The Thinking Practitioner Podcast:

Episode 144: Fascia, Emotion, Inflammation, & Attention (with Robert Schleip)

Til Luchau  

Welcome to the Thinking Practitioner podcast, a podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today. I'm Whitney Lowe and I'm Til Luchau.

 

Whitney Lowe  

Welcome to the Thinking Practitioner, where Books of Discovery has been a part of the massage therapy and bodywork 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 that 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 to review for use in their programs. Listeners can explore their collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics and business mastery at booksofdiscovery.com where you as a Thinking Practitioner listener, can save 15% by entering "thinking" at checkout. Robert Schleip, thank you for joining us today.

 

Robert Schleip  

I'm very much looking forward to it. 

 

Til Luchau  

You've been one of the most influential voices in modern fascia research, both in the lab and in the practice room, certainly in my practice room, you are the director of the Fascia Research Group at Ulm University in Germany, and you've helped bring fascia into the scientific mainstream, while also staying

deeply connected to the world of manual and movement therapies. You are founding force behind the very first Fascia Research Congress back in 2007 and they've continued ever since. And you've continued to shape every one of those in the years since then, we have one coming up in August of this year, which I'll look forward to hearing a little bit about. You've also been a mentor of mine, an inspiration to me, starting back when we were both at the Rolf Institute long

 

Robert Schleip  

time ago, yes, yes, nearly, actually, next year before, you're proud to be a former mentor. Of you and now we are inspiring each other. Okay,

 

Til Luchau  

I don't know if you ever graduated something, if you ever become a former mentor, because you're still inspiring me in many ways, because I've always loved your curiosity, and especially your ability to bring people together and have conversations across disciplines and perspective. And then every time you've been on the podcast before, and we have a couple of visits from you before, those episodes are some of our most popular ones. So I know listeners are going to be really eager to hear what you've been working on and what we're going to talk about today. You and let's talk about let's start by talking about your keynote at the upcoming Fascia Research Congress in New Orleans. Tell us about that. What are you going to be talking about there? Then we'll switch and talk about the event itself.

 

Robert Schleip  

Ah, okay, so this is already the hottest topic. I thought we would build it up, and then I would get to the hottest store. So we start with the hottest topic, at least for me, which, of course, is my keynote. So if you ask me, What are you looking forward? I would say I look forward to my colleagues, and then at the end, I would talk about my topic. But now, of course, I'm very most excited about the topic that has been engaging me in the last one or two years, and that is looking at the connections between the body wide, threshold net, the autonomic nervous system, emotions, particularly in the form of post traumatic stress disorder, and the immune regulation. So that sounds like a whole lot, but they are very intimately linked. So of course, in the field of psychoneuroimmunology, it's been known for a long time that the autonomic nervous system, emotions and the immune system are interacting very dynamically with it. So that is no longer a hypothesis, but now we have very robust data that fascia is part of that intimate game that happens every week, every day and probably every hour, you know. So that is my hardest topic. Okay,

 

Til Luchau  

I am going to pause us right there, because I think we do need a context that is really exciting, because we've for years, and intuitively, many of us think, okay, the motions in the body and tissues and their qualities and their responsiveness go together. But no, we haven't always had robust research or dots we can connect. So I'm really excited to hear about that. But let's, do back up a little bit and tell us a little bit if you don't mind, about the Fashion Research Congress. How would you describe the direction that this year's Congress in New Orleans is going to take compared to previous ones?

 

Robert Schleip  

Some of the old timers are no longer there. Who had shaped it? Leon Chaitow was a very important figure, unreflaming is no longer very present, and Tom Findley, who has been shaping me and this Congress very strongly, they are no longer there, and that leaves room for younger people to grow and take over responsibility and to put in their passion into it. And I can see that very strongly, because now we had a four year pause due to the pandemic, where usually we have the Congress happening every three years. So there is a new generation now, and they are more collaborative, and they ask more clinically irrelevant questions, and they are not so respectful of scientific traditions, where you you stick to the mechanical aspects, and you leave out the emotional factors, if you are in in danger of getting unscientific about it. So you can see, then the agenda, but also in the collaborative spirit, and that they also invite people with outside opinions to take part at that conference. So it has a broader spectrum, and it has a bigger networking spirit.

 

Til Luchau  

You have some really interesting guests at this year's Congress. You have Stephen Porges coming, yeah. Well, I'm excited to be having a conversation with here on the podcast shortly, and his work with the autonomic system lays some interesting groundwork for your presentation. I think. Yeah,

 

Robert Schleip  

yeah, yeah. So I was involved in getting him because we I had been connecting with him decades ago. He used to be research director at the Rolf Institute with John Cuttingham in late 1990s so he did some myofascial fascia-related heart rate variability studies, which probably for two decades, were the top of the Rolfing-related research, and nothing happened after him for a long time. So so this is a highlight for me to get him back and and that also fits to my topic, but also to Gil Hedley's topic, that we look at the vagus nerve from different perspective, from anatomical perspectives, but also the relationship of the vagus and the autonomic nervous system, inflammation, regulation. I know you are on that topic. So the recent research has shown that the body wide inflammation is strongly influenced by the solitary nucleus in the brainstem, and that one listens mainly to the vagus. But it's not only the mammalian vagus, the smart vagus, it is also the old vegus. So I'm like very much looking forward how Stephen Porges, because in last two years, people showed that not all of his evolutionary assumptions are anatomically correct, and he embraced that. So I'm very much looking forward how he will go beyond this, the triune autonomic nervous system in which the social vagus is completely different than the dorsal vagus, and how we look, how they both interact in the regulation of body wide in silent inflammation, and that will be a very nice topic that we never addressed before, however. So we knew from Helen Lorshavor, we knew from other studies that myofascial pain and inflammatory cytokines are basically very strongly interacting via the fibroblast in the fascia system. But now we have them very much linked with the vagus and and the immune system, so that will be a great topic. And it's nice to have Gil Hedley there with his latest anatomical discoveries, where the vagus goes and and how it connects. And then to have Stephen Porges from his vast and very potent I mean, he has influenced 1000s of psychotherapists in my country to work much more mindful, much more potent with a very delicate, body oriented trauma therapy with the polyvagal model that he has developed. So that will be definitely a highlight to have him there and to interact with Gil Hedley, with Carlos Stecc, with you and me and many others.

 

Til Luchau  

That's that's exciting. Gil is such an inspriational map follower. He'll show us the territory. Oh, yeah, own style. And then yeah, Stephen Porges, his theoretical understanding and his framing and his opening doors with those kinds of ideas has been really influential, like you said. And I'm

 

Robert Schleip  

looking forward to introduce Catarina Fede to Stephen Porges, so that would be right there, Steven, this is Catarina Fede, my good old Catarina, because she comes from a new generation, but she she does work that he cannot do in his laboratory, you know? So, so that will be very rich and that, and that's the networking I'm willing to fly over with jet lag and everything, just to connect these different generations, because she knows his work, but she has never met him,

 

Til Luchau  

and her she's done some interesting work around hormones and fascia, yeah, and

 

Robert Schleip  

also the inflammatory cytokines. How you stimulate them? That's right.

 

Til Luchau  

Well, okay, so tell us about your keynote fascia as a neuro immune interface, bridging autonomic regulation, emotion and pain modulation. Is that the right title?

 

Robert Schleip  

It sounds familiar to me. Well, it's enough

 

Whitney Lowe  

for js. What do you want?

 

Til Luchau  

What are you going to be talking about yourself? Because you're the bridge person as well, and you're the one who's helping us synthesize these things.

 

Robert Schleip  

Okay, as you know me, we have lived together for many months preparing for classes. Robert Schleip prepares on the night before you remember that on my on your kitchen floor,

 

Til Luchau  

you've been a good mentor for me as well. Thank you.

 

Robert Schleip  

Of course, I know some of the contents I will share about the depression studies that we have done, but I hope to have some new data. So in a recent study done here in Germany by Leah Oberman, but also supervised by two other professors, including me, she showed that the epimysium around the trapezius is thicker in depressive patients and not the muscle meat, but the epymysium is thicker. And in a previous study, we showed that there is an increased myofascial stiffness, but we didn't know whether that's increased muscle tone news, whether it's the intramuscular connective tissue and or the outer connective tissue, but now we know now it's similar to delayed onset muscle soreness, in which, also in the last one and a half years, Jan Wilke has shown that in delayed onset muscle soreness, which is very different to

 

Til Luchau  

depression, the soreness you get after exercise, for

 

Robert Schleip  

example. So if you run down the mountain and on the next day you cannot walk straight, this is called delayed onset muscle soreness. And now Jan Wilke has shown you can measure one day later that the epimysium so the fascia envelope around the muscle is not only more sensitive, we knew that already five years ago, but that it's also swollen, and now we have a similar but I'm also convinced, Partly different response and different to healthy people in depressive patients. So their epimysium is thicker, but whether it's swollen, I don't know if that term is correct, because we would need to measure the stiffness and see if the water content is increased. So in the DOMs, I'm pretty convinced it's not new collagen fibers. You cannot grow them in 24 hours, yeah. But the hyaluronan can attract more water. So there it's a water swelling. But in the depressive people, it may be starting with a water swelling, with an edema, with a hyaluronan, different water binding, different viscosity in the ground substance, but then it may become a fibrosis, and that's how the ultrasound picture seemed to look like that it's not only thicker, but that it's also more whitish color on the ultrasound indicative, but not totally reliable, of a higher content of collagen type one fibers.

 

Til Luchau  

And then for clinicians, that would imply, perhaps a different time scale on their expectations, perhaps, or a different approach. You had the implication that a great application,

 

Robert Schleip  

yeah, and you and I had been influenced by a Reihan body type thinking 20 years ago, where they have been talking about the body armoring. And I was very hesitant to go into that direction, because I come from that field of plot. Possible assumptions, and where psychological tension is the reason now for every stomach cancer, etc, and we have become much more careful, also due to the replication crisis associated we had that in the last podcast, I think about Amy Cuddy, where people projected on emotional attitudes to influence our hormonal regulation. And the scientists told us, no, that is not replicable. So now we are willing, very careful, to look at emotional factors, including the body armoring hypothesis of Wilhelm Reich, and it seems to be possible that depressive people are less sensitive on the outside. There is even a meta studies who shows it and more sensitive on the inside. And that could be partially a body armoring so you densify your shell, because you're very fragile on the inside, and that would be a character strategy, or at least it's a body wide, not just a local mechanism to respond to it. So you see how I'm talking with long sentences. So we need to go very careful in that direction, but I think we have done our homework, that we can do that, that we go carefully, step by step.

Do you know I'm curious if you found a way to possibly tease apart lack of movement, and how it may be contributing to that? Because in depressive patients, we know there's oftentimes less physical activity also associated with that is that something that they've been able to kind of separate out. No,

 

Robert Schleip  

but that's not only that. Also the head forward posture, you know, that could be influencing that to the same degree. Yeah, those

 

Til Luchau  

rake and those old reckon models. We don't need to spend a lot of time with those. But just briefly for listeners, they postulated different shapes or different even densities or body qualities associated with different character styles or character strategies. And you and I think we did throw those babies out with the bath water and our thinking at some point, because so little ability to correlate those with replicable issues, or to actually have findings we could point to, and so much of it was interpretive rather than deductive. Or, you know, we can map things on. And you're saying now you're finding things that do correlate tissue quality, perhaps, and maybe the overall organization of sensation in the body with these different states. So how about

 

Robert Schleip  

with a you're perfectly right? So whenever you have a myofascial pathology, or at least myofascial pain, you usually have lack of movement. You have a stasis in the lymph and in the fluids, and you have a shift into chronic inflammation. And they all are like chicken and egg right there, right so my friend Werner Klingler, he says, Robert, forget. He will be there at the conference. He doesn't believe into the right in theory. He says it's all about inflammation, you know, and that's why the API Museum is swollen. Forget your character.

 

Til Luchau  

That's I think, in my own thinking, I've left the character idea behind, because it's so shape based in noci variable. But inflammatory processes make a lot of sense, both in my experience, but also my thinking about it, I want to get into that a little bit. And fascia is rolling that. But Whitney, you had a couple questions. I wonder if we want to go there at this point.

 

Whitney Lowe  

Yeah, we can certainly jump in that. I was, you know, curious about a few things, and this kind of ties into what we were saying here. I'd like to hear maybe, if you can elaborate a little bit on on, you know, because I know a lot of people who are coming to the conference also are clinicians wanting to know, like, what can they do, and how might what we're learning now about all these connections with the neuroendocrine system, with the emotional things, how can we sort of intervene with a manual therapy approach to do something about these things? Is there, is there a have we kind of like uncovered any sort of mechanism of of intervention that seems to be most effective in addressing some of these things that we're discovering?

 

Robert Schleip  

Yeah, if I stay with the depression study, they treated the depressive patients either with regular foam rolling or with a sham rolling treatment, which was not rolling, but I think it was rather well done. So instead of rolling with a metronome three seconds in each direction, on their lower back and on their hamstrings, they had them lift their head. And then rest it for three seconds, giving all their weight on the foam roller, and then lift it again. So it was a more mechanical movement, and there was a clear difference in the outcome, only the rolling group and not the mechanical static pressure group, where the maximum pressure was the same, also the physical exhaustion was comparable, because for foam rolling, you need to be physically active and stabilize your half of your body weight, etc. But they did a memory recall test in which they read a list of words to the patients. And then after five minutes, they read another list and asked with each word on the second list, did you hear that word five minutes ago? And the depressive patients, they remember every negative word, even if it was only mentioned briefly once. But if the if you have a positive word in the first list, even if it's there three times and you read it again in the second list, No, I never heard it. So that is a very established and very reliable test to measure, for example, if a pharmacological treatment or behavioral therapy for depression is already working, or whether you need to extend it, and it's not, are they listening? It means there is a filter. And you can tell them the best poetry in the world. You can give them a wonderful massage, but they will not register it. And you tell them one thing, but please come more in time next time, and then they focus only on the little thing that you gave them a negative on that day. And in the foam rolling group, they had significant shift after the foam rolling where they said, Yes, I heard this beautiful guard before, but they didn't have that shift in the other treatment group. And now, of course, what is it in foam rolling that shifts a filter in your brain most likely, and I think it's a mindful attention, because when you're rolling there, you you stop talking to yourself in this rumination. So it's called Default Mode Network in neurology, where you are always talking to yourself. So even if you try to meditate and not have a thought, somebody is talking with himself. And this has some advantages. For example, it may make you more creative. You have more associations. It's very good to talk with yourself and not listen in the present moment for the consolidation of short term memory into long term memory. But for the depressive patients, they cannot stop it. And when you are on the foam roller, and this is our hypothesis that we are now exploring, and you are rolling with your body weight. There, you pay attention. You can I go? Can I not go? Does it get painful? I better pay attention there and you stop talking to yourself, yeah. So we are now repeating this study where the foam rolling people we do mental distraction. So you give them a Stroop test or something where they count backwards in both direction. So that means their attention is also distracted. And then there may not be a difference between the foam rolling and the control group. So that would be but that would be a clear answer. If you do a manual treatment, if you do a stretching, if you do any kind of theory, and if our hypothesis is correct, which I have not yet shown, but it may be true, then if you allow the depressive patient to continue daydreaming, you will not be as efficient, at least on that level, as when you try to get their here and now attention and to listen with 80% of their attention and not just 10% of their background attention to what you're doing, so that would be a concrete application. Yeah,

 

Whitney Lowe  

so let me ask you to kind of project some of your previous findings to you've spoken so much about the extremely rich sensory innovation from the fascia network. Do you think that something like the movements associated with the foam rolling and the fact that you have to have greater proprioceptive control because you're doing those kinds of movements might play a bigger role than somebody, for example, passively receiving a manual therapy treatment.

 

Robert Schleip  

Yeah. I mean, that was a big shift already at the last conference four years ago, and we now look at fascia as our richest sensory organ. If you look at the whole fascia network, not just the envelopes, but also the intramuscular connective tissue, for example. So but then the question is, massage could also stimulate these 250 million sensory networks that you have in your body. But the question is, you may filter them out. So we know that the radicular for my formation in the central nervous system, mostly in your spinal cord, filters out the majority of the potential sensory stimulation coming in. My favorite example is my underwear is touching me now at 1000s of spots, and I could be ecstatic about all these gentle touches that I have there. And if you would replace my underwear with 1000s of pencils or little brushes, I may have a wonderful massage. But since the underwear is considered not to be important, and since it's static and not shifting, my reticular formation is canceling it out. And if you crane your psychotherapist touches me with the same pressure as my underwear is touching me, it may have a profound effect, or it may have zero effect, dependent of whether my reticular formation says, this is interesting. So it's not what you do in the peripheral tissue only. It's how your central nervous system says, I better listen to that. Yeah. And then we have to play with all the tricks, you know. So if you do a painful treatment, they will listen to you. So that is Ida Rolf trick. But I think they are the tricks.

 

Til Luchau  

I want to go there with Whitney. I want to give you a chance. I think any questions you want to ask, no,

 

Whitney Lowe  

well, I got, I got 10,000 in the back. It's all holding for right now. Yeah, all

 

Til Luchau  

right. So I'm excited by, excuse me, what you're describing there Robert around, especially around the distraction hypothesis or discussions, because I remember, in some of my early Rolf training, our Rolfing teacher said, yeah, this second session is so painful. Talk to your client about something else, ask them about movies or something. And there's something in me that said, Wait a minute, this that there's, there's a missing piece there. It isn't just their fascia. We're trying to change or their structure even, we're trying to impact the way they pay attention, or what their brain does with all that. Yeah. And so you're, continuing that line of inquiry with this question. What I

 

Robert Schleip  

think there are this would be another talk. If you have a one hour or longer body work session there, it's good to have some minutes in which you are together, daydreaming, in which you forget where you are, in which some memories come and go and there is a homecoming like you, somebody is stroking you like in the grooming response that the mammalian do, and they are just or your partner is cuddling you in the background and you're reading a book at the same time, this can be very nourishing, but it's on a different level. So for the social safety, for the interception, for the social connectedness, and I'm very much looking forward to Steven Portes to us, not so much for local myofascial pain, but for a sense of I'm part of a social group. I'm not alone, and I can trust the people around it, then it may be good that the touch is happening in the background without you paying attention. So in a 60 minute myofascial Rolfing session. For example, I think it would be good to have in the middle of the session, a couple of minutes, where the client starts to daydream, and you allow him or how to do it, but at the beginning or the end of the session, I don't want them to daydream, particularly if I work with their scars and with some myofascial pain that they have. So this is a very intriguing topic.

 

Til Luchau  

What's the role of attention and focus on attention, present on attention in the effects we see our touch. That's really, really fascinating, because that turns us into experience facilitators or conductors, as opposed to tissue technicians, yeah,

 

Robert Schleip  

but let's be so I will in my lecture, most likely, unless I change it on the night before I I will report about the studies by the osteopathic group in Italy around cherry tally and they did. Some very nice studies where the therapist was having his full attention on their hands and the treatment, and sometimes the therapists were distracted, but the clients didn't know that, and then they measured brain wave activity, or MRI, and in the first minutes, the client's response was the same, whether the client had whether the therapist was there with their attention or whether the therapist was distracted. But after 1020 minutes, there was a significant change. So the mindful attention of the patient. We know that from Lorimer Moseley studies, for example, can have a significant impact, but also of the therapist. So that will be an intriguing topic that I look forward to address. Oh, that

 

Til Luchau  

is intriguing, and is and what is that? There's questions about what that means, mindful attention. Is it this everyday awareness, focused attention, or is it something more, possibly more daydreamy or more altered. I'm thinking of a story from an Italian, one of the leading Italian Rolfers 20-30, years ago, who would tell the story about doing a little bit of craniosacral work at the end of his Rolfing sessions. Yeah, and he would be kind of tired, so he actually put his head down on the table.

 

Robert Schleip  

I don't mention the name, but the story is beautiful, yeah, so he played on the guy, and it's true, yeah, exactly.

 

Til Luchau  

So he put his head down on the table. Somebody could focus on his work, maybe, but he found himself like falling asleep and he's jerk awake and pretend like nothing had happened. And then he started hearing like, what from his clients? Wow. That was amazing. At the end, that was the best part of the session. Wow. I

 

Robert Schleip  

think I'd fall asleep on the table.

 

Til Luchau  

So who knows what role that our attention plays, but there's lots of experiences we've had in our own practices, probably that let us know that is we, our attention makes a difference too, on what happens, yeah, in the session. But that's

 

Robert Schleip  

why I like the fascia people. They have inspiration in their eyes. They are usually not bought the fascia manual therapist. When they touch they are, wow, it's shifting. Maybe they are fantasizing, but at least they are. They are curious, and they they don't have to force themselves not to dread dream because they are fascinated with how fascia may be responding. And in some of the other manual therapists, they are just doing their five treatments, and then they do three treatments there. So the fascination with the tissue interaction is a very beneficial factor for people working with fascia. Of course, other people have it too, but I think it speaks for us.

 

Til Luchau  

You say that's the actual the facial processes are so fascinating that us, yeah, thinking about them, feeling for them, wondering about them. Yes, we, as we work, is an attention focuser, perhaps, or an organizer of what we're doing with our attention.

 

Whitney Lowe  

That you know, makes me think about this. Like and Robert, since you know this research literature so well, has anybody studied this idea of comparing, for example, the outcome results, or any kind of other physiological parameters that we can measure in somebody who really isn't highly engaged with what they feel like is happening in those tissues, versus somebody who's just sort of going through the motions, like you said, like, you know, If anybody's been able to investigate that at all, yeah,

 

Robert Schleip  

it's this great study. The senior also is Lorimer Moseley, which both of you know very well. Sasha Stanton is the first author, and she did a brilliant study, a very excellent design, where people with with complex regional pain syndrome, they developed a touch oriented therapy based on proprioceptive stimulation, where they cured them in a couple of weeks, but only if the clients gave detailed feedback about so the basically they touched one of five points on the back of the hands. And they didn't see the back of the hand, but they saw a photograph of it, and that then they had to say, Oh, this is point number three that I see on the photograph. And then they always got feedback, and that was very profound. But then they did a control group in which they touched exactly the same points, but the client could read a book, they didn't have to give feedback. So the peripheral tissue stimulation was identical, how much pressure, how much stimulation, etc. But the mindful attention was very different, and there was a clear difference between the group. I would have expected the group with the mindful attention to have a more rapid healing, but the difference was very dramatic. There was zero healing, not less healing. Nothing would improve, even after weeks of treatment, if you stimulate the tissue, but the mindful curious here and now, mindful attention was not with the touch. So for that treatment, for Complex Regional Pain Syndrome, and for that therapy, I wouldn't generalize it all, the mindful attention is not a beneficial factor. It's an absolutely necessary factor for any improvement. So for me, that is one of the Nobel laureate studies in manual therapy. It's been done eight or nine years ago.

 

Til Luchau  

Yeah, you've also done some interesting thought experiments around the role of anesthesia in the body work and things like that. So how much benefit do we get when we're actually present and feeling or registering what's happening? But I got a question, what? Why is it a fascia Congress? What's about fascia? Why isn't it an attention Congress? How does the help me connect the dot backward? Where does fascia play a role in this? Because so far, we're talking about some really interesting things, but where's fascia in that? Well,

 

Robert Schleip  

it all started as a 2007 conference at Harvard, where Eric Jacobson, Tom Findley and me and two to three others, we were really lucky to get NIH funding for the scientific conference, and we had good data based mostly on Peter Heinz work to show that the proper fascia envelope. So what is called proper fascia in terminology, anatomica, has a much more significant role than usually have been assumed, where people think you can put the fascia away and you would still understand force transmission. So that was the basis for the first Congress where the proper fascia, the epimysium, the tendon capsules, et cetera, were addressed. And that conference was so successful, where even the Science Magazine reported very positively about it that we couldn't change the name afterwards. We had very good discussions to say it should be called applied connective tissue research, and then we wouldn't have all these nomenclature debates. But because of that history and the science magazine now what's called fascia research includes all the fibroblast, collagenous elements, even subcutaneous connective tissue under the skin. And I think it's not only a challenge, it's it's a benefit, because it's a symbol. We used to think that the fascia is as relatively unimportant or as important as the wrapping around a human gift is, so you can peel it and you still have the same container, and now we realize what has been done for 500 years in western anatomy, where you think you can understand a muscle without the fetal envelope was completely wrong, that each element you can only understand when You see it in its environment, that the environment shapes the hero to a much bigger degree than you may think at the first side, and that is a big shift. So it's not the gluteus maximus, it's not your heart and your liver. It's, of course, they have certain specializations, but it's this ubiquitous, non fragmented, continuously connected, fibrous network that has become the center of the attention. And now, in the beginning, at the Harvard Congress, and also 2009 at the Vancouver Congress, we were, it was mostly about mechanical force transmission. But now, in the last two congresses, we are moving towards the sensory aspects. And then, of course, you are very right. You know, we should move beyond the mechanical, collagenous network and see it as a sensory network for perceiving our own body, but not only our body, our connectedness into the world. So it's about perceptual issues.

 

Til Luchau  

You're really helping me think this through for myself, because I get stuck, I think, in a split between the tissue and all these other topics you're talking about. About attention, inflammatory response, autonomic function. And when I sometimes, I have to say this for myself, when I hear people talking about fascia, that means so many different things, and people talk about it in ways that's you're not talking about the tissue that I know you're talking about some bigger symbolic process that is probably really great and cool, but I get hung up on, like, trying to make it mean something about the tissue, and you're helping liberate that for me a little bit, understand that we are talking about context. We are talking about the autonomics and all these things, and the fascia becomes our keyword, or maybe our symbol. It, would you agree with that? Or is there? I

 

Robert Schleip  

very much agree with it. Yeah, it reminds me of miles, beautiful distinction between a man made machine and a robot and a body that has been grown from a seed so each body that you touch, including your own body, it used to be a millimeter small, and then week by week, it expanded. And so this how, this is how you take shape, and how you develop your limbs and everything. And if there is any adhesive material, it will continue to grow with you in a non fragmented way. And of course, it has the biggest stretch on the outside, and that adhesive material that has grown with you, even if there were certain fragmented bones that moved away, but that adhesive material that connects everything and has followed the history of You, evolving from a seed into the world that is our fascia network. So it keeps us together, not only in the force transmission between the diaphragm and the pericardium and the pelvic floor, but also because our nerves have followed that. So the way how we perceive ourselves in the world is within that adhesive body wide, non fragmented fascia network. And I think this is a beautiful perspective. And now at this Congress, we are looking at the sensory aspects, but also more the autonomically sensory aspects, not just proprioception and pain, but in the way, how safe we feel in the world, how much curiosity we have. So how? How, whether we are afraid, whether we feel like the world is nice and we can open our tentacles will shape the way, how the fascia goes into densification or not.

 

Til Luchau  

I really want to underline that you're describing not just sensation, proprioception, control. You're describing our basic assessment about whether we're safe or not, yeah, the realm of the insula, or the autonomic function to provide us with either the mobility to respond or the internal processing we need to one of

 

Robert Schleip  

the studies that, since he's not coming there, but he's one of my new heroes, Andreas Brandl, an osteopath. He's not yet very much known, but I see him on a line with Catharina Fede and many others. He measured his heart rate variability for 30 days with a very elaborative system, and on the same 30 days, he measured the sliding mobility of the thoracolumbar fascia. He developed a way with a standard ultrasound, just like a cheap ultrasound, like I have here, it costs as much as I hydraulic table, but not more. So he measured in real time, and he developed a way how you can measure it without hours of calculation. So while the client is undressed, you tell him your lumbar fascia is 15% more mobile than last week. Whatever you have been doing, it seems to work. Keep keep doing it. So he measured the sliding mobility of his thoracolumbar fascia for for one months, and he measured his heart rate variability. And then he went together with a statistician who measures these interactions, and they showed that there is a 48 hours delay whenever he had a stressful event. In that 30 days, 48 hours later, the sliding mobility, or theoracular lumbar fascia, was diminished, and that was unexpected by us. But of course, now we looked at the data, and this is very exciting. So in these 30 days, he had hundreds of minor stress things going out of the house and thinking he forgot the keys or I didn't answer the. Etc, or I'm too late. I didn't prepare. Where are my slides? But he had three major ones. So in this one month, he had one argument in the kitchen with his wife and two with his oldest daughter. And you could see dramatically how 48 hours later, his lumbar fascia was stuck. But he also showed and I'm not sure whether that's unique for him, because he's very active in sports, in whatever stress he does as he still goes mountain climbing several times per week, and in all of these events. Seven days after the stressful event, he had a super compensation where he had a more fluent fascia than without the argument. So we know the super, super compensation for muscle strength training, so you irritate the muscle by too much loading, then it cannot functionally work very well. But if you allow it to recover in a beneficial way, and you don't injury too much, it may be more resilient afterwards. So that, for me, is a very nice study. And then, of course, we discussed with him, we should repeat the study. And next month you try, you know, in every family, there are certain topics that you learn not to talk at the wrong time about it, you know, because they are sensitive. So we gave him the, of course, humorous suggestion, you do the experiment again. And next month you try to say, we need to talk about this in the kitchen, you know, I wanted to clarify this here, now and then, you have more banging doors and people sleeping on the couch, but we would have better data you and I to analyze for fashion research. And you can see my Of course, that is done. So then his wife, she would find out why she has been moving out of the house. He sacrificed his marriage for his facial research. You know, how far can you go? Of course, this is only in fun there, but it's a great question. You know, whether that 48 hour delay, I think we can explain it from cell culture effects. So the adrenolin stimulates adrenaline receptors on the fibroblast membrane, and after 24 hours, that leads to more TGF beta expression, not after six hours, and the TGF beta expression will then stimulate normal fibroblast to grow into real myofibroblast over a period of four hours, and then they can start to do something like a fibrosis. So I think we have some very good indication. But I'm curious not only about the 48 hours, and whether it starts with densification and may lead into fibrosis later, probably not in 48 hours. But I'm also interested in the Super conversation. You know that the homosis principle, you challenge the body, not only with cold water plunges and with intermittent fasting, but maybe also with emotional stress. And then you keep digesting. You lick your wounds, and you continue to go jogging and mountain climbing and hugging people, and then seven days later, you may possibly be a more resilient person. So that is exciting. That is

 

Til Luchau  

exciting. I'm going to brainstorm a couple questions that pop up in my mind, what if, in this theoretical study, you do next phase with him, he gets some body worker does some movement therapy, yeah, be right after the kitchen conversation is the recovery different from that emotionally

 

Robert Schleip  

stress. We should get you there, yeah? Structure to bring up hot topics, yeah? And then you go with him downstairs.

 

Whitney Lowe  

That's the trip. Be there at the moment.

 

Til Luchau  

Be there. Or what happens if he gets the body work before bringing them up? Yeah, does he even want to bring them up? Or does he bring them up in a way that isn't quite so disruptive to the system? Who knows? All these questions, but where do these arrows flow? Yeah, yeah.

 

Whitney Lowe  

You know, one of the things that's really fascinating I'm hearing is kind of go through this in historical and timeline process. I'm thinking of what you were referring to with the early Congress as being a lot oriented around force transmission and the way those the things were happening throughout the body. And then it seems like there's a whole crop of manual and movement therapy approaches that really flowered and blossom. And out of those ideas, and now it seems like we're, we're it's almost like we're moving into a completely new paradigm now. And maybe some of those things might be dissipating a little bit in terms of the the focus of what we think is happening, and maybe we're at the brink of a completely new way of looking at a lot of the things that we do. Yeah, the effects you're getting from from our work.

 

Robert Schleip  

Another topic, which we had at the connective tissue in Sports Medicine Congress a month ago, that is also a quadra annual Congress, not as large as a Facial Research Congress, but we do that every four years, where we look at from an academic research perspective, the role of the fascia connective tissues in sports medicine. And I can report that at the last conference, there was a new topic that I did not expect, and this is the importance of circadian rhythms, that the collagen synthesis is not only require certain biochemistry, certain nutrition, vitamin C, zinc, etc, and mechanical loading. But also, there is a timing that the collagen material, the proteins are made inside of the cell, in the endoplasmic reticulum at night, in a good functioning farm orchestration. And then the collagen fibers are made primarily, not exclusively, but in a well functioning body during the day. And the small fibers are made in the morning hours, and the medium fibers in the late morning and in the afternoon. You do the big fibers. And that is how you do a well functioning farm where people know about the organic times. And that's how a good cook makes a dish he doesn't have only you need three spoons, but you need you put this in the oven first, and then you wait and you put the salad last. Now in tendinopathy, but also in adolescent idiopathic scoliosis, the circadian rhythm for whatever reason, is upside down. So people are producing collagen at random times, you know, and then you don't get the same quality as you have. So we know that the rhythm and that the rhythm is not only in the brain, in the Super chiasmatic nucleus, it's in all the cells. They have an internal clock. Certain things you do less at night, and others, you do more at night and the same thing during the daytime. But if that rhythm on your inner farm is disrupted, where people get up in the middle of the night and feed the chicken and they sleep in the morning, then you have a disrupted collagen repair and collagen synthesis in general. So that is emotional factors contribute to that our lifestyle contributes, lack of movement interferes, the influence of morning activity, cold showers, relaxation before you go to sleep. So you want cortisol activated in the morning and you want militant in the evening, and not the other way around. And that is an important subject. And now they found out, for whatever reason, in any kind of tendinopathy that is disrupted, and also in many other things, it's probably not one cause. The other is chicken and egg. But if you don't include that in your strategic plan, you will be less efficient, and we didn't include that five years ago. So that is definitely, I know we have Keith spah there for the first time, and he comes exactly from the same field as Michael Cael that I'm just reporting from the Copenhagen school. So he will report how tendon mostly responds in the collagen synthesis, to not only to mechanical loading, but also to this circadianism And to nutrition. Yeah.

 

Whitney Lowe  

So you know, we're kind of getting near our wind up here. One last thing I'd like to kind of ask and lead with, is, if there's, like, a single takeaway we you'd like every practitioner listening to apply on their you know, Monday morning after the Congress or when they go back to work, something that really captures the essence of all of this fascia research. What? What kind of things can you. Point people in the direction of

 

Robert Schleip  

you become a baby under the stars again. I'm just sharing that because I slept outside of my parish last night and there was little Robert, and there's a big Milky Way, and you realize we know nothing. And that's exciting. It's really exciting. It makes you fresh. You know, there is a Milky Way, and we are humans here. So that freshness, I hope, even if you have been a practitioner like I know both of you for several decades, if you go to the Congress and you interact with people like Katharina fade or Stephen porches, or many others, and they can tell you again, you're a little child and this is the galaxy, and you are nothing, and what we are doing is just the beginning, and so much more is happening than you have been dreaming during your daytime Adventures where you didn't see the sky above you. So I think it's like sleeping outside. You get out of your narrow Rolfing chambers or bone chamber, and you go, Holy cow. You know, if I touch somebody with the intention of touching their fascia, I may be doing so many things, and so you will come home with more beaming eyes and being more humble about what you know probably right. That's That's great. Yes.

 

Til Luchau  

All right, so the seventh International Fascia Research Congress coming up August, 10 through 14th, 2025, in New Orleans Fascia, FRS congress.org, that's FRS congress.org. We'll put the link in our show notes. We'll also put a reminder that there's a coupon a thinking practitioner listeners can save to save $100 off of the registration that coupon code is "thinking", enter that when you sign up for the fascia research Congress to save $100 Robert Schleip, we're going to read our final sponsor rollout, and then I'm going to thank you for your time and inspiration and this big sky that you've painted for us. The thinking practitioner podcast is proudly supported by ABMP, Associated Bodywork and Massage Professionals, the premier association for dedicated massage and bodywork practitioners like you. When you join ABMP, you're not just getting industry leading liability insurance, you're gaining practical resources designed to support your career, from free, top tier continuing education and quick reference apps like pocket pathology and five minute muscles. ABMP equips you with the tools you need to succeed and grow your practice.

 

Whitney Lowe  

And ABMP is committed to elevating the profession with expert voices, fresh perspectives and invaluable insights through their courses, the CE courses they offer, the ABMP podcast, Massage and Bodywork Magazine, which does feature industry leading leaders like my partner til here and myself, thinking practitioner, listeners like you can get exclusive savings on ABMP membership at abmp.com/thinking. So join the best and expect more from your professional applications and your professional associations. Thanks again to all of our listeners. Again, I want to say just a big thank you to Robert schleip for joining us here today. This was a fascinating, wonderful, inspirational conversation as always, and we thank you all for hanging out with us today. You can stop by our sites for the video, show notes, transcripts and any extras. You can find that over on my site at Academy of Clinical Massage.com Until where can they find that for you, all

 

Til Luchau  

those podcasts, resources and much more is on my site at Advanced dash trainings.com and we what you and I want to hear from you with your ideas or input about the show. Just email us at info, at the thinking practitioner, or look for us on social media and YouTube. I am at Til Lucau, my name and Whitney, where can people find you? Also

 

Whitney Lowe  

under my name, Whitney Lowe on social channels as well. So thank you again for joining us over there. We really appreciate your if you would take some time to rate us on Apple podcasts or your whatever yours your preferred podcast platform, it does help other people find the show, and you can hear our hear us wherever you happen to listen to your podcast. So please do share the word, tell a friend, and again, a big thank you to Robert Schleip for joining us here today.

 

Til Luchau  

Thanks for the big sky perspective. Robert, always inspiring. You make me want to go sleep outside right now. Thank you for that. See you later, everybody.