Book Review: Guimberteau - Architecture of Human Living Fascia

Book Review: Architecture of Human Living Fascia

I have recently devoured the new book from Handspring Publishing by Jean-Claude Guimberteau and Colin Armstrong on the Architecture of Human Living Fascia.

Jean-Claude Guimberteau has become famous in the bodywork world because of a number of DVDs starting with Strolling Under the Skin that he released in 2005. These were incredible because he was using an endoscope to film the structures of a living human body whilst the patient was undergoing surgery. These films showed the wonderful and beautiful moving fibrillar network of collagen, elastin and extracellular matrix that is present in all of us.  I, for one, now can not hear the Blue Danube Waltz without thinking of fascia.

This book shares more information about the network of fibres that extends throughout the living human body from the epidermis down into the cells from which we are formed. This book looks at the level of the mesoscopic, which is the scale between the macroscopic (whole body) and the cellular microscopic. This mesoscopic is a level of the body's structure that some people feel has arguably been overlooked in anatomical study.  It is here, with the use of an endoscope during routine surgery, that Guimberteau and Armstrong find and examine the fibrillar network of collagen fibres, the micro-vacuoles that contain the extracellular matrix. Here the authors show how this network surround, permeates and shapes the different structures of the body from the tendons to the bones to the muscles to the organs.  This book is not just very clear about what is being discussed but it shows you  with incredible pictures and videos (more about that later) so you can see what is being discussed with your own eyes.

The authors structure the book in such a way that there is a logical progression from what this structure is, how it develops and adapts to our daily lives, how important this is for our efficient usage, what happens when there is injury and how manual therapy can have an impact. There are wonderfully insightful comments from a number of leading authors, scientist and therapists in response to the information shared in this book.  There is a great section about how the body responds to incisions of surgery, and also the exposure of the moist interior of the body to air. There is a great detailed description of scarring and the creation of interruptions the fibrillar network that reduce its ability to function smoothly.

What really sets this book apart from many of the others looking at the fascia are the sumptuous images and photographs in this book. They are clear and well described so you know what you are looking at (and where in the body) and through a wonderful use of QR codes (those square bar codes you can scan with a smartphone) you can get to watch new videos showing what is being discussed in the book. There is a DVD enclosed as well for when you can't get internet access, or do not have a smart phone.  These videos are locked with a code that you get with your copy of the book, and are well worth getting access to.

Overall I would say that if you like fascia then this book is well worth having. The videos and images really bring the body and fibrillar network to life and show how wonderfully chaotic and logical the whole thing is.  There is so much information packed into this book that I feel it deserves multiple readings (and viewings) to really get to grips with what has been so wonderfully shared.

Book available directly from Handspring Publishing here.

About me:
I am a Bodyworker based in the UK specialising in Myofascial Release and based in London (Clerkenwell and Stanmore). I have successfully completed the UK's first Advanced Clinical Diploma in Myofascial Therapy run by Myofascial Release UK. I have become completely fascinated by the fascia and attended the inaugural British Fascia Symposium. There is more information about me, where I work and the approaches I use on my website RelaxReleaseRenew.co.uk

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Let it Go! Let it Go! (Nothing to do with Frozen)

"Let it go, let it go
Can't hold it back anymore
Let it go, let it go"

Lyrics from Disney's Frozen*

Unwinding is one of the three core techniques to the John F Barnes style of Myofascial Release along with Cross Hands Releases and Rebounding.  It seems to be the body releasing stored traumatic events and can appear incredibly freaky to the unaware.  It can seem to be like someone is possessed (like in the Exorcist) with heads spinning (apparently) uncontrollably, arms flailing and legs windmilling all over the place.

I first experienced someone unwind on me on my first morning of my first Myofascial Release Course in 2012.  Gently pulling someone's leg and the next thing I know I'm barely holding on and then they're going up into a shoulder stand (on a narrow massage couch in the middle of the room).  The capable teach brought that episode under control and I suddenly realised that all the other students were staring at me and the person on the couch as if we were completely mad.  It felt perfectly natural as I was working on, with just me trying to work out where I needed to be and what the patient needed to allow this to go on.  Some of my fellow students looked like they had just witnessed something from another planet and seemed to be quite horrified and scared of the process, whilst others were just jealous.

As a closed mouth, emotionally repressed Englishman, I always thought it would be a struggle to be able to actually unwind, and that it was very unlikely to happen to me and certainly not in some acrobatic scene-stealing way that would make me the centre of attention.  The first crack appeared on the Breast Health workshop, when my shoulder and arm started windmilling around.  It was a most incredible sensation I was in control, but not in control of my body, I knew it wasn't the therapist working on me doing the movements, she was merely assisting.  I felt great afterwards and quite happy that that is what was going to happen for me with unwinding: small, gentle movements, nothing dramatic. I was wrong.

At the most recent MFRUK course I suddenly found my body unwinding.  I had said at lunchtime (in response to someone who said that unwinding freaked the out) that "I don't unwind and most unlikely at this course"; my body disagreed.  This was just the right place and time for an unwind.

So what happened during my unwind?  Well it started off normally, but then I just had to roll over onto my front (with a bit of an uppity moment when my arms were in the way) then the exorcist moment happened: my legs moved upwards towards vertical like a contortionist from Cirque De Soleil (being face down and in the zone I don't know exactly how far they actually went), this happened a couple of times and then my pelvis was held in position by the therapist working on me and my legs went beserk and into a full lotus position, and then the unwind completed.

How did it happen? I am not certain and it does not happen with everyone and in every session.  It occurs when the client's body is in the right place and time, and the mind is in a focussed and calm zone.  It then happens, and like the song there is no other option other than to let it go, you really can't hold it back any more.  Not being able to hold it back? That's not exactly true as you can engage the mind to stop and come out of the unwind if it felt more than the client and/or the therapist can handle or if the situation is wrong (which is what happened on my first experience.)



I will say that it definitely felt like someone had hold of my legs, and they were in control of what they were doing, but I knew it was me.  I could also see memories from an incident when I was at university that was being relived.  I used to be flexible enough that one of my party pieces was going into full lotus position, walking on my knees in it or haning from a chin up bar.  The incident that I was reliving was one time when I was hanging upside-down from the chin up bar in lotus position and my grip went.  Panic set in as I was unable to release my legs, I think I ended up hanging by one arm as I managed to get out of it but that is what I released.

Afterwards I felt hot, exhausted and absolutely fantastic. It truly felt like a burden had been lifted, and I had been doing the lifting, but there was a complete freedom from something that I couldn't have named before.. There was, and still is, an amazing looseness to my hips that has been missing for years.  Full Lotus still escapes me, but I feel like I am much closer and less fearful working towards it in a sensible way (rather than in bad way I did with the exuberabnce of youth)

So now I'm really looking foward to the two day Unwinding Course I'm doing with Myofascial Release UK in November 2014.

*Sorry to all of those sufferers who are now singing the song in their heads. But this line really does feel right for this posting. At least I've not asked you to build a snowman...

An object lesson in the Myofascial Web

One of the key ideas about the myofascial network is that it is a continuous web that surrounds, envelops and defines the elements (muscles, bones, organs) of the body and that what happens in one part of it has an effect on every other part of the body.  It is something that I discuss with my clients all the time and they are amazed when they feel that this is the case.  Over the last couple of weeks I've been painfully shown how interconnected the body's connective tissue is.

I arrived at my Stanmore clinic one morning limping because of a sharp pain in my left knee, every step was agony.  Adam (one of the chiropractor's) checked it and put some tape on it to provide some stability whilst I got on with my clinic. Later, when I had more time, I got another Chiropractor (Owain at Clerkenwell Chiropractic) to check it fully, with no apparent structural problems, thankfully.  I am now working with Owain to rehab the knee to finally resolve the instability, however I really need to work on myself to clear out the myofascial restrictions that will have formed both this time and in the build up to this crisis.

This particular knee issue has been happening for many, many years.  Over a decade ago my best friend got married, for the stag do we went paint-balling. All was going well until at the start of one game I was sprinting for cover, my left ankle gave way and I fell forwards.  Apparently, though I do not remember, it was a spectacular dive and roll into cover that my friends thought was really impressive; I didn't care as I was screaming in agony.  I had to be helped off game area and that was the end of my day paint-balling.  Unfortunately I was the driver, and it was a manual car.  I had to drive home in rush hour through London in a manual car using my injured foot on the clutch.  That night I put a compression bandage and elevated it, putting cold towels on it and that was really all the rehab I did at the time (this was a long time before I was a body worker).  Oh, and there's going to be an emotional element to it as it caused me a lot of grief at work because I took a week off work as I couldn't drive, but that's a different story.

So the reason I'm writing this is that the cause of a lot of my issues come from an ankle that was badly hurt over 10 years ago that I did nothing about.  This time it was the knee that has been hurting, and this has flared up periodically over the last 10 years.  I've usually popped pills and the pain goes after a couple of days, so that means it had gotten better or that is what I thought was the case.

This time I noticed something: I could feel the whole of the left side of my body tighten up.  Having seen a number of Chiropractors and Osteopaths over the years I am aware that I have a functionally short left leg, which means that my pelvis is twisted that causes low back pain, that then travels up into my neck, head and then my jaw and then to my sinus and the dreaded pain that that causes me.

This time I could feel that there had been a preceding tightness in my lower leg running up from the outer side of my ankle, the knee was then being pulled out of place because of that.  This then causes the hip to tighten, pulling inwards causing tension across the pelvic muscles, causing the Sacro-iliac joint to grumble.  The left side of my ribs then collapse down and a muscle in my back threatens to spasm.  I can then feel that the left shoulder is pulled out of place, which I ignore as it's always a bit sore but that's only because of my job, it then hits the base of the skull and over to my jaw, which causes the sinus to become incredibly painful.

So this time I'm going to do something about it.  I've already had a couple of very productive rehab sessions with Owain (thelondonchiro.com) who I'm lucky enough to work with at Clerkenwell Chiropractic and he has been putting me through my paces (and introducing me to the torture device that is a red bouncy hemisphere [pictured]) and I'm really glad to have been doing it.  Yoga has definitely helped, as it has all the way through, and the wonderful Bridget (bridgeyoga.co.uk) is really good at making sure I do not hurt myself.  I've been working on myself with some Myofascial stretches as well, but think I really need to find someone local to me to help out more.  In the meantime I've been having more massages, which are always very nice. In combination all of these approaches have been really helping me.

Time for resolutions

Happy New Year! I feel like 2014 is going to be a great year.

It's at this time of year when magazines are full of articles encouraging you to set yourself goals to get fit/ lose weight. I'm happy to help you achieve those goals by helping ease aches and strains in the muscles you are discovering you do actually possess, correcting your postural bad habits and supporting the changes you are making.

Personally I don't usually do much in the way of New Year's Resolutions: they don't last and then you feel guilty, and to be honest if you really wanted to do something why wait until the New Year to do it. However, I'm not against reviewing where I'm at and setting some goals that I can work towards during the year.  Last year I decided a goal was to make something in the kitchen (over and above lunches and dinners) and that has been quite successful (Spelt rolls, Jamaican Gingerbread, crumpets, cheese & blackpepper english muffins, and Christmas cake) even if not entirely healthy.  I had also decided that I should increase my cardio workout so all the walking I've been doing has been very good for this especially as I've increased the pace.

So this year's selection are (in no particular order):

1) Do more to look after myself by doing yoga more regularly, having regular massages.  I've already made a start on the yoga, and I've got my first massage booked in.
2) Celebrate the positive, and not the negative/foolish. With all the social media that I look at it is all too easy to fall into the laugh at the idiot type, I will try to be more positive.
3) Learn more techniques.  This really is a given as I have to complete Continuing Professional Development (CPD), I just need to book them in.
4) Blog more. Already making a start on this one.  I think my aim will be one a month, but that might change.
5) Run more Reiki courses.  These are already happening: next Reiki Level 1 on 1st/2nd February 2014, and Reiki Level 2 at the end of March.

So these are my goals for the year.  What about you?

Breast health myofascial workshop

I recently went to a Myofascial Release special workshop for Breast Health run by Linda from Myofascial Release UK. The day focused on techniques that work the soft tissues of the arm pit and upper chest area and that are especially beneficial for women, particularly for those that have had treatment for breast cancer, however everyone can benefit from them (as I was to find out for myself).

I was not entirely certain why I was actually attending the course; I had bought a block of workshops and this (in my mind) would be the least useful one.  I was wrong, very wrong with that idea.  In the weeks before the course I started to think about my clientele and realised that I have a number of clients who this would be really good for (some have recovered from breast cancer, others have had surgery in this area, a number have breathing issues and a lot have tightness in this or the immediate surrounding area) and I realised that I should have ways of treating the chest so that I truly can follow what the body wants treated (with the client's permission of course).

This is an area that is often not worked on in a "typical" massage/body work session, but think about it: these structures and the ones they connect with are central to the whole body: the pectoral muscles impact the arms, the latissimus dorsi connect to the lumbar fascia (and are frequently repositioned for reconstructive surgery after mastectomies), the fascia covering the breastbone connect to the abdomen, and there are deep fascial connections to the lungs, the heart, the anterior neck muscles and this is a gross simplification of the whole structure.  Linda talked about what she had seen on a dissection course that she had attended where one of the cadavers had had a mastectomy.  She said that there was a thickening in the fascia that spanned the whole front of the body, and it was like a web radiating out through the abdominal walls, deep in to the pericardial sack, the lungs and far farther than anyone expected.

The techniques look at the area from the armpit to armpit, from throat to diaphragm, but really in a true treatment it would be extending beyond this elsewhere into the body.  From my experience on working on the Myofascia in the rest of the body I can easily understand how beneficial these techniques and approaches would be for people who have suffered the physical trauma of surgery, and chemotherapy for treatment of breast.  The gentle work to release the adhesions and restore some semblance of normality to the soft tissue could have such a profound effect for people and probably a lot more that haven't really considered that this could be an area of tightness for them.  Three of the techniques worked directly on or below the breast itself, but they can be adapted or not used depending on how the client feels about them being worked on.

I am fortunate enough not to have had any surgery to this area, but I have had poor posture when using a computer for many years when working in an office.  I also enjoy yoga on a weekly basis (if not more) and spend a lot of time working to expand the chest area.  I was very surprised how much techniques we learnt working on the armpit, ribcage and breast bone areas had a profound affect on my body, particularly freeing up an on-going tightness in my left shoulder.  Going to yoga later in the week I could feel a vast improvement in what is normally my tight arm and shoulder, so great a difference that my "good" arm sudden became the one that needed more stretching.  The breathing techniques at the end of the session were fuller, more balanced and deeper than they had been before.

I have to say a big thank you to Linda (who ran this sensitive course) and my fellow students for running a very supporting course where I (personally) felt secure enough that I was able to unwind (where the body releases tension in a physical way) not once, but three times.  I can honestly say that that was the first time I felt safe enough to properly do it.  Thank you to the therapists who facilitated this for me, I am continuing to feel the work that you/we did and it feels amazing.

Don't have the scars to prove it - Myofascial Abdominal scarring workshop

In the middle of June 2013 I did two workshops with the wonderful Linda of Myofascial UK, the first looking at the Spine & Sacrum (read my thoughts about here) and the second was on Abdominal Scarring.

Most of the people who were on the course had been there the day before, so there was less of a having to get to know everyone feel to the start of the day, and we basically got started straight away.  There were some laughter to start with because one of the leaders running a course in the room next door to us was wearing a T shirt saying "Powered by Orgasm" on it (no, I have no idea what the course was but everyone appeared normal).  

This laughter typifies the day, there is an atmosphere of easiness to the courses, with little anxiety about doing the techniques (once you've got yourself correctly positioned) and more about experiencing them and seeing what happens.  It is part of what makes the courses a joy to attend.

I am fortunate in that I have not had any abdominal surgery (and I hastily look round for something wooden to touch) so do not have any scars that would benefit directly.  However I have already come across and worked with a number of people with scars and know that they have a far reaching effect on the body, and also be a store for repressed emotion.  With the abdomen this can lead to digestive issues, and postural issues (just think of what your favoured position is if you have a stomach ache)  .

In fact the curling into a foetal position , with a 'collapsed' (i.e. shortened) front is an exageration of the slumped position we can easily adopt sat behind a PC/in the car/in front of the TV. So working on this area can be beneficial for so many people who lead sedentary lives.  It is an area that is also frequently overlooked as the pain is on the back of body, but might be because the body isn't fully straigthening up.

The first technique we learnt was skin rolling, and I'm pretty sure that every single person on the course had areas that were restricted (possibly adhered) somewhere in the abdomen.  It was quite an eye opener for me on actually how much of my stomach area needed work, and it was very different for each individual. I do tell my clients that I have had everything done to me that I do to them, so I know what it is like to some extent.  So yes, this is a painful technique (think chinese burn/rippy-burning sensations) but the end result is great.

We learnt a lot of other techniques to ease the abdomen from the diaphragm down to the bladder and pelvic floor and each one was quite remarkable in how effective it was in someone who thinks they stretch well and isn't too restricted in this area. It was very common for releases in the stomach to be felt/accompanied by releases in areas of the back and shoulders, so the abdomen could play a large part in people with back problems and this is something that I will be including with more of my clients when it is necessary.

The direct work on the scar was interesting in that it can be applied not just to scars but also to the belly button (and it can be remarkably, exquisitely painful) and I had two people working on me whilst we were practicing this.  One worked on my belly button and the other on the only scar I have (on my left knee from when I was aged 8 or so and I thought it was fully healed).  The belly button was really quite tender in places, but things felt great afterwards, but I've worked with people in this area so know that it can have a large impact on the digestive system.

I was really surprised about what was happening with the 30 plus year old scar on my knee, I could feel tension down into my big toe whilst it was being worked on and afterwards the texture of the scar was very different (smoother, more pliable and a different healthier colour) and it was a pleasant surprise.

Working on the stomach can have a big impact on people who've had surgery (e.g. appendectomies, caesarians, investigative endoscopies) and this workshop provided me with a number of really useful approaches that I can and will use with my clients.  It has reminded me that I also need to pay attention to what is going on towards the front of the body when people come to me to treat the back.

Since the course I have had a couple of clients who have really benefited from the techniques I learnt over this weekend.  They have all felt a reduction in pain and an opening sensation in the areas that I've been working on.

So next up is the long anticipated unwinding course in September, which should be great fun.  I just need to learn how to fully relax before then, so I can get the most out of it.

Put your back into it, or not - Myofascial Spine & Sacrum workshop

Last weekend I had the joy of going to a couple of workshops run by Linda from MyofascialUK On Saturday I went to the workshop that focused on the Spine and Sacrum, with Sunday focusing on Abdomen (Scarring and adhesions, read about it here).  Having been to their TMJ workshop before I vaguely knew the format: meeting new people and learning techniques that enhanced what I already knew to help in this area.

One thing I do love about these workshops is that they're attended by a loyal group of therapists.  You meet a large number of people that you met at previous courses or workshops. So beforehand and during the breaks it is nice to catch up with how they're doing, what they've been up to, and what courses they've been on and have they been to America to study with John F Barnes (whose style of Myofascial Release we're taught by Ruth & Linda and something I would love to do, Sedona sounds great) There was one lady who I knew, as I walked from the Tube station, that I was going to see again (the last time I'd met her was at the MFRUK stand at CamExpo in October 2012) and there she was sitting waiting to go to the other course that was being run.  We still had a good chance to have a quick natter as we were waiting for the workshops to begin (and she's doing really well, been the US and loved the courses)

So back to the course that I was going to: Spine & Sacrum.  I work at two chiropractic clinics so I see a lot of clients who have back, neck and spinal problems so increasing the number of techniques that I can use makes perfect sense.

The spine is made up of all the vertebral bones (from the coccyx to the cervical vertebra that sit just beneath the skull) and sits around and protects the bundle of nerves that form the spinal cord.  Problems with the vertebra and spinal muscles can impact on the nerves that exit between each vertebra (which is why problems in this area can be quite so painful)

The sacrum is the wedge shaped bone (made up of 5 fused sacral vertebrae) that forms the back of the pelvis, sitting between the 2 ilia (that I refer to as the 'wings of the pelvis,).  These three bones form the pelvic girdle and whilst we often consider that these are a single fixed bone there is some movement between them each time with move the legs, and indeed the sacrum can become stuck put of position which can cause major painful conditions.

During the day there were some great techniques that focused releasing the erector spinae (the group of muscles that sit either side of the spine), pelvic muscles as these interact with the ilia that have a direct impact on the sacrum and some delightful new ways to reach specific muscles that have a key role in the health of the spine (I'm thinking of the Quadratus Lumborum and Psoas here).  Also a couple of rather lovely whole spine techniques that relax everything all the way up.  I'm not going to go into the specifics of the techniques (you'll have to go to the course to find out or have a treatment from me)

One of the key things that this workshop reminded me about is that less is more: if I'm straining then I'm pushing too hard and in fact some of the greatest and most profound releases happen when I exert little pressure.  It is a lesson that is worth learning again and again, as coming from a massage background, it is hard to remember that deep pressure is not always needed.

I feel like I came away from the workshop with techniques that I will use immediately. As I learnt things I could feel myself drawing up a list of clients that this technique would be good for, and they will hopefully benefit from them the next time I see them. In fact I've seen and worked on two regulars who liked what I had done and saw the difference in their life.

There can always be more ways to treat the spine (as there are so many things that can go wrong) so this workshop could probably be a week long course and we'd still want to know more.  In fact I already know I will be signing up for more workshops (The Advanced Upper & Lower Body 2 day courses come to mind) with them next year, after I've done the ones that I have already signed up for later this year.

TMJ fascial workshop

Those of you that I have seen and worked with are probably very bored of me talking on and on about Fascia, but I find the subject fascinating. It is even more fun to work with, especially using the techniques taught by the lovely people of Myofascial UK who ran the course I attended on the Tempro Mandibular Joint (TMJ) back in February. I have used the techniques and information that I mention here with a number of people all with great success in relieving pain around the jaw area.

The TMJ is where the jawbone meets the skull and can be an area we hold a lot of tension in and this can lead to a number of issues including chronic sinus pain (as I personally have suffered from), head aches, jaw misalignment and TMJ Dysfunction (TMJD).

There are four main muscles that work in this area are the:

• masseter, temporalis, and medial pterygoid, which closes the jaw
• lateral pterygoid, which is the only muscle that opens the jaw.

The day started off with introductions within the small group and assessments of each others jaws.  Apparently my jaw was slightly swollen on the right side, and moved to the left and had a couple of popping noises as it closed (which caused some squeamishness from one of the follow attendees)

The fascial techniques are all very slow and seemingly gentle, though they can take you through some very tender moments as you reach, release and move through binds and adhesions.  It was a great group to work with, though trying to keep a straight face and not laugh when someone was working on you sometimes proved harder.

The intra-oral (inside the mouth) work on the pterygoids was a case in point, I found it very hard not to laugh nervously as my partner for approached snapping on a pair of latex gloves.  The laughter did not last very long as once her finger was working on releasing my pterygoid muscles the pain took over (this is, in my humble opinion, one of the most painful techniques I know) The basic technique was something we’d learnt on the Level 3 iMFT course, but with some added techniques to work with the sphenoid at the same time.

The other most peculiar thing that day, which followed the rules of the John Barnes style of Myofascial Release of following where the body leads, was having my hair pulled to release something because my forehead had flushed with a red flare that is one of the signs we look for, it felt weird but much better afterwards.

At the end of the day, my jaw felt much looser and was better positioned.  Though I did have some rather unusual red marks around my face from some of the techniques. The marks have now faded (thankfully) but the relief and freedom is still here 3 months on and that feels great.

Next up for me is the Spine & Sacrum and Abdominal Scarring workshops in June. I really can't wait