Fernando Luiz Bertolucci

Fernando Luiz Bertolucci

Fernando Luiz Bertolucci

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Science Meets Practice

Let’s Say Something about Fernando’s role in the Secret Life of Fascia

Luiz Fernando Bertolucci, MD, BSc, physiatrist, biologist, Advanced Rolfing® practitioner, Rolf Institute Anatomy Faculty, co-creator and teacher of the Myofascial Release training in ABR (Brazilian Rolfing Association), creator of the Muscle Repositioning technique.

 

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Fernando Luiz Bertolucci 

Pandiculation: An organic way to maintain myofascial health

DucreuxyawnPandiculation: An organic way to maintain myofascial health by Luiz Fernando Bertolucci, MD

Pandiculation is the involuntary stretching of the soft tissues, which occurs in most animals and is associated with transitions between cyclic biological behaviours, especially the sleep-wake rhythm. Yawning is considered a special case of pandiculation. When, as often happens, yawning occurs simultaneously with pandiculation in other body regions, the combined behaviour is referred to as the stretch-yawning syndrome (SYS).
Although today it is possible to trace the main neural pathways responsible for the expression of the SYS, its intimate biological meanings are still poorly understood. In the First International Congress on Yawning, held in Paris in 2010, different hypotheses were presented about the main possible SYS’s mechanisms and purposes (summarized in the book: The Mystery of Yawning in Physiology and Disease, edited by Dr O. Walusinski), ranging from ethological to neurophysiological perspectives.

This article explores the hypothesis that the SYS has an auto-regulatory role in our locomotor system: to maintain the animal’s ability to express coordinated and integrated movement by regularly restoring and resetting the structural and functional equilibrium of the myofascial system.
The ideas presented here initially arose from clinical observations during the practice of a manual therapy called Muscular Repositioning (MR) (Bertolucci, 2008; Bertolucci and Kozasa, 2010a; Bertolucci, 2010b). These observations were supplemented by a review of the literature on the subject. A possible link between MR and SYS is presented: The neural reflexes characteristically evoked through MR are reminiscent of SYS, which both suggests that MR might stimulate parts of the SYS reaction, and also points to one of MR’s possible mechanisms of action.

 

 

Muscle Repositioning: A new verifiable approach to neuro-myofascial release?

 

Summary

The clinical observation of involuntary motor activity during application of a particular style of myofascial release (Muscle Repositioning—MR) has led to the hypothesis that this technique might evoke neurological reactions. Preliminary EMG recordings presented here show involuntary tonic cervical erector action during MR. Involuntary eye movements were also observed. This article presents these experimental data, along with clinical observations during the application of MR in the treatment of musculoskeletal conditions. The author hypothesizes that MR might constitute a novel manual technique: it produces unique palpatory sensations for the practitioner (e.g., a sense of firmness to the touch and the integration of bodily segments into a single block) that correspond to unique sensory experiences for the client. The article raises the possibility that MR’s specific sensory input might activate the central nervous system, thus eliciting neural reactions. These reactions, in turn, might be related to the technique’s efficacy. As the EMG objectively measures reactions contemporaneous with subjective palpatory phenomena, MR potentially brings the objective and subjective into congruence. EMG monitoring of touch could serve as an objective criterion in the development of treatment protocols, as well as a feedback tool for teaching. Greater objectivity, precision and reproducibility are all possible outcomes of such an approach. The author believes that MR can be used in various therapeutic settings—either as the principal approach, or as an adjunct to a variety of other approaches.

 

 

 

Muscle Repositioning: Combining Subjective and Objective Feedbacks in the Teaching and Practice of a Reflex-Based Myofascial Release Technique

Muscle Repositioning (MR) is a new style of myofascial release that elicits involuntary motor reactions detectable by electromyography. This article* describes the principal theoretical and practical concepts of MR, and summarizes a workshop presented October 31, 2009, after the Second International Fascia Research Congress, held at Vrije Universitiet, Amsterdam.

The manual mechanical input of MR integrates the client’s body segments into a block, which is evident as a result of the diagnostic manual oscillations the practitioner imparts to the client’s body. Segmental integration is achieved when the client’s body responds as a unit to the oscillatory assessment. It appears that manually sustaining the condition of segmental integration evokes involuntary muscle reactions, which reactions might correspond to mechanisms that maintain homeostasis, such as pandiculation. It might be that these reactions are part of the MR mechanism of action and underlie its clinically observed efficacy in the treatment of musculoskeletal disorders.

For the practitioner and the client alike, segmental integration provides unique sensations. In teaching MR, these paired sensations can be used as kinesthetic feedback resources, because quality of touch can be guided by the client’s reported sensations, which should match the practitioner’s sensations. Another form of feedback with respect to quality of touch is the visually discernable degree of segmental integration. Finally, because the involuntary motor activity elicited by the MR touch can be objectively monitored through electromyography and possibly other instrumented measurements, the MR approach might yield objectivity, precision, and reproducibility—features seldom found in manual therapies.

Keywords: Muscle stretching exercises, yawning, myofascial pain syndromes, physical therapy (specialty), fascia, martial arts, teaching, rehabilitation, musculoskeletal manipulations, sensory feedback

INTRODUCTION

Muscle Repositioning (MR) is a new style of myofascial release that elicits involuntary motor reactions detectable by electromyography(,). The MR technique was discovered serendipitously during Rolfing Structural Integration sessions that the author administered to other Rolfing practitioners. The “client” colleagues noted that the work they were receiving felt somehow different from techniques familiar to them. The observation was made so frequently that the author and a group of Rolfers undertook an empiric investigation of whether MR was indeed significantly different, as a technique, from techniques commonly employed in Rolfing.

The participants confirmed that the MR approach was unlike their customary techniques. They had to rely on parameters that they did not customarily consider, such as the firmness of the tissue engaged during the maneuver and the integrative response of other body segments. They also recognized as unfamiliar the sensations that client and practitioner alike experienced. The participants concluded that MR was most likely a distinct technique. It seems to affect the fascial system in a singular way, while simultaneously engaging the nervous system in a manner that might evoke homeostatic mechanisms. The principal concepts of MR are summarized in the subsections that follow.

Tissue Manipulation Integrates Body Segments

One hallmark of MR is a distinctive way of engaging and twisting connective tissue structures (fascia) around harder structures (bones, joints). First, the practitioner’s hands anchor a portion of skin and move it in a particular way relative to the underlying tissues. The palpable resistance to the initial mechanical input guides the practitioner to orient the touch in the proper direction. Apparently, the input reaches first the superficial fascia and then stresses progressively deeper fascial structures as the maneuver proceeds. Something strange then happens: The client’s body segments become immobile relative to each other, suggesting that the particular way in which MR stresses the soft tissues elicits the intersegmental linking of body parts, manifested as an apparent “unification” (“integration”) of the client’s body into a single block.

Segmental integration can be seen (video links are available at http://musclerepositioning.blogspot.com/) and also palpated when small oscillations are imparted to the client’s body. With MR, the segments move as one, whereas with ordinary oscillation, the movement begins where the body first receives input and reaches the rest of the body sequentially. As a diagnostic tool, the oscillations work like sonar: The resistance the practitioner feels in response to the manual mechanical perturbation—and simultaneous visual observation— inform the practitioner about the level of integration present in the client’s body.

The client, too, senses the difference in the body’s response to integrative as compared with random oscillation. When receiving the integrative touch, clients can feel the synchronous movement in response to the diagnostic oscillations, often describing a sensation of expansion in the cephalocaudal direction or the formation of an “axis” through the body. As discussed later, this sensation brings to mind the sensations experienced during pandiculation, as well as those cultivated during the practice of certain styles of martial arts and yoga. In the clinical experience of the author’s group, the exploration of these sensations helps the client to differentiate various qualities of movements and postures in daily life, which is important to the treatment and in the prevention of musculoskeletal disorders. Finally, these sensations can be an important source of feedback to guide the quality of touch when MR is taught.

A Characteristic Firmness to the Touch

Once the MR touch generates intersegmental integration, the practitioner senses a unique “firmness” under the hands. This distinctive springy sensation causes the practitioner’s force to rebound. This firmness feedback is key to the MR technique and should be present continuously. In addition to being part of the technique, the sense of firmness is also a form of intrinsic feedback in both the practice and instruction of MR. Usually, the practitioner feels the firmness progressively intensify during the maneuver. The author believes that this firmness might be a reflection of the client’s physiologic state, to which the treatment is continuously connected and adapted. The proper location and direction of the necessary mechanical stimulus cannot be foreseen, and continual adjustments to the composition of forces, mainly shear and torsion, are necessary.

How does the MR practitioner elicit the characteristic firmness? The tissues must be approached at an oblique angle. This approach, together with counterpressure from the inertia of the integrated body segments, seems to direct the resultant vectors so as to produce internal shear forces among musculoskeletal structures in precise directions. A clear sensation of relative movement among myofascial compartments is produced. The movement happens in small increments, which become larger toward the end of a maneuver, after which the subject often feels a burning sensation. For the practitioner, the feeling resembles that of blunt dissection surgical technique, in which the surgeon discriminates neighboring structures with a blunt instrument, such as the fingers. Blunt dissection creates minimal surgical lesions because it discriminates structures at natural separation points— along the planes of cleavage. In an MR maneuver, the practitioner can often discern which cleavage planes are most likely involved.

Perhaps the direction and concentration of forces in MR release abnormal adhesions in areolar connective tissue within muscle compartments and between other fascial structures. Because these adhesions influence relative muscle position, one of MR’s possible mechanisms of action could be to re-establish relative muscle mobility and to let the muscles optimize their positions relative to each other in movement. This optimized relationship might produce better myofascial force transmission, as described by Huijing(), from which better motor function might follow.

Involuntary Motor Reactions Suggest Involvement of the Nervous System

When manual contact with the sense of firmness is sufficiently precise and sustained, the client begins to show involuntary motor reactions of various kinds. These kinds of reactions were first recorded during a maneuver in the occipital region: isometric activity of the cervical erectors appeared and progressively intensified during the maneuver. Simultaneously, the practitioner felt his hands pressed into the table by the involuntary extension of the subject’s head and upper cervical spine. The reaction can be strong enough for the muscular activity to be both seen and palpated (demonstrated at http://musclerepositioning.blogspot.com/).

Other involuntary motor activities observed include eyelid flickering, horizontal eye movements, tremors, and clonic and tonic appendicular movements. A few subjects have even shown the extreme reaction of involuntarily rising from supine to a seated position (demonstrated at http://musclerepositioning.blogspot.com/). The observation of such phenomena led the author’s group to hypothesize that the MR touch might stimulate physiologic neural reflexes, and to perform electromyographic (EMG) measurements to test the hypothesis.

EMG Monitoring Confirms Involuntary Motor Activity

In a previous study(), EMG monitoring of the cervical erectors during an MR maneuver at the occiput showed the presence of an involuntary muscle reaction, absent before the maneuver, that appeared during application of the maneuver and disappeared almost immediately after the maneuver (Fig. 1). Involuntary horizontal eye movements were also observed (demonstrated at http://musclerepositioning.blogspot.com/). These movements were mostly slow, periodic, side-to-side horizontal movements, the amplitude and velocity of which varied during the maneuver. In a new set of EMG recordings(), a maneuver in the thoracic region also elicited involuntary tonic activity in the cervical erectors (Figs. 2 and and3),3), in conjunction with synchronic lumbar activity in half the subjects. Taken together, these data suggest that evocation of reflexive motor activity might be a hallmark of MR in general.

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