Presentation Notes: A Whiff of Fascialates - Merrithew.com

A Whiff of Fascialates 

(fascia and breathing 

science meets pilates) 

Laurie McLaughlin PT, DSc, FCAMPT,CMAG 

Background 

Over 20 years as a manipulative therapist 

Teacher / Examiner in Canada / NAIOMT 

Chief Examiner for Canada 1999-2005 

Private Practice Owner 

DScPT 

Assistant Clinical Professor 

McMaster University 

HaNSA 

Advanced Practice Physiotherapist 

Member Ministry of Health Expert Panel for Spine 

Member of Canadian Spine Society 

Dysfunction 

Laurie McLaughlin 2012 

www.proactiveeducation.ca 

1

Practice Based 

Evidence 

Clinical Observations and Hypothesis: 

Must be something affecting function and 

movement other than just local articular 

and muscular tissues 

Has continuity 

Is a communication system 

Transmits force / load 

Is responsive 

Fascial / Connective 

Tissue Anatomy 



2

Fascia 

The Connective Tissue that 

can be seen by the 

naked eye! 

Gray’s Anatomy 

Connective 

Tissue 

Extracellular Matrix 

Fibrous Proteins 

Ground Substance 

Secreted by connective tissue cells 


Connective Tissue 

Cells 

The cells are imbedded in the 

matrix 

Resident Cells 

Fibroblasts 

Adipocytes 

Mesenchymal stem cells 

Migrant Cells 

Macrophages 

Lymphocytes 

Mast cells 

Granulocytes 




3

Connective 

Tissue Roles 

Structural (mechanics of ECM) 

Defensive (cellular components) 

Organizes and influences growth 

and differentiation of 

surrounding tissue 


Connective 

Tissue Categories 

Blood 

Bone 

Cartilage 

General Connective Tissue 


Connective Tissue / 


Insoluble Protein Fibres 

Mostly collagen 

Allows for tensile properties 

Comprises ~ 30% body’s protein 

Proteins with 

adhesive and water 

binding capacities 

Elastin 

Provides resilience 




4

Connective Tissue / 


Distributes mechanical stresses 

Provides structural framework for cells to 

attach to or move in 

Provides watery environment where 

metabolites, gases, and nutrients diffuse 

readily among cells and the vessels 

going through it Gray’s Anatomy 

General Connective 

Tissue 

Irregular 

Loose, dense 

and adipose 

Connective 

Tissue 


Regular 

Regularly oriented 

fibres in response to 

stresses 

Fascial sheets 

Aponeuroses 

Ligaments 

Tendons 

Loose Connective 

Tissue 

Meshwork of thin collagen and 

elastin fibres 

“Extensively distributed” 

Provides for connection between 

tissues yet allows movement 




5


Tissue 

“Interstitial “loose” connective tissue 

constitutes a continuous network 

enveloping all limb muscles, bones, 

and tendons, extending into 

connective tissue planes of pelvic and 

shoulder girdles, abdominal and chest 

walls, neck and head” 

Langevin 2002 


Tissue 

“This tissue network is also continuous 

with more specialized connective 

tissues such as periosteum, perimysium, 

perineurium, pleura, peritoneum, and 

meninges.” 

“Connective tissues permeate all organs 

and surround all nerves, blood vessels 

and lymphatics.” 

Langevin 2002 


Consists of both a delicate web with fine 

branches penetrating all tissues, 

and 

major “trunks” forming connective tissue planes 

and linking all parts of the body with each 

other 

Langevin 2004 



6

Dense Connective 

Tissues 

Found in places of high mechanical 

loading: 

Periosteum 

Muscle 

Nerve sheaths 

Where there is a need for protection: 

capsules of organs and glands 

adventitia of large vessels 



2 main functions: 

1. Separate and allow gliding 

2. Connect or transfer force 

• Fascia can affect muscle quality 

• If it becomes a tough leathery 

container, compresses or torsions, the 

muscle can’t function properly 

• Muscle will take the shape of the 

container and its function depends on 

the shape or space it is given 

Voyer 



7

Muscle Connective 

Tissue 

Endomysium – surrounds individual myofibres 

Perimysium – separates and envelopes 

myofibre bundles, 

- more prevalent in tonic muscles 

- greatest amount of blood vessels within it 

-increases passive muscle stiffness 

Epimysium – around the whole muscle 

Schleip 2006 


Tissue 

Provide intramuscular pathways and 

reinforcement for nerves, blood vessels and 

lymphatics 

Extensive matrix of connected tunnels 

Muscle fibre # doesn’t change after birth 

Interaction between muscle cells and ECM 

governs muscle turnover, hypertrophy and 

injury repair 


Tissue 

Specialized connective tissue runs between 

muscles and bone 

Dynamic connection or ‘dynament’ 

Structural support adapts to changing distance 

between bones through range 

Different muscle to muscle 

Nerve endings where stress is high 



8

Fascial Compartments 

Contraction of muscles within a compartment 

increases pressure increasing contractile 

efficiency of other muscles in the 

compartment 

Provides cyclic pressure changes in gait serving 

as a ‘secondary heart pump’ 

Assisting with perfusion to the muscle itself 

Fascial Contractility 

Fascia is able to actively contract 

Myofibrils are present in fascia and 

respond to smooth muscle 

stimulants and relaxants 

Schleip 2006 


Evidence 








Is responsive 



9



10



11

Continuity 

Anatomy limited by dissection process 

Described by nearby structures 

Doesn’t highlight the tissue as a whole 


Evidence 








Is responsive 



12

Fascia and Nerves 

Nerves are covered in 3 layers of fascia: 

These fascial layers are innervated by the 

nervi nervorum 

Bove 2008 

Tibial Nerve 

So… 

Nerves are covered in 

(innervated) fascia 

Fascia throughout the body is 

innervated 

Can we separate them 

NO! 



13

Acupuncture 

Meridians theorized to follow fascial planes 

Hypothesized needle grasp due to 

mechanical coupling between needle 

and connective tissue 

Hypothesized needle manipulation transmits 

mechanical signal to connective tissue 

cells via mechanotransduction 

Langevin 2004 

Traditional Chinese Medicine 

Helms Acupuncture Energetics 

Myers Anatomy Trains 






14




Acupuncture Points and 

Cortical Communication 

Acupuncture points in the foot have been 

found to stimulate the occipital lobes on FMRI 

Stimulation of the eye directly by using light 

results in similar activation 

Points stimulated 2-5cm away do not result in 

occipital stimulation 

Cho 1998 

Mechanotransduction 

Ability of cells to perceive and biochemically 

interpret mechanical forces 

Mechanical force effect on cell shape 

emerging as key regulatory mechanism in 

cells, tissues and organs 

Mechanotransduction likely has widespread 

effects on connective tissue cells and 

vascular/neural elements present within it 

Langevin 2003,2005 



15

Functional 

Positions 


Evidence 








Is responsive 

Force Transmission 

Within the muscle via Fascia 

Between muscles via Fascia 

From muscles to other tissues via Fascia 

Huijing, PA. 2002,2003 



16


Evidence 








Is responsive 

Long term 

Short term 


Evidence 








Is responsive 

Long term 

Short term 



17

New Science 

Schleip 

Fascia as Spring 

‘Fascialates’ Ideas 

Elongate along fascial planes 

Balance workouts to address fascial planes 

(sides and spirals in particular) 

Consider controlled spring-like motions 

Add some ‘quiet’ impulse type movements 



18

Fascial Planes 

May want to consider 

Gentle mobility work from either end of the 

chain (eg. saw + df,nf alternatively first) 

Watch for areas of poor mobility in the chain 

May want to consider 

Hands on cuing 

If possible controlled movements in and 

around - not just along - restricted area of 

chain while monitoring response (limited by 

body awareness) 

Work ‘with’ springs not against to do impulse 

and spring like motions 

Referral for specific fascia work 



19

Time for Referral 

Diminished range of motion 

particularly when put ‘in series’ 

Discomfort post session 

– headache etc 

Breathing 

Breathing 

Just because we breathe 

perpetually 

from when we get here 

to when we leave 

Doesn’t mean we do it well! 



20

Breathing 

The average person breathes 

around 30,000 times a day 

If each breath is only a fraction off 

normal the overall effect is 

significant 

Epidemiology 

Disorders of breathing and 

continence have a stronger 

association with back pain 

than obesity and physical 

activity 

Smith et al 2006 

The muscles surrounding the 

abdominal cavity contribute to 

spinal control, continence and 

breathing 

Hodges et al 2007 



21

Changes in any one of these key 

functions may affect the 

coordination of these muscles 

Hodges et al 2007 

People with back pain brace with 

their superficial abdominals and 

diaphragm (decreased 

diaphragm descent) and have 

poor core muscle activation 

Hodges and Richardson 1999, Radebold et al 2001, 

O’Sullivan and Beales 2007 

Travell &Simons’ The Trigger Point Manual 



22

Breathing 

Regulation 

All about CO 2 

NOT O 2 

Most important peripheral 

and central respiratory 

sensors are for 

CO 2 

Physiology 

Normal Range of arterial 

and alveolar CO 2 

35 – 45 mm Hg 

Hypocapnia 

below 35 mm Hg 

Physiology 

Hypocapnia 

Overbreathe 

Increased rate 

Increased Volume 

Or BOTH 



23

HUMAN BODY 

100 TRILLION CELLS 

SEVERAL HUNDRED 

THOUSAND KILOMETRES 

OF HOLLOW TUBES 

R Price 

EVERY CELL 

NEEDS O2 

Every cell needs a 

regular and 

uninterrupted supply of 

oxygen for function and 

regeneration 

Symptoms will occur if 

this supply is erratic 

R Price 

EVERY TUBE NEEDS CO2 

Tubes are hollow organs 

surrounded by bands of 

smooth muscle. 

These bands go into spasm 

when CO2 levels are low. 

R Price 



24

BREATHING AFFECTS 

EVERY ONE OF THE 

BODY’S ELEVEN 

OPERATING SYSTEMS 

R Price 

THE 11 BODY SYSTEMS 

DIGESTIVE 

ENDOCRINE 

CARDIO- 

VASCULAR 

INTE- 

GUMENTARY 

LYMPHATIC 

MUSCULAR 

NERVOUS 

REPRODUCTIVE 

RESPIRATORY 

SKELETAL 

URINARY 

R Price 

HH (pH) Equation 

Sick, exercise ++ 

pH = [HCO 3¯] (metabolic) 

PaCO 2 (breathing) 

Reflex, 

Regulated by breathing 

behaviour 



25

Voluntary Control 

We can override the reflex systems 

consciously or unconsciously 

Emotions!! 

BUT if overused due to learned 

responses (habits), can 

decouple the brainstem reflexes 

Smooth Muscle 

Contraction 

Vessels 

Gut 

Bronchi 

Fascia () 

Response to 

Hypocapnia 

Shift of sodium Altered 

+ potassium 

electrolyte 

balance 

- hydrogen ions__________ 

= increased metabolic rate 

= increased O 2 requirement 



26

Response to 

Hypocapnia 

Decreased blood flow 

+ Bohr Effect 

+ Reduced Nitric Oxide 

= Decreased oxygenation 

Kidney Response to 

Hypocapnia 

Altered ion exchange in 

the kidney results in 

contraction of ECF 

volume 

Fascia 

Breathing 

Altered chemistry of ECF 

Decreased volume of ECF 

Reduced Nitric Oxide 

Smooth Muscle contraction 

(wound alkalinity & MFB) 



27

Brain Pet Scan 

2% body 

weight 

Uses 20% O 2 

(10X more than 

you’d think) 

So… 

Needs Blood! 

“… any tissue without enough 

blood supply is going to starve to 

death – your brain included.” 

John Medina 



28

Any Literature 

Chronic Back Pain Is Associated 

with Decreased Prefrontal and 

Thalamic Gray Matter Density 

Apkarian et al 2004 

Accelerated Brain Gray Matter 

Loss in Fibromyalgia Patients: 

Premature Aging of the Brain 

Kuchinad et al 2007 

Meditation 

Attention to breath 

Thicker cortex in attention and sensory 

processing areas on MRI of people who 

meditated 

Effect most pronounced in older subjects 

suggesting that meditating could reduce 

some of the cortical thinning and cognitive 

decline seen in aging 

(Lazar et al 2005) 

Meditation 

Neural processing was found to be more 

coordinated in a study looking at people with 

extensive training in meditation (Lutz et al 2004) 

Complex cerebral blood flow pattern developed 

during meditation in 8 experienced Buddhist 

meditaters compared to normal waking state 

(Newberg et al 2001) 



29

SPIRIT 

B 

O 

D 

Y 

Breath 

M 

I 

N 

D 

Hypocapnia 

Symptoms 

Neurological 

Psychological 

Respiratory 

Cardiovascular 

Muscular 

Gastrointestinal / Urogenital 

General 

Hypocapnia Symptoms 

Neurological 

Paraesthesia 

Visual disturbance 

Headaches / migraine 

Dizziness 

Faint feelings 



30


Psychological 

Anxiety 

Phobias 

Panic 

Cognitive Dysfunction 

Depression 

Anxiety and Depression 

Approximately 25% of the population 

experience an anxiety disorder during 

their lifetime and many people have 

both anxiety and depression 

More than 1 in 30 Canadians suffer from 

some form of depressive illness 

Stress 

WHO calls stress a worldwide epidemic 

Negative effect on health 

(well over 50% of primary care physician visits) 

Costs ~ $300 billion US / year 

Stats Canada: 14% of men 

11% of women 

No 

stress 

66% of Americans would seriously welcome help 

dealing with stress! 



31

Hyperoxic Brain Effects are 

Normalized by Addition of CO 2 

Macey et al 2007 

14 children were given 100% oxygen 

Induced hypocapnia 

Increased activity in autonomic and hormonal 

areas (insular cortex which projects to 

hypothalamic & amygdala sites [increased 

sympathetic outflow] and cerebellum – BP 

control) 

Addition of CO 2 abolished this response and 

decreased sympathetic tone and 

cerebellar activity 


Respiratory 

Shortness of breath 

Irritable cough 

Tight chest 

Dyspnea 

Asthma 

Asthma 

9% of US children below 18 years of 

age had asthma in 2001, 

compared with 3.6% in 1980 

WHO reports that 8% of the Swiss 

population suffers from asthma 

today, compared with 2% 

25–30 years ago 

More prevalent in affluent countries 

Studies show benefit with breathing 

retraining 



32

“Surprisingly High Prevalence of Anxiety 

and Depression in Chronic Breathing 

Disorders” 

80% had anxiety, depression or both 

Kunik et al Chest 2005 

Cardiovascular System 

Coronary artery spasm 

ECG changes 

Altered QT variability index 

Decreased heart rate variability 

Thomson 1997, Sullivan 2004 



Palpitations 

Tachycardia 

Atypical chest pain 

Vasomotor instability 

Cold extremities 



33

Cardiovascular Changes 

High Blood Pressure 

(vasoconstriction) 

Increased tendency for platelet 

adherence and plaque formation 

(NO) 

ECG changes 

(ischaemic) 

Cardiovascular Disease 

in Canada 

Myocardial Infarction: 770,000 / yr 

Stroke costs $2.7 billion / yr 

Cardiovascular disease costs $18 billion / yr 

Heart disease and stroke underlying 

Cause of Death in 1/3 Canadians 

Cardiac Rehab 

Myocardial Infarction RCT in Netherlands 

Both groups: aerobic exercise 

Experimental: 6 hrs breathing / relaxation 

Followed at 2 and 5 yrs 

Fewer serious cardiac events (17% vs 37%) 

Fewer hospitalizations 

Lower cost 

vanDixhoorn et al 1989, 

vanDixhoorn & Duivenvoorden1989 



34

Musculoskeletal 

System 

Increased membrane excitability 

related to the shift of Na + , K + , 

and H + ions across membranes 

Reduction in ionized calcium 

Thomson 1997 


Musculoskeletal 

Cramps 

Pain in head, neck and shoulders 

Tremors 

Weakness 

Stiffness 

Hypertonus 


Gastrointestinal / Urogenital 

Dysphagia 

Aerophagia: flatulence, belching, 

bloating 

Irritable bowel / bladder 

Increased urinary frequency 



35

Irritable Bowel Syndrome 

IBS affects 13 - 20 % of Canadians (CSIR) 

One of the most common disorders 

doctors diagnose 

Stress thought to be a big factor 

More common in women 

Gender Differences 

Men have higher CO 2 levels generally 

Progesterone increases respiratory rate as well 

as pH (alkylosis) 

Increased progesterone levels in luteal phase 

(between ovulation and menses)* 

Increased levels in pregnancy 

Loeppky 2001 

General 

Neurological 

GI/ Urogenital 

Pregnancy 

Psychological 

Muscular 


Respiratory 

Could some of these symptoms be minimized with 

breathing retraining 



36


General 

Sleep disturbance / Apnea 

Weakness 

Exhaustion 

Night Sweating 

Nightmares 

Myths About Breathing 

Myths about 

breathing often 

cause breathing 

problems 

Breathing Myths 

Breathing is all about OXYGEN 

Carbon Dioxide is a toxic waste gas. 

Deep Breathing is good for you 

If you want more oxygen you have to 

breathe more often and deeper 

Breathing in and out through your 

mouth is OKAY 



37

MYTH # 1 

Breathing Is All About Oxygen 

This is only partially true 

It is about the availability 

of the oxygen that is 

being transported 

via the blood 

MYTH # 2 

CO2 IS A TOXIC 

GAS 

Many people confuse carbon 

dioxide with carbon monoxide - 

which is deadly 

CO2 also gets a lot of bad press 

as a result of 

Global Warming 

CO2 Is Not A Toxic 

Waste Gas 

If CO 2 was such a toxic 

gas and if the air that 

we exhaled was 

“poisonous” how would 

we be able to do 

mouth-to-mouth 

resuscitation 



38

Cells And Tubes 

Anything that 

interferes with the 

function of any or 

all of these will 

produce symptoms 

CO2 Is The Common 

Factor In Both Of These 

Systems 

LOW CO 2 causes smooth muscle 

tubes to go into spasm and 

interfere with most body 

functions - causing SYMPTOMS 

LOW CO 2 reduces the flow of O 2 

from blood into cells - causing 

SYMPTOMS 

MYTH # 3 

Stressed or upset 

Take a deep breath…. 

WRONG!!! 



39

MYTH # 4 

If You Want More 02 You Have To 

Breathe More 

Exactly the opposite is true 

The more you breathe the 

less oxygen is available 

to your cells 

MYTH # 5 

Mouth Breathing is OK 

Mouth breathing is 

harmful to your 

health 

The Nose Is An Air 

Conditioner 

The hairs trap floating particles 

The mucus has an enzyme that 

kills viruses and bacteria 

The sinuses produce 2 litres of 

water a day to wash, 

humidify and temperature 

control the air going to the 

lungs 



40

Mouth Breathing..... 

The mouth moves roughly SIX TIMES more 

air than the nose 

Mouth Breathing reduces CO2 in the lungs 

and therefore in the blood 

Low CO2 in the blood reduces oxygen flow 

to the cells 

Stamina is reduced 

Recovery time is lengthened 

The Capno Trainer 

Better Physiology Ltd. 

Capnography 

Evaluation 



41

Capnography 

Woman with 

Lumbopelvic Pain 

33 year old with persistent pain post partum 

Difficulty lifting/caring for her child 

Plateaued improvement with hands on 

Poor core muscle activation 

(Transverse Abdominus, multifidus, pelvic floor 

DIAPHRAGM) 

Increased global muscle activation 

(External Oblique, Internal Oblique) 



42

At rest vs contracted 

EO 

IO 

TA 

IO 

EO 

TA 

TA at Rest 

TA contracted 

TA vs IO contraction 

EO 

EO 

IO 

IO 

TA 

TA 

TA contraction without IO 

TA contraction with IO 

Travell &Simons’ The Trigger Point Manual 



43

Initial Assessment 

Breathing Results 

•Decreased CO2 

levels 

•(avg CO2 = 26 

mmHg) 

gasping 

Aborted 

breath 

Breathing results after 

four biofeedback 

sessions 

•Optimal breathing ch 

•Avg CO2 = 38 mm 

•Avg resp rate = 8 

Woman with 

Lumbopelvic Pain 

Once able to breathe well was able to 

activate her core 

Began a pilates based exercise program 

and did beautifully 

Able to care for her child 

(mother in law went home) 



44

Case History 

Patient with 13 year history of LBP 

Unable to exercise without flaring 

Once able to breathe, could activate core 

and participate in a pilates program 

Had her FIRST successful exercise attempt 

Able to go on a European vacation 

No longer required ongoing‘treatment’ 

Breathing Evaluation 

Consider Breathing Pattern Disorder: 

Persistent Pain 

Flare with exercise 

Stress 

High Achievers (Us! And our switched 

on patients) 

Unexplained Symptoms! 

Careful with global system bracing 

(especially while ‘bearing down’) 

Gentle/quiet breathing (Not harsh) 



45

Breathing Retraining 

Can done individually and/or group format 

Rental for self management development 

Thankyou! 

laurie@proactivehealth.ca 




46

Presentation Notes: A Whiff of Fascialates - Merrithew.com

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