I recently attended some continuing education courses for my professional standing. Generally my continuing education is very hands-on, but this one was different. I sat for two day watching the replay of a fascia congress that occurred earlier in the fall in Boston. The replay allowed about one hundred and thirty massage therapists in BC to see where the cutting edge research of fascia is taking place and I was delighted to see how intrinsic fascia is coming to be considered to healthy function of the body. This article will not be a recap of the recap, as, even I must admit, the replay was not endlessly riveting, nor am I going to tell you the most technically detailed data or the specific clinical information I managed to extract, instead I am going to talk about the basics of fascia.

I may have lost a few of you back the first time I mentioned “fascia”. It is a term that did come up in some of my previous articles and which is dear to my heart and my practice, but, you ask, what is it? Fascia is a connective tissue in the body and it comes in a variety of forms that provide several functions within the body and it is one of the most common tissues found in your body. Made up of collagen and elastin arranged in a honeycomb like matrix fascia acts to separate, to contain and to protect your body and its various parts. The two basic categories of fascia are superficial and deep (or investing).

The largest single piece of fascia in the body is the superficial fascia. This layer runs under your skin from the top of your head to the bottom of your feet. The thickness and toughness varies with its location and from person to person. Deep or investing fascia surrounds our individual muscles, bones, and nerves. This encapsulation also occurs within muscles and nerves with each muscle and nerve fiber having its own fascial sheath. There are also several sheets of thick fascia in various parts of the body. These types of fascia act differently from each other and in this article I am going to focus on the superficial fascia.

Generally speaking superficial fascia is not terrible tough or thick, though as our subcutaneous fat stores are contained within this layer some of us have thicker superficial fascia than others, and that thickness can vary for an individual over time. This layer of fascia is designed to keep out skin separated from the muscle and bone underneath, to allow our skin to slide over these deeper tissues when we move. This type of fascia is actually quite delicate. You can easily tear it by pushing with your fingertip, but it is also very powerful. If you have ever grabbed a hold of a cat’s skin, or a Char-pei’s you know that their skin moves on their underlying tissue – and so does yours. Another place you may have seen fascia is the last time you pulled the skin off a raw chicken breast (apologies to the vegetarians). As you pull back the skin of the chicken you have likely seen the shiny clear material that lifts up with it, that is the superficial fascia.

Most people can pick up their skin in several places on the body; try it on your forearm. How much or how little can you pick up? The quantity is partially reflective of your heredity. Everyone has unique levels of collagen vs. elastin in their connective tissue, and this affects how pliable your skin, ligaments, tendons, and fascia are. More elastin means stretchier tissues. The other factor that could be impacting your ability to lift the skin up is whether or not your fascia has extended little collagen bonds into your tissue. Why would it do that? Immobility and any inflammation encourage the fascia to send little fibrous strands into the surrounding tissue. So if you have injured you arm or tend to overuse your arms (i.e. spend a lot of time typing or mousing on the computer, massaging people or playing racquet sports) you are more prone to the development of adhesions. These adhesions may be limiting, completely or partially, your ability to lift your fascia or they may be making it uncomfortable (a stretching or burning is the common description for the sensations that occur with picking up shortened fascia).

Other than an interesting party trick or a way for a mother cat to pick up her kittens without injuring them what does this superficial fascia do? Well, as I said it keeps the skin separate from the underlying tissue. This is important in allowing the body to move freely and with ease. In everyday movement your various muscles contract and relax in a myriad of directions and when the skin becomes stuck to that underlying tissue it creates lines of stress in the skin and can lead to discomfort with movement as the skin is stretched, or overstretched in too many directions at once. Once it becomes stuck the fascia tends to constrict at the point of restriction and that can limit movement and exacerbate the discomfort with movement that I already mentioned. The other problem that can develop is that there are many blood vessels and nerves that travel just under the skin and when the superficial fascia becomes restricted these structures are compressed and their function can consequently be impaired.

Over long periods fascial restriction can become distortion and the pull on the fascia can lead to postural distortions. Conversely, postural distortion can be a causal factor in creating fascial restriction. Fascia provides a certain amount of stabilization within the body and by constricting or allowing stretching of itself superficial fascia is often called into action to stabilize the inherent instability we create within our bodies with postural distortion.

There are the basics of the superficial fascia. In my next article I will look at the investing, or deep, fascia. In that article we will look at the importance of fascia in allowing our muscles to work efficiently and freely.

As we enter the early fall it begins, the repeated ads and signage posted at pharmacies about flu shots and flu shot clinics. Many of you have probably heard the controversy too. The controversy about vaccines generally and the flu shot specifically.

I could run through all the lists of who should and who should not get the flu shot, of why to or why not. I could tell you how they design flu shots and dispel myths about certain risks, but that would be reiterating. All that information is nicely and clearly laid out on Health Canada’s website just follow this link: It's Your Health - Influenza (the "flu"). Or I could tell you about those who argue against the flu shot, but again, they have very good material already out there, just follow this link: Vaccination Risk Awareness Network. Following the above links will give you two contrasting view about the flu shot, both quite rational and well presented. I am not going to restate all of those facts here.

What am I going to offer you? I am going to look at some of the options you could pursue if you don’t want to get the flu shot. I want to be clear - I do not feel that the flu shot in intrinsically evil or bad. I simply believe that there are risks associated and that there are other options to improve your resistance to the flu.

But what are your options? You do not want the flu, so what can you do? In fact, there are lots of thing you can do to minimize your likelihood of getting the flu this winter. The easiest is to keep clean. Wash your hands often and thoroughly. Be sure to get between your fingers, under your nails and along the edges of your hands. This simple habit has been repeatedly shown to reduce the incidence of flu. Hand washing is one of the most important things we can stress with our children to reduce the spread of influenza. Children tend to touch everything, including their eyes, noses and faces, which make them excellent vectors, transmitters, of pathogens. If you have small beings in your life I highly recommend increased hand washing for you and them.

The other obvious thing you can do for yourself is a bit more complicated – stay healthy. Eating well, drinking lots of water, exercising and getting enough quality rest are things we all mean to do all the time, but during the flu season these steps can hugely reduce risk of flu by ensuring you have a healthy immune system (the exercise, the food and the sleep) and nice moist mucus membranes (the water).

Why would you want moist mucus membranes you ask? Mucus membranes (i.e. the lining of you nose) are one of the first lines of defense your immune system has. When your mucus membrane is moist they act as physical barriers to pathogens, and all those nose hairs help too. The hair acts as a physical filter that traps viruses and bacteria. The moist membranes act kind of like those brown sticky fly strips. The pathogen gets past the hair and then gets trapped where the cellular immune function can go to work on destroying them. This is one of the reasons air travel can often lead to illness. Not only is the air re-circulated, it is also dry and dries out the mucus membranes. Keeping well hydrated can help maintain moisture in your mucus membranes. Some doctors also suggest a saline or baking soda solution be used to flush the sinuses to help maintain moisture levels, especially during plane travel. The nasal decongestant sprays do not serve this function as they are actually designed to dry the membranes out to reduce the stuffiness that occurs when your body is fighting a pathogen.

As to improving your diet, exercise and sleep I am not going to tell you it is easy. If it were easy none of us would be overweight, out-of-shape or tired all the time. I am just trying to reinforce the importance of trying to incorporate these factors into you flu-season routine. And incorporation is the key. For lots of people they just can not imagine taking an hour three days a week to exercise, or giving up dining out/taking in. So don’t do either. Just walk somewhere you might rather drive or that moldy oldie – take the stairs not the elevator. As for food, if you are eating in a restaurant try to choose the salad with your burger, and maybe make it a chicken burger. These are not novel suggestions, but they are sound. Give yourself credit to, don’t decry if you ate out four of seven nights, as usual, be happy if you chose the salad three times, the chicken twice and a wrap some other time. It all counts and it all helps!

Assuming you are doing your best with these, what can you do to add a bit of insurance? There are a variety of other options, most of them take you into the realm of complementary medicine and like the lifestyle advice above involve ways to keep yourself healthy, improve your immune system, and maybe make incorporating some of the lifestyle steps a bit easier.

Vitamin supplements, especially A, B-complex, C and E are useful for improving your immune system. There is a homeopathic remedy, oscillococcinum, which can be taken preventatively. A visit to a naturopathic doctor can often provide you with the best options with regard to these options as they are well versed in vitamin supplementation and homeopathy. Some naturopaths are also certified to practice acupuncture, which flows into the next set of options.

This is my option of choice. I first tried it because I knew from a friend who was a registered practitioner of Traditional Chinese Medicine that acupuncture and herbal remedies could help the immune system. I have stuck with it because it has worked. In the early fall I get an acupuncture treatment that is designed to support and increase my immune function. My TCM Practitioner usually gives me herbs to drink as a tea to reinforce the acupuncture. I am very closely exposed to a large number of people through my work so I know that this option is good protection.

You could also add Massage Therapy and or reflexology to your life. Both of these disciplines have been shown to help immune system function. These options also offer opportunities to just stop, and get some rest. My reflexologist regularly puts me to sleep and from both on and off the table I know that massage can put recipients to sleep, or ensure a better sleep that night.

So give some thought to your alternatives and do some research. You may decide that the shot is for you, or you might not. I just encourage you to make an informed choice and understand that there are other active measures you can take to decrease you risk of the flu.

If you are lucky it is virtually invisible, if not it can be pretty darn ugly, and that is just on the surface. When you start delving down you find more of it, and at this point invisibility isn’t such a blessing, and the impact of it can be more profound than you would think. What is this? It’s scar tissue. That’s right, the thick, not too sensitive, sometimes pink or red result of all injury to our bodies. This stuff is pervasive and occurs throughout our bodies, often in places we would not imagine.

So the first thing to do is define what scar tissue is, and, perhaps more importantly, why it is. Scar tissue is the fibrous, collagen rich, elastin poor granulose tissue that your body uses to repair soft tissue (muscle, tendon, ligament, and fascia) injury within your body. Almost anytime inflammation occurs in the body so does scar tissue. With more profound injury and in cases where there is tissue loss the scar tissue can be quite extensive, which of course makes its impact that much more significant. The why of scar tissue is that your body is trying to piece back together tissue that has been ruptured or to reinforce tissue that it believes is not strong enough. Basically this is the duct tape of your body, and just like duct tape it is darn handy and is an essential part of your bodies self-repairing system.

Now that is all very positive, so why was I maligning it in my last article, and why have I been dropping portentous hints in this one? Well, have you ever used too much duct tape? It makes a bit of a mess, can prevent something that should move from doing so and, if it is laid down incorrectly it can stick other things to it and that leads to even more problems. This is exactly the problem with scar tissue. Too often it is laid down randomly in the body and you end up with a scar that is larger than it needs to be, that is sticky, disorganized and dysfunctional. The other complication with both duct tape and scar tissue is if you lay down this stiff, not very stretchy material in the middle of some mobile, active material it becomes a stress point, a place where you actually have more chance of the original fabric becoming damaged. And if it happens to sticks together two stretchy things that want to stretch in different direction you are guaranteed to lose some of the original movement and to do constant, minor damage. To have little, tiny tears in the fabric happen every time you move. Now in a t-shirt that will ultimately mean the duct tape pulls off, or you get a hole or a tear in the nearby fabric, not great for the t-shirt. Now imagine that process within your body. Two muscles stuck together by scarring, every time you move small tears in the muscle fibre, a bit of inflammation, a bit more scar tissue, a bit less freedom of movement, a bit more tearing….eventually you get a rupture, here the duct tape analogy falters, for the scar tissue will not be what ruptures, it is too strong and too well enmeshed in your muscle, you will always end up with another muscular rupture adjacent to the scarring. The process then begins again. This is one of the reasons someone will have a recurrent injury. Sprained and strained ankles being an ideal example, with ankle injury you often see a mild to moderate strain or sprain followed by a series or minor irritation that the person bandages and works/plays through, and then another serious incident, and this time, even if the incident is only of the same intensity the injury will be greater, because the area is compromised. That is the great downside of scar tissue, it compromises our tissue.

Now, on the bright side this is a process that can be modified. Through proper rehabilitation treatment and exercises scar tissue development can be made more functional and less compromising. Both machine based (i.e. ultrasound) and manually applied (i.e. frictioning) techniques can help ensure that your scar tissue is laid down in a tidy manner that improves its functionality and surrounding tissue can be prevented from sticking or be released if it becomes adhered. These applications minimize the subsequent issues that I discussed in the previous paragraphs and can greatly reduce the chance of re-injury.

Cosmetically this also reduces the visibility of the scar. There are two aspects to this. One, the scar is smaller and there is less likelihood of the scar becoming keloid (a keloid scar is one that overgrows the perimeter of the original injury, is raised and discoloured). Two, the adhering of adjacent tissue that often occurs with untreated scars, especially ones of significant size or severity, creates lines of pull in the skin. If you have every seen puckering, or indentations around or over a scar that is the result I am describing. These lines can become very entrenched and distort your skin. The other, less cosmetic issue can be discomfort. It is this second development is the one that can lead to that pulling, overstretched feeling that you may have experienced if you have scars of any significance.

My next posting will touch on a seasonally relevant issue, the flu shot. Good, bad, ugly? What is your best course of action?

Healing, whose job is it anyway?

In my last posting I finished with the idea that no medical profession can heal the body, only provide and promote an environment within the body for it to heal itself. That may seem like a rash statement, but let’s take an example and see if you agree.

Option #1: You break a bone and choose to go untreated. The bone would grow back together – your body would heal itself. Sounds good, and once upon a time that is exactly what would have occurred, the body would have been left to do its best with no real intervention. In some cases the body would have completely failed and the person would have died (either from blood infection or from a bit of fat from the bone marrow getting into the blood stream and causing a stroke or heart attack (medical-ese = fat embolism). Alternately the person survives the injury but with ongoing pain and permanently reduced function. The most common causes of chronic pain and dysfunction in for the survivor would be non-alignment of the bone, which would mean the bone would no longer be doing its job properly; and/or trauma to the surrounding soft tissue (fascia, muscle, tendon, or ligament), which may not heal well or functionally. In almost all cases there will be some remaining dysfunction with this option, which is why it is great that we now have Option #2.

Option #2: You break a bone and go to an emergency room where they x-ray you to determine if the bone is broken. If necessary the beak is aligned, and often a cast is put on to prevent shifting. With extreme fractures there may be surgical repair using plates, screws, or rods to provide internal fixation to severe fractures. You are also given pain-killers and anti-inflammatory medications to ease any suffering from the trauma and the healing process (NB: inflammation is a part of the healing process). We might be encouraged to eat calcium and protein rich foods to provide out bodies with the building blocks of the tissue that needs repair and replacement. In six weeks or so you have the cast removed and you generally have a nice straight bone. Then you embark on a course of rehabilitation treatment. This can encompass a wide variety of treatments - physiotherapy and/or massage therapy being most likely - with therapeutic exercises prescribed by any or all of the medical professionals you are dealing with. At the end of your treatment you should have full movement, no residual pain and your strength should be at pre-accident levels or closely approaching them.

So Option #2 is optimal. So some will ask, “What do you mean the body heals itself? Obviously medical professionals play a large role, how is that not healing?” But I contend that the body is doing the healing, medical professionals are assisting the body to do its best, most functional, least painful job of healing, and trying to prevent negative side effects.

Having pointed out the importance of your body in healing I will turn to why intervention is a good thing. In the above scenario you often have individuals who want to shortcut the process. They take their cast off early; they try to use the injured part too soon, or too vigorously. They do not undertake rehabilitation; of fail to participate in there rehabilitation by doing the stretching and strengthening that is recommended. In this shortcut version of option #2 the complications of the injury may be minor and the person may manage fairly well. They may just accept that they are slightly impaired, their reasoning being “Well, I broke my ____, shouldn’t I be impaired/in pain”. The answer to that is a resounding NO! In most cases quality follow up care and rehabilitation can have a person suffer no negative after effects. Rehabilitative care will ensure the restoration of balanced muscle function and maximize the functionality of any scar tissue that is the main soft tissue complication arising from a fracture (ah, scar tissue, the unsung villain, and hero, of the body….but that is for another time). Being active in your rehabilitation is essential. During the early stages of healing getting lots of rest and not over-exerting are the main requirements and they take little effort on your part. In the rehabilitation stages the demands begin to increase. In some cases this is great as the injured person is eager to begin activity – though in those cases the trick is to avoid over-doing. In most cases though, because the pain is gone, and the cast is gone, the person allows themselves to not do anything more, to believe that all is well as it stands and to not do more. This is a sad thing as no matter how much any professional works on a person it is the active participation of that person that allows the full progression to wellness to occur.

As I referenced earlier, scar tissue will be my next topic. How you may ask is this an important topic, well, watch for my next posting and I will tell you about the vital role scar tissue can play in wellness, and un-wellness.

Medicalese - Translating Medical Language

There is a grade one strain in the biceps femoris at its origin. That’s clear, concise medical-ese for “you have a very minor boo-boo where your bum meets your thigh.” It might not be a good idea to go run a marathon for a couple of days but otherwise you’re fine. Was anyone worried there for a moment? The first sentence of this paragraph is at the heart of an issue most people face every time they visit any sort of medical professional. What the heck are they saying?

I run into this problem both at work and at home. My brain goes to that medical place and suddenly the roll shutters come down over my audience’s eyes and I am talking to no one. I have a husband who gets the willies when we watch “Grey’s Anatomy” or “House” because of the surgery scenes and all those body parts. Imagine how much he loves when I start talking about the three different ways your large intestines move food through themselves – while being possessed by a Latin dictionary.

In our defense medical professionals are put through several years of not just being encouraged, but required, to speak this way. During this time we are surrounded by lots of other people who also speak our language and are on the same amazing voyage of discovery that we are taking. It is like French immersion for anatomy geeks! After several years of this deep immersion we are turned loose into the world to learn to talk in real English again.

Sometimes the transition isn’t pretty, and sometimes we forget that there is a transition to be made. Some of us do not even try. Imagine us as foreign travelers trying to remember the bit of the local language that we learned back in high school. I try to include both technical terms and lay terms in my explanations, I will even drag out my book of drawings so I can point and show my clients what I am talking about. My clients seem to be happy with this style of communication and hopefully it is a style you encounter often. If it is not the style you encounter, try not to be afraid and ask questions, and keep asking them until you actually get an answer you understand.

In my opinion clear communication would help improve relations between medical professionals and the public that relies on them. In a perfect world all practitioners would a least try to make this shift and in doing so alleviate a great deal of frustration in patients and their families that is in no way helpful in promoting well-being.

As this is not a perfect world even persistence will not always get you the answers you need. If this is a situation you are experiencing or you at some point encounter, I suggest taking a notepad when you go to your next appointment and take notes. You might even get a friend or family member to accompany you and take notes for you. This companion serves two purposes, allowing you to listen to the practitioner and perhaps coming up with questions you do not think to ask. You may also want to take a list of questions or concerns with you so you do not forget them during the rush of the appointment. Make sure to ask for spellings from your professional, otherwise you may just be inviting more frustration. After all that stuff in you lungs that makes you cough is phlegm, not flem. You can then review the notes and, if you need to, go to a site that list medical terms with their translations, like this glossary of medical terms.

This is not a solution to the problem of poor communication that exists within the medical world. The frustration of patients who have obscure words thrown at them in stressful situations by individuals who are supposed to be assisting them is a frustrating one. What I offer is a coping mechanism, a way to educate yourself so that you are not left in the dark about your own condition. You may think this is unfair and the professionals should learn better communications skills. You are right and wrong in that. We professionals should have better communication skills. However, it is fair to expect you to take responsibility for your own body. Ultimately you are responsible to make the choices that determine your course of care. Expecting you to make an effort to understand what we are trying to communicate (even if we are doing it badly) is not unreasonable.

Patient responsibility feeds into another topic. I have many people coming into my office desperate for me to “fix” them. I am always very flattered that they have such faith in me, but I also dread those words because I know that I can only help them to heal themselves. This is the topic I am looking at next: the action of the body in healing itself, and how the medical profession can facilitate and improve that process.

Introduction

Have you ever been told at the chiropractor that “your L5 is subluxed” and been terrified? Or been sent for some sort of treatment that had you scared witless? You leave the office of your professional “caregiver” feeling fearful and worried? Often, we discover that the whole thing was very minor and nothing to be concerned about. Do you then feel relieved? Or do you feel angry that no one bothered to take the five minutes to explain what was happening to YOUR body? On occasion the worry is legitimate, something significant has gone awry in our bodies and we need to worry about what might be coming. Even when this is the case though wouldn’t it be nice to receive an explanation you understand?

We walk around in our bodies all day and sleep in them all night and yet most of us have little or no idea how hard our bodies are working for us or what all the little messages they send to our conscious mind mean. I am constantly amazed by this, and even more startled that so many people are so happy with not knowing. If you are one of those people, you should probably stop reading now as my purpose here is to educate and inform. I am a firm believer that if we know more about our own bodies we will take better care of them and be able to make better decisions about what we need to worry about.

I am not going to advocate running marathons or mega-dosing on vitamins for everyone. For some that may be the right course at some point or always, but I do not do either of those things so why would I tell someone else to? I believe in making educated decisions to balance improved function with enjoyment. My goal is to create a life that meets my body’s needs and maintains its well being without needing to sacrifice all the pleasures of that life. A practice that I find as dysfunctional and endless indulgence without thought to the consequences, even in the face of bodily rebellion.

Too often the lack of information people receive from medical professionals and the lack of general education about human function leave patients frustrated and confused. Too often they quest around among their friends and acquaintances for someone who has been where they are in hopes of learning about what is happening to them. I am the first to say that the support of friends is a wonderful thing, but rarely do two people have identical experiences of any event, let alone one involving their unique body. The result is the passing on of information that may not be correct, especially with the rapidly evolving state of our medical science. It also means information that has been heavily filtered by the lenses of memory and misapprehension gets passed onward. After all, there may not have been give any real explanations given to the first person and be interpreting their experience based on incomplete or erroneous assumptions.

That leads us neatly into what I intend to make this series about. I want to provide some illumination of the shadowy world of our bodies and the medical professions that are designed to care for them. I want to do this in a way that eases anxiety and allows individuals to go, or not go, to their medical professionals with intelligent questions and enough knowledge to understand the answers those questions bring. I will al so try to provide some resources for people to learn more on their own and to find answers to questions they may not want to ask out loud.

Let me introduce myself so you can decide whether you think it is worthwhile to keep reading. I am a Registered Massage Therapist in the province of British Columbia. I have had training that is similar in duration and scope to the training for a physiotherapist, a chiropractor or a nurse - or a third year medical student. British Columbia has one of the highest standards of training for massage therapist in the world. My massage training created in me an acute appreciation and curiosity about the human body. My practice as a RMT has led to the revelation that though science is constantly revising and expanding their knowledge of the human body and its capabilities, the general public knows very little about the bodies that support and propel them through the universe. I suppose I shouldn’t be surprised. Not so long ago, I was one of those people who didn’t know my patella from my kneecap (by the way…they are the same thing!!).


I hope that I have engaged your interest and you will be looking for the next installment of the series. I will be looking at the issue of patellas vs. kneecaps – or medical language and the layperson.