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🎙️In this episode, educators, authors, and massage therapists Rachelle Clauson and Nicole Trombley discuss the surprising sensitivity and functional significance of the ankle’s fascial retinaculum. Their conversation with Whitney and Til also ventures into Rachelle’s work on the Fascial Plastination Project, and their hands-on anatomy educational offerings via AnatomySCAPES.

Scroll down for the full video and transcript! 

Key Points in the Podcast

- Introduction to The Thinking Practitioner Podcast - 0:00
- Introduction to guests and their work - 0:50
- Overview of the Fascial Plastination project - 3:50
- Discussion on the retinaculum and its significance for hands-on therapists - 9:58
- The role of the retinacula in proprioception - 13:44
- The connection between structure and neurology in hands-on therapy - 19:58
- Overview of the AnatomySCAPES project - 29:50
- The challenges of teaching anatomy to massage therapists - 34:50
- The importance of revisiting and relearning anatomy - 38:22
- The value of in-person workshops and the accessibility of online resources - 45:01
- How to learn more and connect with the guests - 57:22

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(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

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Til Luchau Advanced-Trainings        whitney lowe

        Til Luchau                          Whitney Lowe

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Your Hosts:

Til Luchau Advanced-Trainings Til Luchau

whitney lowe Whitney Lowe

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Full Transcript (click me!)

The Thinking Practitioner Podcast:


Episode 119: The Ankle's Most Sensitive Fascia (with Rachelle Clauson & Nicole Trombley)

Key Points in the Podcast

- Introduction to The Thinking Practitioner Podcast - 0:00
- Introduction to guests and their work - 0:50
- Overview of the Fascial Plastination project - 3:50
- Discussion on the retinaculum and its significance for hands-on therapists - 9:58
- The role of the retinacula in proprioception - 13:44
- The connection between structure and neurology in hands-on therapy - 19:58
- Overview of the AnatomySCAPES project - 29:50
- The challenges of teaching anatomy to massage therapists - 34:50
- The importance of revisiting and relearning anatomy - 38:22
- The value of in-person workshops and the accessibility of online resources - 45:01
- How to learn more and connect with the guests - 57:22

Til Luchau:

Hi. This is Til Luchau. This summer I'll be offering my Ankle Issues course via live stream. This will be the first time this course, which is the latest in my Advanced Myofascial Techniques series, will be available remotely or by recording. You can join us live. You can even bring a client and work on it there're with us in real time, if you want CAMT credit or certification credit, or the course is affordable enough that you can just sign up and watch the recording later at your leisure. All those options will earn you NCB credit. And for a limited time thinking Practitioner listeners like you can save an extra 15% with the coupon TTP at checkout. If you go to Advanced-Trainings.com and sign up for the ankle live stream, you'll see all those options there. The Thinking Practitioner Podcast is supported by ABMP, associated bodywork and massage professionals. ABMP membership gives professional practitioners like you a package including individual liability insurance, free continuing education, and quick reference apps, online scheduling and payments with Pocket and much more.

Whitney Lowe:

ABMP's CE courses podcast and Massage and Bodywork Magazine always feature expert voices and new perspectives in the field, including from Til and myself and from our guests today. Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking. Til, who are our mystery guests with us here today.

Til Luchau:

Our guests today, Rachelle Clauson. Nicole Trombley, welcome. Thanks for having made the time to come be with us. You are from San Diego, you're both massage therapists, authors, and the co-directors of AnatomySCAPES, which is pretty cool. We're going to hear more about that later. You also write, like Whitney mentioned, for Massage and Bodywork Magazine, where you co-author the Anatomy for Touch column. Welcome. What else would you like our listeners to know about you? Maybe Nicole, could you start?

Nicole Trombley:

Yeah. Rachelle and I work together in the dissection space when we're not at the massage table. I have a background and training in biology and biochemistry, so I love bringing that micro molecular world to my hands-on work as I'm obsessively massaging and thinking molecularly, but also to our work in teaching in the dissection space. That's one of my passions.

Til Luchau:

That's so great. How about you Rachelle? What else would you like people to know about you or your background?

Rachelle Clauson:

Awesome. That’s a great start. This is very current with where we are in the world right now of moving from the part of 20 years or more doing massage and studying the body, studying anatomy. I've got a mixed background before I started doing massage, doing things that were with the body in other ways. I was a dancer. I did a lot of ballet. I started studying anatomy actually as a ballet dancer non-professionally, and then I continued to study theater and mime. So, I have a lot of movement background that informs a lot, I think, of how I work with the body and how I think about the body, probably how I move when I'm doing massage as well, bringing that movement. Beauty and anatomy have always been very interlaced for me, and I know we'll talk about probably a little bit later as well as that project that I worked with where that was a very key part, which was bringing a plastination project into being. And that was an amazing thing about the almost visual arts, overlapping anatomy and the bodywork movement world.

Til Luchau:

That's where I first made your acquaintance. That's what caught my eye as it were, your involvement in the Fascial Plastination project. So, I do want to talk about that and I just want to underline what you said about your interest in the beauty aspect of what we're doing as well, as well as the technical and anatomical pieces there. But if we could, let's start with your recent article in Massage and Bodywork, which we were focusing on the retinaculum. It fit perfectly with our ankle theme that Whitney and I are doing around now. But could you tell our listeners something about what the retinaculum is and why it might be significant for us as hands-on therapists to learn about it?

Rachelle Clauson:

Yeah, absolutely. We both wrote the article together. We always co-author our articles. One of us takes lead, but we're always... Nicole does a lot of the research and we do a lot of the discussing and writing together. And one of the things that, besides it being a very fascinating piece of fascia that has quite a bit of research coming out on it, I think from a touch perspective, I found it an interesting thought that sometimes we gloss over certain parts of the body that aren't so muscle oriented. And typically, retinacula is found in parts of the body that aren't so juicy, that aren't so squeezy, that aren't so thinking about working out the muscle system and being at the joints of the wrist and of the ankles. Based on research and what we know and what we're learning about retinacula right now, which is pretty phenomenal stuff, knowing that our touch to those areas can have influence and it sometimes might be actually critically important for restoring good function, especially post-injury.

Til Luchau:

Okay. For our listeners who don't know, the retinacula is what? What's it made out of? It's found in our wrists and shoulders in these non-juicy places. What is it made out of?

Nicole Trombley:

Yeah.

Rachelle Clauson:

What is it?

Nicole Trombley:

It's part of the deep fascia system. And yeah, we have them at our ankles, our wrists, usually around joints. There's retinacula at the elbow, at the knees, these are some of the more famous ones. And to look at the ankle, there's more than one retinacula. There's multiple retinacula over the extensors, multiple over them. There's lots of retinacula. And one of the best ways to describe them at least from the fascial perspective is they're reinforcements of the deep fascia. That deep fascia, the myofascial, the fascia, that is part of the musculoskeletal system that's working with that. And then with that, we start looking at it as part of the proprioceptive system.

Rachelle Clauson:

Right. And maybe just to give even a bigger overview, I'm big on overviews. I think that a lot of times we can talk detail about structures, fabrics in the body, but we zoom in on them, and so then it's like, well, how does that fit with the whole story? And you don't necessarily know where to hang these pieces of information if you haven't seen the bigger, broader picture. And fascia, obviously your listeners, I think, probably would have quite a bit of understanding of fascia. But I think it's really important just to make a distinction here, even within the fascial system, how many different types of fascia appear. And something as diverse as the, let's say the dermis of the skin is a part of the connective tissue system that's connected on through with the fatty layer, which is the adipose tissue that has a collagen component, carry that on down through to a membrane within the fatty layer of the superficial fascia, carry that on down deeper into the skin ligaments and retinacula cutis that connect even further through the deep adipose tissue.

And then you come to-

Nicole Trombley:

Finally.

Rachelle Clauson:

... finally, the deep fascia and the deep fascia goes even further. So, it depends on where you are on the body as to what kind of deep fascia you're coming to. So, on the trunk, different from on the limbs. And the limbs, we like to describe sometimes as having these sleeves or stockings of fascia. So, if you can imagine putting on a shirt or maybe even a body suit or a wet suit that you have these sleeves that your arms go through. Underneath the fatty tissue, you actually have a sleeve of deep fascia. That to me is not discussed nearly as often as maybe what would people think about the sausage wrapping? You'll talk about every muscle has its own enveloping fascia. That is true, but that is a muscular fascia that singularly envelops one muscle at a time.

What we're talking about is an aponeurotic deep fascia, which envelops more than one muscle, and in the case of the limbs, it envelops the entire limb. So, the whole arm has a sleeve and the whole leg has a sleeve. But of course, it's not only that simple, it goes more complex than that. We'll probably talk about that more in a minute about compartments and how these divisions then that they actually dive into the bone and connect this three-dimensional, pocket filled structural organization to the entire system of the whole body. So, the muscles live and interact with that fascial system in really specific ways. When we're talking about the retinacula, so giving that frame, we're talking about a thickening, a reinforcement in that more sleeve or stocking. That's the part that would be on the limbs.

So, if we're talking deep fascia on the trunk, it's going to be different. The hubs of deep fascia are more in the low back and in the abdomen. And then once you get through the fatty layer, you are right to the epimysium in a lot of the muscles, whereas that's not the case when you are on the limbs. I'm just going to this one more point, I throw it back to Nicole, but this idea of fascia as a system, systems have organs. If you think of the entire fascial body as a system, Carla Stecco has suggested that we could recognize the retinacula as an organ within the fascial system with a very specific job to do. Dah.

Nicole Trombley:

And that job would be?

Rachelle Clauson:

Yes. Next question.

Whitney Lowe:

Yes, I wanted to hear some more about the job because my perspective about the retinacula has always leaned a lot on its biomechanical function as sort of a pulley system because we talk about them being at the distal extremities, the ankles and the wrists especially. So, I'd like to hear a little bit more about what your ideas are on the job there.

Nicole Trombley:

One of the reasons we wrote this article is because the retinacula are a piece of anatomy that there's a little bit of a story behind. And the story that we all learned, particularly, I think, at massage school anatomy is one way and that the wrists and the ankles, we've got bracelets and strappy sandals of retinacula. But when we go into the dissection lab, the work that we've done, at least in the dissection lab, and when we bring massage therapists into the dissection lab, what we actually see on the limbs is a little... The retinacula are recognizable. It's like, yeah, that's okay, that's the retinacula. But it's not exactly the same story that we learned when we learned the retinacula. So, the original story is a biomechanical story. It's exactly that. And the story goes back, even Vesalius, who is that great Flemish anatomist who upended the history of anatomy and changed the way anatomy was talked about back in the 1500s.

He started drawing and writing about the retinacula as a biomechanical structure and as a distinct and separate structure. So, the retinacula were drawn as bracelets. They were drawn as the straps on your gladiator style sandals. But when we go into the lab, even though we can see them and we can see it's like see the sleeve and you can see this white concentration at the wrist, for example. It's completely continuous with the sleeve. If you tried pick up that bracelet, the entire sleeve is going to tent and pull with it, you could pull the whole arm with it. It's completely continuous, it's not a separate structure. So, when we started seeing this like, hey, wait a minute, that's not the way bracelets work. That's not exactly what we were expecting to see. Started doing a lot more of this research into, well, what is the story here? And that's when we started really getting into... Carla Stecco has done most of the work on it-

Rachelle Clauson:

A lot of research on it.

Nicole Trombley:

... really for a long time. It's not even new research. We're talking 20 years ago that really, she started studying this and it was already in the research preceding that at some level. When you start looking through her research, she signals people well before her in 1980s and into the 1970s who commented, "The retinacula, they don't really look like they're up to the job. They're flexible."

Rachelle Clauson:

Could they really strap it down, if that was really what they were doing.

Nicole Trombley:

Yeah, is really what they're up to. And they were finding innovation. They found that these structures had free nerve endings as well as Pacinis and Ruffinis in them, and so they were innervated. So, it didn't quite add up. Nothing really went that far with that research.

Til Luchau:

Can you tell our listeners about Pacinis and Ruffinis? You're saying basically maybe they're not just pulleys, in fact, maybe they're not to their job, but we're finding these funny things in this. What are those things again?

Nicole Trombley:

They found nerves. They found free nerve endings, but then they found these encapsulated nerves which serve as mechanoreceptors. Pacini, which are nerve endings with a connective tissue capsule around them that can actually perceive pressure, Ruffinis perceive stretch. There's these around the nerve endings. And these are nerve organs that are important in, we find proprioception.

Rachelle Clauson:

And they're completely continuous with the fascia. I think this concept of continuity is the thing to really highlight here. The idea that they're not just straps and sandals, but they're a continuity of these sleeves and stockings. Let's give them names. On your upper limb you've got the brachial fascia is from shoulder to elbow, and from elbow to hand you have the antebrachial fascia, and that's a continuous fascia with different anchor points throughout it, but it's still a continuous thing with different names based on region. Same thing in the legs. You have a continuous fascia that's of the entire lower limb, but on the thigh it's called the fascia lata, and below the knee it's called the crural fascia or the fascia cruris.

And these retinacula live in those sleeves, so it's continuous with. If you have a pull on one, you have a pull on both. And the containment is by all, it's not just the containment of this reinforced area, but the entire thing is actually providing containment at a level stronger containment. There's reinforcement where the collagen is more dense, where there is a strengthening of the fascia in this specialized area and these specialized specializations of deep fascia, otherwise possibly considered an organ of the fascial system would be what the retinacula are. And then the second piece, this idea that... Think about when you're talking about Vesalius, they weren't studying the microscopic view. There wasn't a way to be able to perceive that it did anything other than a biomechanical function because we weren't into the neurology of things at that time.

Once the microscopic, not just the macroscopic big view, but the little view of the microscopic view and starting to study innervation, starting to see, first of all, the idea that fascia was innervated at all as a system was a new thing. No one knew that until they started looking for it. And then now we have researchers that are looking really specifically, and so Carla's work to see what is this concept of the fascia serving as a proprioceptive role. She has this really great presentation. I encourage anybody listening to this to go find it. If you just go to YouTube and search Carla Stecco, it's one of the first ones that will even show up, and it's from a symposium where she presented in 2014 at something called the lecture, Sportfisio, so I'm assuming that's physiotherapist.

Til Luchau:

We can link to that in the show notes for sure. Yeah.

Rachelle Clauson:

For sure. Her presentation was called Fascia Research and Proprioception Implications in Sports and the key points that she made in this lecture, I've gone back to, literally, over and over and over again for years now because it's so dense. It's a 20-minute presentation, but there is so much about the proprioceptive role of fascia in the lecture. To summarize, she basically suggests that if fascia is serving a proprioceptive role in the body, then it has to be able to have certain features, and she lists four specific features that it must have. Number one, it has to be innervated. If the fascial system's not innervated, then it's not a part of the proprioceptive system. It has to have nerve endings that end in that system to be recording, receiving data and information and connecting with the rest of the nervous system.

Number two, it has to be able to perceive the contraction of the underlying muscles. And this is where my sleeve and stocking analogy completely breaks down because a sleeve is obviously something that you can slide on and slide off, and same thing with the stocking, whereas the fascial system is not quite that simple, but it's a good place to start if people don't know anything about fascia. But then like anything, once you have your basics, you got to go deeper. And when going deeper, what's very clear is that many of the muscles, if not all of the muscles have a connection to the fascial system as a larger system of communication. It's embedded-

Til Luchau:

You're talking about a mechanical connection, you're saying?

Rachelle Clauson:

Yes, a mechanical connection, and those can show up in different ways on different parts of the body. Sometimes the fibers of the muscle, like in a pennate muscle, actually fan out. I like to think of a quill from those pens that they signed the constitution with, and you've got the point of the quill of the feather of the ostrich, and that's the tendon end, and then the muscles coming off like feathers going in both directions. The edges of those feathers don't converge again to the other end of the quill. They actually reach to the outer edges of the brachial fascia or anti-brachial fascia. In the forearm, you've got the extensor carpi ulnaris and the flexor carpi ulnaris are very good examples of this. If you cut that muscle open, you can see how they don't go to the end tendon, they actually embed in the fascial bag of the anti-brachial fascia.

So, they're tensioning and stretching the fascia with contraction. And no matter how it shows up, this is the same everywhere. On the upper body you've got the fibers of the deltoid muscle that actually... they're epimysium, they're endomysium, they're perimysium are continuous and actually form the brachial fascia. When the deltoid is contracting, it's going to the bone with its tendon, the part we all know, but it's also contracting the fascial bag. This outer fascia is being contracted in different regions by different muscles. In the arm there's multiple muscles that all embed into this bag, including the deltoid for the lateral aspect, the latissimus dorsi for the posterior aspect, pectoralis for the anterior aspect, and the medial aspect actually comes from the fascial connections that come both from the pectoralis and the latissimus where they converge to the medial arm.

All throughout the body, these sleeves are interwoven with the actual fibers, which means that the fascia can perceive the contraction by being stretched with the muscle. Briefly, points three and four was it has to always have a specific organization that is consistent across all bodies and not just an anatomical variation. These specific organizations can't just be on me but not on you, if they have to do with proprioception. And in the past they were noted. There's literature and textbooks that actually recognize them, but they were recognized as anatomical variations or anomalies or they were seen as insertions or origins but not seen as important probably because at that time not understanding the innervation part. Then the last part is about being able to transmit forces over a distance. Is the fascial continuity as the structure of fascia, as the fabric of fascia have enough stiffness to it that if I pull on one end, it actually can translate that force further down the road because if it's really adaptable and stretchy, then the muscle can contract and pull on the fascia and it doesn't translate that force anywhere.

This is what really challenges this idea of the fascial web. A word that's used a lot and not incorrectly, but maybe it gives us the wrong visual in our minds of being just this amorphous, highly adaptable, can make it into any shape. If it's very webby and soft and flexible and stretchy, then it can't have a part in the proprioceptive story. It has to have levels of resistance in different areas in order to do that, which brings back to the retinacula, which has these thickenings and this stiffness in it that the muscular force and the muscular tension and that biomechanical element is communicating. It is communicating to the retinacula in those ways. That was the short version of those four points. We could go onto any of them with quite a bit more depth, but it's a great place to start to think about fascia as proprioceptive organ and proprioceptive system. Yeah, it communicates within that.

Til Luchau:

Why does this matter to hands-on therapists? Why does it matter that fascia be proprioceptive in addition to some mechanical effect? Why is that an important concept?

Rachelle Clauson:

There are several ways to go about answering that question. Where would you like to start?

Nicole Trombley:

I'll let you start with that one though. Taking beyond the retinacula then just in general that the fascial system communicates, is that what you mean?

Til Luchau:

As a hands-on therapist, why would this be interesting to me? It's totally interesting to me as a anatomy geek, but how do I put this into practice? How is this going to inform what I actually am doing and thinking about and experiencing on the table?

Rachelle Clauson:

If you think about the fact that you have now, what you now know is that this whole fascial system is a communicating system. Then what problems start to arise if there's something going on in that fascial system that's interrupting communication. And that's where we'll see pain, dysfunction or a lack of coordination and a lack of proprioception. We were talking about the ankle sprains in particular, that ankle sprains and the concept of instability, oh, I really have to stabilize my ankles. They need to be stiff and stable in order to not roll my ankle. You can probably talk about this part. Really recognizing there was some studies that were done about the instability of the ankle perhaps having a lot to do with a lack of proprioception due to injury to the organs that are responsible for that.

There were four different things that were seen in this particular study that were seen as consistent where there was no ligament damage, but it was from a collection of people who had repeated ankle injuries, ankle sprains when they took a look with MRI, I believe, to see what was going on with the retinacula in those areas. You want to talk about that?

Nicole Trombley:

There was an MRI study, this is actually one of Carla Stecco's studies, where they looked at 17 healthy volunteers. They volunteered, but they had a history of ankle sprain. I think they had to qualify with at least several months of ankle instability. And they used MRI to analyze the retinacula. Were there alterations in the retinacula and there were. I think in all of them they found alterations of some sort at the ankle. In I think 10 of them there were alterations. Some of them were increased thickness, so reinforcement of the retinacula itself, there were gaps in continuity in the retinacula, and there were also things like adhesions to the subcutaneous tissue, so that subcutaneous tissue around the ankles.

Usually, we can slide it a little bit. There's not a lot of fat there in most of us, and we're able to slide that skin and subcutis over that deep fascia. But when there's adhesions between the subcutis and that deeper fascia, you're not going to get the sliding there and that adhesion is going to pull, potentially, on the deep fascia as well. That's just really interesting in terms of what they were actually able to observe in people who had this history of chronic ankle instability subsequent to ankle sprains. But I think-

Til Luchau:

I love it. You mentioned that in your article as well, that study, and it does point to the ways that maybe repeated injury is having a structural effect in a region that you're postulating... I'm a friendly follower for sure. It says there's a lot of dense innervation, there's a lot of mechanoreceptors here. Does the mechanical changes in that structure change the way that we're perceiving it, change the way the brain is interacting with it? Like you said, maybe there's more pain, nociceptive signaling. Maybe there's just a change in coordination and the way that I use it, maybe it's a change in the body schema. Then as hands-on therapists, what do we do with our hands given that knowledge?

Rachelle Clauson:

And that's where the next part of that we can speculate more than, quote, definitively this is the thing to do. But I think both you and Whitney, were talking about this in your last episode as well, is the different things that we look for and to feel the textures. Get in there and see what you can palpate, and see if you can see how easily does the skin move, see how easily do the joints move and how much glide. Do you feel a sense of stuckness that just shows up really even at the skin level? Is there adherences to the fatty layer? Some of these adhesions were actually to the fatty layer that's above the fascia in those areas, so it may be quite perceivable. I did a workshop with Antonio Stecco who did actually this, I think, part was involved with this study where they did look at the chronic functional instability after ankle sprain study.

They have a particular method, the Stecco method is using friction and creating local inflammation to help to reorganize or stimulate the body to say, hey, this is still not prepared. Come in and take a look at it. So, there would be some suggestions of that treatment that would work well. I personally have worked with quite a few people that have had foot injuries or ankle injuries. And I have merely, and I do say this genuinely, I have merely traced the anatomy that has been the focus of the treatment. I have gotten curious with my fingers, I've gotten curious with my hands and my thumbs, and I have just gently mobilized all the things without having any grand plan just to see what I feel. A lot of times, things will show up that just strike you as not quite right.

Tracing and giving all of this touch specifically to each one of the bones, each one of the ligaments, each one of the retinacula, each the joints moving and palpating and just slowly walking through all of the tissues and have the client stand up and say, "The pain is 80% gone, what did you do?" I'm like, "I touched your anatomy." We can get really clinical about a plus. B, do this if this, and there's certainly really good osteopathic and clinical testing for certain types of injuries and how to treat them. But I personally have a bias that if we start to really understand all the anatomy, not just the things that are the cutaway parts, the purest of the most understandable, isolatable structures, but feel all of it, which includes this very blobby, non-defined, sometimes almost see through or what is it fascial system that changes its texture and tone in so many different ways, but instead are present for all of those layers in the adipose and the fat and the skin that we somehow will be working in a very holistic way that allows the whole form to into a better place.

Whitney Lowe:

I'm curious to hear, I know we're still in the process of figuring a lot of this out and learning a lot about it, but I'm curious to hear your maybe opinion or perspective since you've now spoken so much about the rich innovation in these areas and how much that plays a part in proprioception and our understanding of what the body sense in that area. If you think a lot of what we do when you talk about these treatment strategies of tracing the anatomy, do you think with this extensive, rich innovation in these areas that those responses that we're getting are more maybe neurologically based versus we're doing something specific to the tissue? Or do you think we're doing something more to the tissue or maybe what mix of both? I'm curious about your perspective on that.

Rachelle Clauson:

Can I just say all the things? All the things, because I think they're not separatable. The nerves are structures. Where they're living, are they happy nerves or are they pissed off? Are they irritated? Are they like, eh, it's too dry in here, or my clothes are too tight, I can't move? I think in cartoons in my head a lot of the times, and I've done this whole story about how the nerves, if they're not getting fed and if they're not being nourished and if they can't move with ease, then they're going to get pissed off and send a signal. So, clearly our perception of our bodies... I have a client who's lost function of pretty much the left side of his body after a car accident that severed a lot of the nerves that were in his neck. It's very interesting to work with him. He can't feel me in certain parts of his body, and of course parts of his body are non-responsive to any impulse to contract, it has no muscles on those sides.

The nervous system is so vitally important and it is so much a part of how we feel ourselves, how we have awareness of what's going on with us, but they're also physical. We're not just a walking brain and nerves. We're not maybe something even more ethereal of electrical signals. We're not just electrical signals. We are fibers, we are fluids, we are different organizations of fibers and fluids. We are different densities of fibers and fluids in different types of tissues that are constantly informing that nervous system. So, changing one changes the other. The interdependence is completely inseparable in my mind.

Nicole Trombley:

That's sort of how I think about it too. That all of the nerves and the input we can put into the nervous system, they're in a physical environment-

Rachelle Clauson:

Physical environment,

Nicole Trombley:

... that we can put in mechanical input too. In areas like our deep fascia, sometimes we're trying to affect the remodeling of the collagen, but there's also this liquid gel element-

Rachelle Clauson:

So important.

Nicole Trombley:

... of hyaluronan, if we want to stick with the retinacula. The retinacula are the most hyaluronan-dense part of the fascial system. Hyaluronan, it's a glycosaminoglycan, it's gel lubricating, sometimes thick, sometimes more watery substance that is layered... The deep fascia that Rachelle was talking about, these sleeves and stockings is about two to three layers thick. It's like baklava sheets of phyllo dough with thick gooey stuff in between it. It's that happening in a micro level, but these sheets of the baklava need to be able to move slightly separately from each other. Whether you've got force going in a longitudinal direction or transversely. Hyaluronan responds to mechanical stress.

Rachelle Clauson:

The bonds change. The mechanical bonds change with touch and with stress.

Nicole Trombley:

If that's one thing that we can manipulate is the viscosity of the hyaluronan in our deep fascia, that's going to inform how the collagen fibers are pulling on the nerves within that deep fascia. That's more the framework that I'm using. 

Rachelle Clauson:

I think when you think About that a lot, the slidey, glidey, gooey stuff is really a huge focus of my work these days that I don't really care about how tight or toned the muscle is. I want to know how well is that muscle able to glide over the things it's supposed to glide over. How strongly is it anchored to the things it's supposed to be anchored to, and how free is the motion capacity based on these densities of hyaluronan densities of fluids? Is there enough fluid even in there? Have they gotten glommed altogether? So, I'm thinking a lot more about the fluids in those parts of the body than I am the neurological contraction and response. But ironically, when you put your focus there, you start to give these really sumptuous, luscious sorts of treatments, which has a very positive neurological effect on your client who will oftentimes go into a state of deep relaxation and then they let go of the muscles. I'm not making them let go. I'm bringing their nervous system to a place where they can really let go and relax.

Til Luchau:

Well, this picture, you're painting of a continuum, it's not either structure or neurology, it's consistent with where the field is going. We're post-structural. And we started really questioning all of our structural explanations for things and our ability to actually do things like can we actually reorganize collagen? I think we're moving into a post-pain science realm where we're saying the pendulum is swinging, some we're saying actually structure does do something, the actual ways the layers glide or don't, the ways the density is there or is not influences, perhaps, what the nerves are perceiving, the signals they send. And we're looking for ways to work that really encompass them whole continuum. And you've given us one there to talk about how your hands are feeling things in the tissue, and yet you're thinking about the ways that you're also influencing the brain's perception of what's going on. And you come up with this luscious experience on the client's side, you're singing to the choir. Thank you very much there.

Whitney Lowe:

Yeah, it sounds like-

Rachelle Clauson:

Love you guys.

Whitney Lowe:

... what we're all describing is this amoeba response of one day it bulges out towards neurologically influenced, another day it bulges out towards hyaluronan uninfluenced and fascial influenced and proprioceptive. Another day it bulges out toward real structural problems. It's just what happens to be. There's always a mix of those different things, but the mix may vary or something.

Rachelle Clauson:

Yeah, from one situation to another, one area to another one person to another.

Til Luchau:

Is it time to tell us about your fascial plastination project?

Rachelle Clauson:

Oh my gosh. How many hours did you say we had for this?

Til Luchau:

Not enough. This is the part one.

Rachelle Clauson:

Oh, it's so much fun. Thank you so much for giving me this opportunity to chat about this stuff with you. It's so fun to think with other thinking practitioners. We like to nerd out on all this stuff, but it's so tangible, it's so accessible and it's so real. I think that that's where our passion and drive comes from is to really share these stories. It's not something that's so rocket science, hard to comprehend. It's really tangible stuff. And we tend to use a lot of analogies in our teaching as well to help people just think in the really familiar spaces of, you've seen this before. You know this, you know how you would interact with other substances, like things in your kitchen. We use food analogies a lot because we know about textures and layers and how things respond. It's a fun thing to be able to share with people. One of the biggest things that I've had the pleasure of being a part of in this topic of sharing meaningful visual information with people came in the form of the Fascial Net Plastination project. What a ride.

That was a project that started, actually, I think the application process was in 2017, and it's still kind of going, but for the next five years of my life, I was really, really deeply involved with this project, which was a collaboration of the Fascial Research Society with Body Worlds and the headquarters of Body Worlds' actual laboratories, which is called the Plastinarium in Guben, Germany. Robert Schleip headed up the request that this collaboration happened. It was not a new request for 10 years. They had been asking, can we create a full body plastinate, which is a cadaver that has been preserved through a method called plastination where all the water in the body is replaced with plastic that is odorless. It is permanent, it holds its shape, it can be viewed outside of the dissection lab and the artistry of the people that work on these projects and have developed this, and the woman who has spearheaded the invention of Body Worlds is beyond measure. They are true-

Til Luchau:

So, these are museum quality exhibitions showing anatomy that came out originally as a musculoskeletal anatomy. And this was a moment when at Robert Schleip's initiation, he got that team interested in fascia. And you were part of that original plastication project? Yes.

Rachelle Clauson:

All the way through to its final revelation. There were two unveilings, one that happened during COVID in Germany on site at the Body Worlds exhibit because the Fascial Research Congress got postponed by a year. But then the big reveal at the Congress happened the following year of a single

Til Luchau:

Whitney and I were there.

Rachelle Clauson:

Yes, you were. It was good to see you guys there. It was a female form, and the goal was to dissect and show the fascial system a goal that was set with lofty ideas on how that could be achieved. We all could see it in our mind. It's like a hollow body that you can see through and you can see the sleeves and the stockings and the compartments, and you can see all of the spaces and all the other stuff is gone, which would be great if it were a computer program where you could just click delete and all that stuff would go away. But there were so many barriers to its creation just on the physical possibility of it. How do you get inside of a closed unit and remove the items that are in it without destroying it? That was a big first question.

What would give structural integrity to the entire form if everything that held its volume and shape was removed? How would people understand the continuousness of fascia with the rest of the structures of the body if the other structures of the body had been removed? And then the very practical stuff is like once you've removed things and then you're going through the plastination process of embedding everything, infusing everything with plastic, what would prevent all of these new compartments, devoid of their muscles, from collapsing on each other, sticking together, never to be re-volumized. The original project was cautiously accepted as a challenge accepted. Let's get going and see what we can come up with. But the original design turned out to be incredibly different from the final design in some respects.

I think once we got going the right direction, what we realized was there would be a story told through Windows, a story told through leaves and pages and flaps and pockets and stair steps down, leaving a lot, actually, of all the other structures in place in order to show how fascia connects one thing to another. We posed the question, how do you dissect, which means separate, something that's, the essence of its role is that of connection. It was just like-

Til Luchau:

In many ways you were doing a reverse dissection. You were highlighting the things that usually get taken away to show these connections as opposed to showing the muscles or the parts that traditional dissection shows.

Rachelle Clauson:

Yeah,

Til Luchau:

Tell us something briefly about the reveal. We want to at least spend another minute on this before we change topics and then especially how people might be able to get a glimpse of it themselves.

Rachelle Clauson:

Yeah, so the reveal was... What do you mean? Tell about where it was shown?

Til Luchau:

Yeah, what was the culmination? What did you come up with? You wanted to make this model, this 3D model. Did that happen? What was that?

Rachelle Clauson:

Yeah, it did. I think it happened in a really great way. The emphasis then became how do we show fascia from surface to depth, from head to toe, from front to back? We were able to do that, showing in very specific ways, preserving the skin. For example, there's a piece of skin that is still there that runs along the back of the body in a beautiful spiral line and then goes down the leg, and then the next layer is the adipose or subcutis with the superficial fascia membrane embedded in that. And then there's a strip that parallels that shows to that depth. Beyond that, the next strip shows too, the superficial fascia membrane layer. So, this stair stepping down and then to getting to the deep fascia. And then in the antebrachial fascia and the brachial fascia and the fascia lata and the fascia cruris, these sleeves and stockings, windows were made into the deep fascia, deep diving suit, as Robert Schleip, likes to call it the compartments and understand how thin, even though incredibly strong the deep fascia is, it's really thin.

In the lab it's pearlescent and it's somewhat translucent. Once it becomes plastinated, it becomes a little bit more opaque, and of course, creates more stiffness than is there. But we were able to show that. But then even deeper structures like the mediastinum. We were able to show the view from inside of the rib cage where you can see the fascial structure's, continuity from the throat down to the diaphragm and then into the brain, the meninges of the brain. I think that what was so amazing about this, there's so much diversity within the fascial system that we were able to show samplings throughout the entire form of how these exist and appear in such different ways with different jobs and different appearances to help, for maybe the first time, to start to get in the mind maps that we have of the human body to put the connected, like you said, the stuff that's removed to put that connected tissue back into the story.

Most of us, when we think of anatomy, we think of a muscle chart, and all the fascia is gone, and the muscles have been bubbled out. The ones at the bottom of the butt is so funny to me. The gluteus maximus does not have that shape of the bubble butt that's underneath that is fat on every single human. I don't care how skinny or how much you work out that is a fat shape, not a muscle shape. But to make our muscle charts not look weird, they actually fill in where the fat has been removed with muscle to make it look like a normal body to you. So, FR:EIA, we named her as the fascial... It's called Fascia Revealed: Educating Interconnected Anatomy is an acronym we made for her name, just out of respect to give her a place and a reference point. It was not her real name in life. But she is now currently living in the Berlin exhibit of Body Worlds. If you're near there or are going there, highly recommend going to see her. They have turned it into-

Til Luchau:

Berlin Body Worlds. Yeah.

Rachelle Clauson:

Yeah, an entire-

Til Luchau:

Is there any online imagery available? Are there places where people can go and see it?

Rachelle Clauson:

There's little, actually. They're very protective of their plastinates and of their dissection approaches and those kinds of things. There is some. When you go to the Body Worlds' website, you will see three different views of FR:EIA and you can get a really good idea of her. Of the project itself, you can learn more about that from the Fascial Research Society's page. It's fascialresearchsociety.org/plastination, there's some information there. We also have a Linktree. If you look up Fascial Net Plastination project on Linktree, there's a series of links of all of the different... There's a mini-documentary that I filmed for that. There's also a short trailer that I filmed for that. And then articles that have been written by myself for ABMP Magazine as well as for Massage and Bodywork Magazine, as well as quite a few of the other participants that have written different articles about FR:EIA in different publications. There's links to all of that. We'll put that in the show notes too. I think that would be a great resource if people want to dig in, learn a little bit more.

Til Luchau:

Awesome. We'll be sure to list those as well. Tell us how that led to the collaboration the two of you are doing. What is AnatomySCAPES? What's that like and how does that connect what we've been talking about?

Rachelle Clauson:

Really directly, very directly because after five years of back and forth and two particular years going back and forth a lot to Germany, sometimes for a month at a time to do this dissection. I was dissecting 40 hours a week, and it was great. It was educational beyond anything I've ever read in a book, because a lot of the things that show up, you're like, wait, this isn't even in the book. What is this? But I really got bitten by the bug of studying in the lab. So, when I came back to the U.S. and I wasn't going back to the lab in Guben as much, I was really hungry for another opportunity and was introduced to the fact that we have labs here that are bioskills labs that were open to having massage therapists that are not clinical anatomists, do research and study there. So, I invited Nicole to come with me and the rest is history. But go ahead and tell the history of that.

Nicole Trombley:

The project, AnatomySCAPES, birthed out of a moment in time as well, it was high pandemic here in California. Our massage practices were being shut down every few months, but the lab wasn't shut down. So, we also had time to actually go into this lab that has been unbelievably supportive of us. Before we knew it, we had... I have a team of massage therapists who work with me. Suddenly had many workshops happening and we spent probably, what, two years really just in the lab as much as we could, learning, exploring, and suddenly putting curriculum together from a massage therapist perspective.

I'd say we're trying to teach anatomy from a little bit... It's not the anatomy you want when you have to study for your boards or you're taking the MBLEx or an exam or you're trying to master the muscle charts. This is the anatomy that is about continuities, about textures. We look a lot at fat and skin as well as the deeper fascial system. We definitely see muscles. We're still in love with muscles, but we're looking at where tissues glide, where they root-

Rachelle Clauson:

And relationships, yeah.

Nicole Trombley:

Yeah, and how can we peek beneath the surface and see how these tissues are moving under our hands and trying to give ourselves a better understanding of what we're touching, what we're feeling, and how some of the more superficial layers influence and masks sometimes what we think we're feeling underneath.

Rachelle Clauson:

Yeah, for sure. The cushions. We call them removing the cushions to be able to feel things in isolation. And then you put the cushions back on and now suddenly you can feel it better. So, your palpatory skills go through the roof and your mind map gets so much stronger and you have-

Til Luchau:

So, this is a online resource where people can go see your dissections. And with all these qualities you've been describing, am I on the right track?

Rachelle Clauson:

In person.

Nicole Trombley:

In person.

Rachelle Clauson:

We do in person workshops.

Til Luchau:

In person. Thank you.

Rachelle Clauson:

It's all in-person. Because we're emphasizing so much the palpatory aspect of it. Now, we do have online courses. And our online courses include a lot of the things that we're talking about today as well as a great amount of imagery and some shorter video clips to help to demonstrate what we're talking about, whatever the focus is for that class. But as far as the really elaborative dissection, you have to come into the space with us because that's really where the heart of it is. At the same token, we spend a lot of time in the lab as well as in the classroom. I've been to dissection courses that spend most of the time in the dissection lab, which is great. They're very expensive. You want to make the most of every minute. But sometimes I've had a hard time, where do I put this information?

I just saw stuff that I don't know, I don't recognize it. It's so different. What's allowing it to be where it is and what's its role and job? We've taken a lot of time to put together a lot of really beautiful written materials.

Nicole Trombley:

They are beautiful.

Rachelle Clauson:

They're really colorful. They're read magazines instead of course handbooks. Also, we're both crafters and we like to touch things and see things in 3D. So, we're pulling out magnets and yarn, and we're always making things in the classroom space as well to help really solidify your understanding of what it is that you're seeing in the lab.

Nicole Trombley:

We delve a lot into the science. We think that... We don't think, we know science is not that accessible to a lot of the population. And it tends to be true for a lot of massage therapists. Not everyone wants to know the science, and not everyone needs to know the science, but a lot of us do.

Rachelle Clauson:

It can be heavy though. It's hard to read. 

Nicole Trombley:

Yeah. So, we spend a lot of time delving into the science and trying to do it in a way that makes it really accessible. So, we'll geek out on hyaluronan, but we also talk about hyaluronan and water having a love story. We use some 3D models to talk about that relationship between hyaluronan and water and how it's influenced by mechanical touch and heat to really try and get that concept in a really deeper way for people, so it doesn't just-

Rachelle Clauson:

Just doesn't roll back out of your brain. It's like it's in your body, you understand it, you know it, you've had fun with it.

Nicole Trombley:

Yeah, the dissection lab is overwhelming enough. We don't need to flood people with really complex concepts. We want it to be really understandable.

Rachelle Clauson:

But keep it high level. Yeah, it's kind of the both. How can we be the interpreters of this information to bring it to the practical space where you work and live?

Whitney Lowe:

Yeah, it seems a challenge a lot because so many people in our field of massage and manual therapy view anatomy as something you had to get through in school. I think once they leave, a lot of people just feel like that piece is behind them. So, it seems like you're really doing some interesting things here to try to inspire people and get the energy and enthusiasm about this is a whole different way to look at why this stuff is really relevant and important there. So, it sounds like you've got some challenges to reframe some of the mindsets around the value of learning anatomy stuff and going back and maybe like re-learning and re-looking at it from a completely different lens now.

Rachelle Clauson:

Yeah, for sure. No, thank you for recognizing the challenge, but also that we're trying to do that in a way, hopefully, that people do get excited about. I would say that I've heard from a lot of massage therapists that will say, I don't know anything about anatomy, my anatomy training was too fast, too short, and now I'm facing these bodies with these problems, and I don't even know what I'm touching here. They are actually of their own accord recognizing that they probably didn't pay enough attention because like you said, initially you're like, yeah, yeah, yeah, yeah, I kind of... Or maybe it's exciting to them, but it's a lot to know.

We're still constantly revisiting muscles we thought we knew and then going like, oh, or tissues. We thought we understood. I can reread the same thing over and over again, and I can definitely, every single time I go into the dissection lab, I always learn something new, always, because not only is it endless as far as the depth with which you can understand something, the viewpoint with which you can view something, but it also has to do with the fact that every single person is different on your massage table and after death. The cadaver donors are people that had real lives with real experiences with real exercise programs or not and health issues or not. So, every single one of them comes in just as uniquely as your patients who come through the door. So, you're going to learn something from them. We actually always say that, and this is not an uncommon thing to say, but the donors are the professors. We are the guides.

We are there to guide you through their story, to learn about what's going on here, to help you see things that you will find consistently in yourself and in other people, but also things that are unique to this person's story, and the record that they left in their tissues is a lot of times how Gil Hedley will reference it. It's such a profound way to learn. We're trying to also make it accessible, affordable, not having to commit huge amounts of time. We're doing shorter workshops partly on purpose so that it's a less expensive investment so that you can get the benefit of it. But still taking our time to introduce people to the space slowly enough that it's also not a jarring experience, but one that they can go away with and be saturated but not oversaturated. 

Til Luchau:

These are your live events, we'll be sure to link to those on our site. I want to thank you for joining us today. Briefly, what would you like people to know about connecting with you on our way out here? What would you like them to know about how they can get in touch with you, and what they should... If they go to your beautiful site, by the way, what should they click on first? How can they find out what you're up to now?

Rachelle Clauson:

Oh, if you're interested in studying with this, click on the workshops tab first and look for the Matrix class. We've got one that's coming up in October, so there's still time to plan.

Nicole Trombley:

There's four spots left.

Rachelle Clauson:

I think there's four spaces left. It's getting to be full, so that would be the very first thing to do. You don't even have to click, you're going to get a pop-up window that's actually going to give you free access to our art gallery, which is a series of images that we've taken from the dissection lab. And then we've done... Do you want to describe what do we do with those?

Nicole Trombley:

We do a lot of photography in the dissection lab and we want to make it really accessible and beautiful. This is cadaver forms. That could be really a lot. It could be a lot to look at. So, we do a lot of really zoomed in looking at fiber direction. And then we enhance the photos a little bit. We pixie dust them-

Rachelle Clauson:

We call it digital pixie dust. It's an in-house term.

Nicole Trombley:

... making them more of an art piece than a harsh anatomical photograph. But it's really our way of... Just what really inspires us at the beauty of the human form in these images. But we do, we have a... Is it the deep fashion collection that's up right now?

Rachelle Clauson:

I think so. It just pops right up. You just give us your email and agree to not share the images or something along those lines. That will be your first thing to do. And if you're not captivated by that, then I don't know what to say because the textures, the patterns, the organization, the tissue of the human body is more beautiful than any botanical gardens you've ever walked through in your life. And it's as shocking as how diverse it is.

Til Luchau:

So, you have some beautiful art, you have your live events, and you have some online courses.

Rachelle Clauson:

Yeah, we do.

Til Luchau:

I recommend people go check that out. We'll link to all that. I want to thank you both for joining us today.

Rachelle Clauson:

Sorry, I was going to say the other links that we would say, we'll put them all in there, but you can find us on Facebook for sure, AnatomySCAPES and also on Instagram. We're working on getting those things going. Of course, we have some podcasts that are going with ABMP right now, as well as our... Every issue, there's a column, with free access, you can get by going to the ABMP website. There's more stuff in the hopper. We've got more things coming your way. But yeah, we'd love to connect.

Til Luchau:

Awesome.

Rachelle Clauson:

And also, sorry, we have membership portal through Patreon as well. So, if you find AnatomySCAPES through Patreon, you'll get weekly content from us and it's good content, videos as well as images, as well as columns, as well as articles-

Nicole Trombley:

Including some dissection videos.

Rachelle Clauson:

And some dissection videos as well.

Til Luchau:

A lot of people don't realize that ABMP articles you can access even if you're not a member, you just got to go to their site. So, I want to really recommend that. Whitney, are we ready for our closing sponsor?

Whitney Lowe:

Yes, indeed. Again, just thank you all both for a fascinating discussion here. We really appreciate your taking some time out to join us here today. Also, keep in mind, Books of Discovery has been a part of the massage therapy and body work world for over 25 years. Nearly 3000 schools around the globe teach with their textbooks, e-textbooks and digital resources. Books of Discovery likes to say, learning adventures start here. And they find that same spirit here on The Thinking Practitioner Podcast and are proud to support our work knowing that we share the mission to bring the massage and bodywork community thought-provoking and enlivening content that advances our profession.

Til Luchau:

Instructors of manual therapy education programs can request complimentary copies of Books of Discovery's textbooks for use in their programs. Please reach out at booksofdiscovery.com and listeners like you can explore the collection of learning resources for anatomy, pathology, kinesiology physiology, ethics and business mastery at the same website booksofdiscovery.com, where you as The Thinking Practitioner listener can save 15% by entering thinking at checkout.

Whitney Lowe:

We would like to say, of course, a thank you to all of you, the listeners and to our sponsors. You can stop by our sites for video show notes, transcripts, and any extras. You can find that over on my site at academyofclinicalmassage.com. And Til, where can they find that with you?

Til Luchau:

My site, Advanced-Trainings.com. If you have comments, questions, things you want to hear about, we love to hear from you. Thank you for the messages. If we do get. Just record a short voice memo on your phone and email it to us or send us an email or find us on social media. But if you want to email us, it's at info@thethinkingpractitioner.com. Social media, you can find us under our names. My name is Til Luchau. Whitney, what is yours?

Whitney Lowe:

Today my name is Whitney Lowe. You can find me on there, social media as well. And if you would please take some time, just a brief moment to rate us on Apple Podcast. It really does help other people find the show. You can hear us wherever you listen to your podcast. Lots of different apps there. So, please do share the word. Thank you again both for joining us today, and we'll talk to you in the next time.

Rachelle Clauson:

Sounds good. Thanks so much you guys.

 

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