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Reflecting on the fashion of fascia

The ‘neuromyofascial unit’ is an osteopathic idea that has informed our diagnostic and treatment approach for at least 70 years. In the last 20 years there has been an exponential increase in research and publication relating to fascia. This research has deepened our understanding of fascia and supported the emergence and legitimacy of therapeutic systems that claim to influence fascia – fasciafitness and anatomytrains are the best examples. Seminal contributions to this and related areas of research and practice can be perused for free on Robert Schliep’s website. The emergent appreciation of fascia has helped add flesh to and invigorate the concept of biotensegrity. Fascia is now understandably regarded as a ‘body-wide mechanosensitive signaling system with an integrating function analogous to that of the nervous system.’

As an osteopath I have reservations about the fashionability of fascia and the tendency of ‘afascianados’ to regard this substrate as the new holy grail in musculoskeletal medicine. My osteopathic interests and approach have less to do with a specific tissue and more with promoting balance and integration across and between whole systems, the patients sense of internal space and autonomic health. Focusing on tissues, even an organism-wide tissue can fragment and reduce us to a singular aspect of our embodiment. In health, embodiment is a transparent, homogenous and non-anatomical experience. It is the job of practitioners to guide patients towards wholeness – a reductive tissue-based approach to this job is sometimes a diagnostic and medico-legal necessity, but can undermine this objective.

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