Fascia in Sport and Movement

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HANDSPRING PUBLISHING LIMITED
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First published 2015 in the United Kingdom by Handspring Publishing

Copyright © Handspring Publishers 2015

All rights reserved. No parts of this publication may be reproduced or transmitted in any form or by any means,
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ISBN 978-1-909141-07-0
eISBN 978-1-909141-42-1

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A catalogue record for this book is available from the British Library

Library of Congress Cataloguing in Publication Data

A catalog record for this book is available from the Library of Congress

Notice
Neither the Publisher nor the Author assumes any responsibility for any loss or injury and/or damage to persons
or property arising out of or relating to any use of the material contained in this book. It is the responsibility of the
treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best
treatment and method of application for the patient.

Commissioning Editor Sarena Wolfaard

Design direction Bruce Hogarth, kinesis-creative.com
Cover Design Gillian Richards
Index by Dr Laurence Errington
Typeset by DSM Soft
Printed in Czech Republic by Finidr Ltd.
The
Publisher’s
policy is to use
paper manufactured
from sustainable forests

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 CONTENTS
Foreword
Preface
Contributors
Section 1 Theory
1 Fascia as a body-wide tensional network: Anatomy, biomechanics and
physiology - Robert Schleip
2 Myofascial force transmission - Stephen Mutch
3 Physiology and biochemistry - Werner Klingler
4 Fascia as sensory organ - Robert Schleip
5 Stress loading and matrix remodeling in tendon and skeletal muscle: Cellular
mechano-stimulation and tissue remodeling - Michael Kjaer
6 Anatomy trains in motion - Thomas Myers
7 Purposeful movements as a result of coordinated myofascial chain activity,
represented by the models of Kurt Tittel and Leopold Busquet - Philipp
Richter
8 Hyper- and hypomobility of the joints: Consequences for function, activities
and participation - Lars Remvig, Birgit Juul-Kristensen and Raoul Engelbert
9 Human movement performance: Stretching misconceptions and future trends -
Eyal Lederman
10 Fascial tissues in motion: Elastic storage and recoil dynamics - Robert
Schleip
Section 2 Clinical application
11 Fascial Fitness -Robert Schleip and Divo Müller
12 Fascial form in yoga - Joanne Avison
13 Fascia oriented Pilates training - Elizabeth Larkam
14 Training fascia in GYROTONIC® methodology - Stefan Dennenmoser
15 How to train fascia in dance - Liane Simmel
16 The secret of fascia in the martial arts - Sol Petersen
17 Elastic walking - Adjo Zorn

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18 Functional training methods for the runner’s fascia - Wilbour Kelsick
19 Understanding mechano-adaptation of fascial tissues: Application to sports
medicine - Raúl Martínez Rodríguez and Fernando Galán del Río
20 How to train fascia in football coaching - Klaus Eder and Helmut Hoffmann
21 Athletic coaching - Stephen Mutch
22 Plyometric training: Basic principles for competitive athletes and modern
Ninja warriors - Robert Heiduk
23 Kettlebells and clubbells - Donna Eddy
24 Assessment technologies: From ultrasound and myometry to bio-impedance
and motion sensors - Christopher Gordon, Piroska Frenzel and Robert
Schleip
25 Palpation and functional assessment methods for fascia-related dysfunction -
Leon Chaitow
Index

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 FOREWORD
For many years both amateur and professional athletes have looked to exercise
physiologists and trainers for ways to improve and maintain their performance, and
avoid injury. Thirty years ago, there was research related to building muscle
strength through concentric and eccentric exercise, with isometric, isokinetic and
isotonic exercises as the building blocks, spaced over various repetitions and
intervals. This was followed by research about muscle loss with inactivity and
exercise to combat that loss, made particularly important by the space programme.
Muscle biopsies showed slow twitch and fast twitch fibres, with little conversion
of fibre types from one to the other. When changes in force generated by muscles
were seen in a matter of days, long before there was any demonstrable change in
muscle fibre size, this was attributed to changes in the innervations and activation
of the muscle. However, all these studies led to the same conclusion: to improve
performance in a specific activity, as opposed to strength in an isolated muscle, the
best training is that activity itself which involves motion of the whole body.
At the same time, models of movement based on muscles and bones were
challenged by the reality of motion that could not be explained. In the low back,
lumbar fascia needed to be added to the model to account for movement
capabilities. The running ability of the double amputee initially declared ineligible
to compete in the regular 2008 Olympic games for fear that his bilateral below knee
prostheses gave him an artificial advantage over athletes with normal calf muscles,
shows that lower leg muscles are not sufficient or even necessary forces in
propelling the human body. Studies of storage of energy in tendon and other
connective tissues showed their importance in human gait. It turns out the normal
myofascial locomotor system in humans is indeed slightly better than spring based
prostheses and in animals, such as the kangaroo, energy storage in tendons is
critical to maintain the repetitive patterns of locomotion (Chapter 10).
More recently, studies have shown that energy storage in tissues around the
shoulder allow humans to throw at speeds over 100 miles an hour, compared to a
meager 20 miles per hour in our closely related primate species. Pre-contraction of
the muscle stretches connective tissues, which then explosively releases to
accomplish a movement for which muscle power alone would be insufficient.
Whilst in the leg large tendons are found in obvious positions to store this energy,
this is not the case in the shoulder. Instead, the storage is diffused across a network
of as yet undefined tissues but the ‘wind up’ for the pitch indicates the whole body
is involved.
The chapters in Part 1 provide a basis to understand principles of the body-wide
tensional network of fascia. There is a continuity of fibrils from the extracellular
matrix through the integrin receptor and the cell membrane to the nucleus. Manual

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massage after exercise can be seen to activate the force conducting pathways to the
nucleus, followed within hours by changes in gene transcription. It is a useful
concept to think of the body as a fascial network with connections to muscles and
bones, rather than the more traditional view of a musculoskeletal system with fascia
connections (Chapter 1). This suggests that the contraction of the trunk muscles
prior to use of the superficial muscle slings, described in Chapter 7, may not be just
stabilising the trunk. Rather, it may be taking the slack out of core fascial layers to
allow ‘prestretch’ and energy storage for release later. Golfers and martial artists
know the power in proper trunk rotation.
As described in Chapter 8, there are clear differences in mobility of tissues around
the joints, with some people being more flexible than others. However, flexibility
is not always a uniform function and the astute clinician will find patients with
flexible elbows and tight hamstrings and vice versa. Indeed there are some rare
muscle disorders characterised by certain tight and other loose joints. The theme of
stretching to increase range in specific parts of the body is continued in Chapter 9
where, again, we find that practicing a task is the best way to prepare for that task
performance. If we return to the notion that fascial tissues store energy for release
during activities, we come to the logical conclusion that stretching these tissues to
the point where their energy-absorbing properties are altered, will result in
reduction in energy release and decreased subsequent performance. The mechanical
interactions among muscle, tendon and fascia in humans have developed over many
thousands of years to allow us to adapt to a wide range of activities. We are just
beginning to understand these to be able to direct such adaptation by specific
exercises and activities, which differ from the final desired task.
Skeletal muscle clearly responds to loading by hypertrophy and other adaptations,
which increase its capacity for force generation. Chapter 5 takes this concept to
connective tissue and explores loading in the context of adaptation or overloading
pathology. For certain occupations, specific cycles of work/rest can be identified
as tolerated or leading to functional loss. Again, task specificity is paramount.
Adult tendons show little change or remodeling in the adult, unless there is wound
healing to be repaired. However, to put this into perspective, connective tissue
turnover every two days is found in the tiny fibres connecting a muscle to the
nearby arteriole, which pull open the nitric oxide receptors and increase blood
flow to the contracting muscle.
Additional aspects of fascial physiology and biochemistry are presented in Chapter
3, giving a wide range of factors to be taken into account to understand the basis for
the broad spectrum of clinical applications presented in the next section. Some
factors are specific to fascia. Others, such as work hardening, are general
properties of hardening by plastic deformation, which have been used with copper,
steel and other metals for thousands of years. To a greater or lesser extent, each of

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the chapters in Part 2 refers back to some of the basic physiology underlying these
activities. By alternating study between Sections 1 and 2, the reader will develop a
facility for analysing potentially beneficial therapies that will extend beyond the
specific ones presented here. This is perhaps the most useful contribution of this
book, to help the reader decide which of the many competing systems of therapy
they will commit to studying further and which they will incorporate fully or
partially into their own clinical approach to their patients and clients. Perhaps,
most importantly, they will also to start to identify which particular approaches
will work for particular patients.
Chapter 25 offers tools and techniques for assessment during the clinical
examination to assist with gathering evidence to guide initiation of treatment and
monitor progress. I expect this book will become a well-worn and dog-eared
addition to the library of clinicians from many disciplines.

Thomas Findley
2014

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 Preface
Fascia certainly connects! It not only connects a large variety of collagenous tissues
within the human body, ranging from tendons to joint capsules to muscular
envelopes, but also the rapidly growing field of fascia-oriented explorations
bringing together many different professional disciplines, personalities and
perspectives. This includes scientists, dance professionals, stretch gurus and sports
medicine celebrities. This book is nothing less than the first interdisciplinary
publication to review scientific and practical approaches investigating the
importance of fascia in sports and movement therapies.
We editors are proud of what has been accomplished in the following pages. In an
extensive and intense collaboration, we have managed to include as contributing
team members the top scientific experts in their fields as well as leading figures
from different practical approaches such as athletic training, yoga, Pilates, sports
rehabilitation, kettlebell training, martial arts, plyometrics, dance medicine and
others.
Note that the range of professional perspectives varies about as much as the
different fibrous tissues that are connected with each other as parts of the body-
wide fascial net. Based on this, the scope of this textbook purposely embraces
different opinions, such as the provocatively sceptical suggestions presented in the
stretching chapter, which are subsequently complemented by different views on the
same topic by other authors. Similarly the myofascial transmission lines of our
colleague, Thomas Myers, are described with their most recent and impressive
advances together with detailed practical applications. However, other models of
myofascial force transmission across the human body are presented as well. Yes,
this book presents many exciting answers and a multitude of reliable and novel
information. However, in addition, it also offers new inspiring questions, careful
hypothetical speculations, as well as clinical observations that we editors consider
well founded and clinically valuable.
A huge thank you has to be expressed to our 26 authors, all of whom have
endeavoured to deliver an optimal contribution from their field for this first book in
a new and promising territory. In addition, the team at Handspring Publishing has
been wonderful in their enthusiastic support of our project. Their extensive
publishing experience and personal familiarity with the field have been beyond
anything that we could have imagined. The pioneering excitement, which was
almost palpable at the first ‘Connective Tissues in Sports Medicine’ congress
(Ulm University, April 2013), and which has been shaping the different networking
projects within this expanding field since then, has provided a strong motivational
backdrop for all involved in this book. We trust that the reader will not only notice

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the exciting collaborative spirit of this new adventure but will also benefit from the
resulting wealth of information and the quality of contributions from our whole
international team.

Robert Schleip and Amanda Baker

Munich and Brighton, November 2014

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 Contributors
Joanne Avison, KMI, CTK, E-RYT500, CMED
Director, Art of Contemporary Yoga, Teacher Training, London, UK
Co-chair Presentation Committee: Biotensegrity Interest Group
Leon Chaitow, ND DO
Director, Ida P. Rolf Research Foundation
Honorary Fellow, University of Westminster,
London, UK
Stefan Dennenmoser, MA in Sports Science
PhD-student at the Fascia Research Project
Institute of Applied Physiology,
Ulm University, Ulm
Germany
Cert. Adv. Rolfer, Gyrotonic/Gyrokinesis-Instructor
Fascial-Fitness-Master Trainer (FFA)
Donna Eddy, BHSc TCM,
Grad Dip Counselling, Dip RM, Cert IV Pilates & Fitness
Physical Therapist & Movement Specialist
Owner & Creator Posture Plus
Co-owner & Creator Everything Movement &
The Swinging Weights Academy
Bondi, Sydney, Australia
Klaus Eder, PT
Lecturer at the Institute of Sport Science,
University of Regensburg,
Instructor for sports physiotherapy at the German Olympic Sport Confederation,
Donaustauf, Germany
Raoul H.H. Engelbert, PhD, PT
Professor of Physiotherapy, University of Amsterdam, Department of
Rehabilitation, AMC Amsterdam
Director, School of Physiotherapy, Amsterdam School of Health Professions,
University of Applied Sciences, The Netherlands
Piroska Frenzel, MD
Master student of the Vienna School for Osteopathy at the Danube University
Krems, Austria
Member of the Fascia Research Project
Division of Neurophysiology,

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Ulm University, Ulm, Germany
Fernando Galán del Río, PhD, PT, DO
Spanish National Football Federation. Physiotherapy Team
Professor at Department of Physical Therapy, Occupational Therapy,
Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
Christopher-Marc Gordon SRP, hcpc, HP
Physiotherapist, Naturopath,
Founder of the Center of Integrative Therapy Stuttgart
Myofascial Pain Researcher
Lecturer Institute for Medical Psychology and Behavioural Neurobiology
University Tübingen, Germany
Robert Heiduk, MSc,
Sports Science Director, German Strength and Conditioning Conference Sports
Coach, Bochum, Germany
Helmut Hoffmann, MSS, MBA
Owner Eden Sport Private Institute for Performance Diagnostics
Sportscientific Director Eden Reha Private Clinic for Sport Rehabilitation
Donaustauf, Germany
Birgit Juul-Kristensen, PhD, PT
Associate professor,
Research Unit of Musculoskeletal Function, and Head of Centre for Research in
Adapted Physical Activity and Participation, Institute of Sports Science and
Clinical Biomechanics
University of Southern Denmark, Odense, Denmark
Professor, Bergen University College,
Institute of Occupational Therapy, Physiotherapy and Radiography,
Department of Health Sciences, Bergen, Norway
Wilbour E. Kelsick, BSC(kin), PhD, DC, FRCCSS(C), FCCRS(C)
Sports Chiropractic Lead
Athletics Olympic Team Canada
Clinical Director
MaxFit Movement Institute
Vancouver, Canada
Michael Kjaer, MD DMSci
Professor, Chief physician
Institute of Sports Medicine, Bispebjerg Hospital and Centre for Healthy Aging
Faculty of Health and Medical Sciences
University of Copenhagen, Copenhagen, Denmark

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Werner Klingler, MD, PhD
Director, Neurophysiological Laboratory,
Neuroanaesthesiology, Ulm University
Fascia Research Group, Division of Neurophysiology,
Ulm University, Ulm, Germany
Department of Neuroanaesthesiology, Ulm University, Guenzburg, Germany
Elizabeth Larkam
Pilates Method Alliance-Gold CPT
Balanced Body Faculty/Mentor
PMA Heroes in Motion® Pioneer
Distinguished Instructor, Pilates Anytime
GYROTONIC®/GYROKINESIS® Teacher
GCFP®
San Francisco, California, USA
Eyal Lederman, DO, PhD
Director, CPDO Ltd, Self Care Education Ltd.
Senior Honorary Lecturer and Research Supervisor
Institute of Orthopaedics & Musculoskeletal Health, University College London
(UCL), UK
Divo G. Müller
FF Mastertrainer
CEO Fascial Fitness Association
Director Somatic Academy
Munich, Germany
Stephen Mutch, MSc (Sports Physiotherapy) BSc (Physiotherapy) MCSP
Clinical Director Spaceclinics.com,
Physiotherapist, Scotland Rugby Team
Vice President Association of Chartered Physiotherapists in Sports & Exercise
Medicine, Edinburgh, UK
Thomas W. Myers, LMT, NCTMB
Director: Kinesis LLC,
Walpole, Maine, USA
Sol Petersen, B Phys Ed
Rehabilitation Specialist and Psychotherapist,
Tai Ji & Qi Gong Instructor
Founder, Mana Retreat Centre, Coromandel, New Zealand
Lars Remvig, MD, DMSc
Senior Consultant,

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Department of Infectious Medicine and Rheumatology
Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark
Philipp Richter, DO
Osteopath, Belgium; Head of the IFAO (Institut für angewandte Osteopathie),
Germany
Raúl Martínez Rodríguez, PT, DO
Spanish National Football Federation, Physiotherapy Team
Director of Tensegrity Clinic Physiotherapy & Osteopathy
Health Area, European University of Madrid,
Madrid, Spain
Liane Simmel PhD, MD, DO
Director, Institute for Dance Medicine ‘Fit for Dance’, Munich
Medical Consultant, University for Theatre and Performing Arts, Dance
Department, Munich
Lecturer for Dance Medicine, Palucca University for Dance, Dresden
Senior Consultant, Dance Medicine Germany eV, Munich, Germany
Adjo Zorn, PhD
Fascia Research Project
Institute of Applied Physiology
Ulm University, Ulm;
European Rolfing Association
Munich, Germany

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SECTION 1

THEORY

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CHAPTER 1

Fascia as a body-wide tensional network:

Anatomy, biomechanics and physiology
Werner Klinger and Robert Schleip

Fascia the forgotten organ

After several decades of a Cinderella-like neglect, fascia has suddenly entered the
limelight within the field of human life sciences. While literally thrown away in
most anatomical dissections, this colourless fibrous tissue had mostly been treated
like a dull and inert packaging organ. There were several reasons for this neglect.
One of which is the lack of clear distinctions based on the ubiquitous and seemingly
disordered nature of this tissue, compared with the shiny muscles and organs
underneath. Another and more important reason for the severe neglect of scientific
attention was the lack of adequate measurement tools. While x-ray imaging allowed
detailed study of bones and electromyography of muscles, for many decades,
changes in fascia were hard to measure. For example, the fascia lata or lumbar
fascia is typically less than 2 mm thick and a local increase in thickness of 20%
was too small to be seen on ultrasound (or other affordable imaging technology in
clinical practice) although it may be easily palpable to the hand of the therapist and
may also be felt by the client during movement.
This unfortunate situation has changed significantly in recent years. Advances in
ultrasound measurement, as well as in histology, have resulted in a dramatic
increase of fascia-related studies (Chaitow et al., 2012). Clinical fields whose
practitioners have an avid interest and participation in this process include manual
therapies, physiotherapy, scar treatment, oncology (based on the matrix-dependent
behaviour of cancer cells), surgery and rehabilitative medicine, amongst others.
Similarly, sports science is embracing these developments. The first congress on
‘Connective tissues in sports medicine’, hosted at Ulm University in 2013, served
as important impetus for the development of this field. Today, fascia has become a
favoured new subject in conferences for sports sciences as well as among
movement teachers.

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