I am trying to keep my promises and write compactly – so far so good (keep the fingers crossed).
Well, for the second day in a row I worn the latex gloves and had a lab gown – although today it was white – not green.
This afternoon was about the rat dissection with fascia manifestation study in mind. At first I’ve got a lady’s size lab gown– so I guess I looked rather comical – the sleeves barely covered my elbows and I could hardly close it (No pics though …) Fortunately, they found an extra one of a decent size and on we went.
The scalpel, pincers and scissors – these were the tools. Frankly – it felt extremely awkward. However, I’ve been fortunate enough to share the table with one of the world’s most renowned dissectors and fascia classification experts – Prof. Carla Stecco from Italy– so thanks to her my initiation into the scalpel usage went smoothly J.
Stretch, cut – and here we go into the observation of the
amazing properties of the superficial fascia; loose/areolar dividing layer of
connective tissue; deep fascia and so on…
Although, I must say that by the time the dissecting process went deeper into the firmly packed layers of the muscles wrapped in epimisium; aponeurosis etc. – I’ve passed the scalpel to the expert…
The first, off-topic note: What is really appealing about the Fascia community is the spirit of fraternity and absence of power struggles. For example, this lady, Prof. Stecco with whom I shared the table today (she is about my age and very approachable and humble, so I guess calling her a ‘lady’ sends somewhat a wrong message) – she was a presenter yesterday but for the rest of the course she just joins the other participants.
This would be completely unthinkable at a cerebral palsy conference where the divide of the rank and file is very rigid. CP conferences are either about preaching by the ‘authority figures’ who expect adoration from the crowd; or about pushing and pitching from the sales people in Botox, Baclofen etc. One can feel the ‘office power struggle’ atmosphere – people are usually formal and closed out to the new things; and most of them first size you up as a possible competitor and not as a potential collaborator.
At the Fascia community, lately internally called ‘fascionados’, – the spirit is very different. There is a sense of shared goal, fascination with the new open horizons and the overall atmosphere of friendliness and collaboration.
But let’s get back to the rat dissection.
At one point we were 6 people circled around a single rat and looking at the dissection at the lower thoracic/upper lumbar area – and I was probing everyone for terminology and definition of how they would describe what they saw.
Amazingly, out of the group of people with extensive professional background, looking at the same area at the same time and able to communicate face-to-face – there were at least 3 different descriptions each emphasizing a different aspect:
· A distinguished sports medicine expert from Canada emphasized that he saw the area as the ‘extended/ joint tendon’ that went to transverse processes of the vertebrae;
· Prof. Stecco – called for separate labeling of ‘true fascia’ vs. the ‘layers of aponeurosis’ based on the properties of fibers and their layout
· The Ulm laboratory specialist, who conducted the class, put the umbrella term ‘thoracolumbar’ fascia emphasizing the functional integrity of several substrates in it in respect to the load bearing.
Then the conversation went further – how many “true” layers do we see – one or two or three or more – and shall one consider the layer as ‘single fiber sheet’ deep or shall one allow for several adjacent sheets to be seen as one layer…
Now imagine that this conversation would have taken place not over the same subject, at the same time and at the same place and not in a relaxed atmpsphere of collaborative spirit – but was conducted via the papers/ e-mails, each of the participants looking at their own ‘sample subject’ and spiced even with a minimal underlying current of power struggle – how would that turn out?!
Fortunately, we do not need to take place in these discussions – it’s enough for us to make 3 essential conclusions:
1. The old ‘classic’, ‘anatomical textbook’, topographic anatomy based myotendonal model of a ‘clean’, ‘selective’ muscle doing ‘clearly identifiable’ “function” – is obsolete. Period.
It’s on its way out, since the old ‘classic’ model is a complete outdated BS that has next to nothing to do with reality even in able-bodied people, not to mention the paradoxically intertwined musculoskeletal structure of a person with Cerebral Palsy.
Unfortunately, that outdated model is deeply ingrained in the ways the current health care system tries to “help” children with CP – stretching, Botox, surgery, casting – everything… Even more unfortunate reality is that with the enormous inertia in the system it will take at least another 10-15 years before your ‘local’ CP specialist will at least realize that – let alone learn more advanced methods.
What does it mean for you? There are more tough choices and decisions to be made on your own – without an authority to back you up.
2. Anyone who advises you of any physical program – has to be able to articulate specifically what is their stance and what are the exact biomechanical choices that your child will be exposed to – based on the extended myofascial understanding that I gave you the peek at (not on the simplistic ‘textbook’ image of ‘muscles’ and ‘tendons’) .
If you do not see that – please keep in mind a well known-chain of process development:
a) Awareness –realizing what is the spectrum of challenges, dilemmas, etc.
b) Understanding – making a specific choice out of a number available
c) Designing the method that has ‘proactive’ features – pursuant to that specific choice; and has ‘defensive’ features – making it ‘fool-proof’ and safe in respect to other contributing factors from a)
d) Evaluating how well did the designed method worked both proactively and defensively
Unfortunately most of the methods of functional training or ‘structural’ attempts currently employed for kids with cerebral palsy – don’t hold any water.
They are more like rituals that are made without much of the effort to analyze the pathways of mechanical impact onto a child’s body.
3. Fortunately with ABR – there is no need to worry about these concerns.
I am obviously aware of them – that’s why the 90’s were so tough for me – the need to make those choices and to compromise and balance ‘proactive’ with ‘defensive’ in the pre-ABR longitudinal techniques when teaching parents – was a sheer nightmare.
Endless sequence of dilemmas: Have I chosen the best compromise? What if I made it too ‘proactive’ and the family will do it wrong and cause more damage by strengthening the wrong force lines? What if I made it too defensive and the family is not going to see enough results? ….
Frankly, I always envied the practitioners who practiced ritualized templates – I found really amazing their ability to disregard all these mind-twisting and gut-wrenching questions by simply avoiding them and happily using the universal ‘crutch’ – “Let’s teach the child the movements he doesn’t know by imitating them and thus sending messages to the brain”.
Our solution is simpler – we do not deal with all these mixed components of myofascial layers and connective tissue in a longitudinal manner.
We treat it as a ‘cushion layer’ – working across it and addressing the underlying deeper surface.
That what makes me sleep relatively peacefully: “No longitudinal impact – no risk of accidentally or mistakenly ‘bumping’ into a wrong force line or a wrong kinematic chain”….
Actually I had 5 more important points that I have picked up for the reinforcement of ABR way of doing things – and that was today alone! All of them are of direct daily importance for you – but my ‘short blog post’ format is very much ruined – so I’ll do it tomorrow or the day after….
Thanks for reading
P.S. I’d appreciate some feedback whether you find these field reports interesting or are you better off waiting for some larger chunks without wasting your time on these smaller bits….