hence the concept that we should be using a different model of physics to explain human movement. If our body is truly made up of 70% water, it makes sense that we should be using a model that is closer to the physics model of fluid dynamics. BioTensegrity does allow us to understand human movement from the perspective of a system that is able to disperse force and distribute it across the body system. Both intuitively and rationally this makes sense. And if the body is able to distribute load then rigid body mechanics will be an incorrect system to use.
It is worth noting however, that as long as we realise that the body is not truly a system of rigid levers, we can still get a lot of value from biomechanics using this system, if we keep in mind that it is only a model.
Should We Jump to BioTensegrity?
For most massage therapists, BioTensegrity is likely to be not much more than another buzzword, for many reasons. Firstly, when subscribing to BioTensegrity, the mathematical analysis of movement becomes ridiculously complicated. Not impossible, but much more complex. The other point to remember is that this is a very new concept, a hypothesis. And while it is a step forward, it really is a step into the unknown.
I would suggest that you keep up to date with the research and developments of people like John Sharkey and Dr Steven Levin as they continue to research. But just don’t make the mistake of assuming that it is all now fully understood.
How Does This Actually Apply to My Clinical Practice?
In many ways, it probably won’t change “what” you do, but it should make you think about the “why” and the “how.” If you haven’t already heard, fascia is basically as strong as steel, so “stretching” of fascia is not just very difficult, but it is potentially damaging. The research into myofascial release (MFR) now focuses on the gliding of fascia. Hyaluronic acid has been the focus of recent research as it is thought to “lubricate” fascial tissues and allow better mobility or gliding.
The role of the nervous system should also be central to any concept around stretching. In most cases your body has the capacity to actually move well beyond what you would experience as a limitation to range of motion. This can be demonstrated by increases in range of motion when under general anesthesia. So when focusing on increasing range of motion through massage, rather than thinking about stretching or molding tissue, instead thinking about making someone feel more relaxed and comfortable in end range, so the nervous system facilitates increased range of motion.
So instead of applying strong forces to try to stretch tissues with aggressive deep tissue methods, techniques that are focused on repetitively gliding tissues and lengthening start to make a lot more sense. The classic, active MFR, is a good example of this, or even pin and stretch. But I think it is time that we stop thinking that we need to “break up fascia” or use force to achieve our aims. I would suggest movement of tissues and nervous system relaxation is the key.