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The Thinking Practitioner Podcast:
Episode 45: Fascia in Movement & Sport (with Robert Scheip)

Broadcast date: 08/11/2021
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Til Luchau:

Hi, Til Luchau here. When I was looking for a publisher for the book I wanted to write I was fortunate enough to have had two offers, one, from a huge international media conglomerate, and the other from Handspring Publishing, which was actually recommended to me by our guest today. Handspring is a small publisher in Scotland run by four great people who love great books, and who love our field. I'm still glad today that I chose to go with Handspring, because not only did they help me make the books I wanted to share, and publish an amazing book co-authored by our guest today, but their catalog has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers, and all professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

I'm Whitney Lowe, and Handspring's Move to Learn webinars are free 45-minute broadcasts featuring their authors including episodes with Til and our guest today as well. So head on over to their website at handspringpublishing.com to check those out, and be sure to use the code TTP at checkout for discount on our guest's book today. So thanks again, Handspring, for sponsoring our episode, and Til, who is this mystery guest that is with us today?

Til Luchau:

Our guest ... I'm so pleased that our guest today is Robert Schleip. Robert, it's your second visit to our podcast, so pleased and honored for that. Just as a brief introduction, you've been called one of the founding fathers of modern fascial science, because you were instrumental, amongst other things, in organizing the first Fascia Research Congress at the Harvard School of Medicine in 2007, where it turns out that both Whitney and I were in attendance, and in the four fascia conferences since then, and in the one next year in Montreal. You trained as a Certified Rolfer, which is where I met you, and then you also, interestingly enough trained as a Feldenkrais practitioner, and you've been a bridge really between clinical practice of bodywork and science for several decades now. You have an impressive new book out, the second edition of Fascia in Sport and Movement, which you co-edited with Jan Wilke and Amanda Baker, and we wanted to hear all about it. So welcome, Robert, welcome a lot, and is there anything else you'd like people to know about you?

Robert Schleip:

Yes, I have been a good friend, collaborator, common troublemaker of Mr. Luchau for several years now, and it's my first time to link with you, Whitney. I've been hearing and admiring your work for many decades also, so I think what we share is a dedication to looking with seriousness, and an openness for new possibilities in the massage therapy manual therapy, but also movement therapy field. What you said too, that I'm mostly spending my ... most decades of my life as a manual therapist based on the Rolfing method is actually true from my perception. The movement educator was always an add-on. I've been lucky to be the first German-trained, or the first German trained in the Rolfing method in 1978, spending about three decades with my clients trusting my hands before I took a sabbatical to visit science land. I thought this would be one year, and I felt like Alice in Wonderland, I felt like these scientists are very strange people, but I started to admire and to love them, and then I extended my sabbatical for another year, and now I'm here 15 years later still on my sabbatical.

Til Luchau:

Still, and you've still actively engaged in science, I believe, as well as in bringing people together and writing quite a bit. I haven't told you this, but I actually have a little note in my phone where I save questions for Robert, things that when I get a chance I want to ask you about. I'm actually practicing a severe form of self-discipline today to stay focused on a couple of questions, and mostly around this amazing book because I was so pleased when you revised it. I'm going to work in some of my questions as we talk about the book, but is it okay if I just jump in to that, to start talking about the book because I'm excited about it? Is that okay with both of you?

Whitney Lowe:

Let's hear about it. Yes, for sure.

Til Luchau:

All right, the book's title is Fascia in Sports and Movement, and Robert, you just described yourself as having even more background as a manual therapist, as a body worker, how would you say the book is relevant to body work or massage or manual therapy even though that's not in the title officially?

Robert Schleip:

Part of it is based on research, but also based on my own life and what happened there, but based on the research. I would like to point out that also in fascia research one of the most high quality researchers is Helene Langevin, she is now the Director of the National Council of Complementary and Integrative Medicine. I said it without stopping even, which is the world's richest and most potent research institute in the field of complementary medicine. It's a direct branch of the NIH in the United States, and that is a position that I never dreamt of, Til, that one of our people would get in our life chance. It's such an important position. In one of her very well-done studies she had shown that if you have fascia adhesion, for example in animals in the lower back, and you do not change the movement patterns of the animal, you only treat the adhesion let's say with a manual therapy, then you only get half as much improvement as if you also changed the daily movement.

Robert Schleip:

That's why my joke has been, or why I created the joke if you're a manual therapist, who is not a movement educator, you should only charge half as much per hour if you think about the value that your clients are getting. So you can loosen some adhesions in the lumbar fascia, we could look at that, how we do that, we now have ultrasound to show it. Is lumbar fascia adhered in this client? Then most likely fascia has a driving or contributing component, if not you may need the psychology or the muscles or something else, but if you only loosen the adhesion and don't change the movement habits, how they untie their shoe, how they elevate, how they do the stairs, how they dance, etc., how they go jogging, then they will be back pretty soon. So that would be a scientific answer to your question, but also in my life I started to discover sitting in front of the desk doing online education, and then sitting in my treatment room is not as fun as if you also do dancing and running, and Pilates, and stretching and all these things.

Whitney Lowe:

This sounds like it's kind of a combination that I'm seeing, what we have traditionally looked at as fascial approaches, but also bringing in a lot of sensory motor integration, and motor learning, that type of thing, would that be accurate way to refer to that?

Robert Schleip:

Yeah. I think, Til, when we started to become assistants first in the Rolfing School the manual therapy was considered to be everything, and then some of the female spouses of some of the senior instructed, "Why don't we do also some movement?" We thought it's a nice add-on, but that has changed in the last 30 or 40 years in the Rolfing School, but also in many other schools. This is now common practice, to change the daily movement repertoire of your client is as important as how you use your fingers when you are pushing adhesions or other dysfunctions.

Whitney Lowe:

It seems ... I noticed in the book a couple of times, and also we were hearing it a lot more in the manual therapy communities, this term or concept of fascial fitness, is that where that's aimed also, is looking at not just trying to make corrections, but also enhancing health of all those tissues too? Would that be an accurate way to describe that approach?

Robert Schleip:

Yeah. It happened in 2009. I think, Whitney, you were there at the 2007 conference, where you were right, I was one of the troublemakers together with Tom Findley, and Leon Chaitow, and many others, where we had been catching the ball backwards and forwards. We're very lucky to get this tax-funded scientific event that was basically the boost of scientific research in the field that exists before, but more in complementary medicine research, but not in quantity assessment focused rest on the research. It was the conference after that, in 2009, in Amsterdam, where after one of the presentations, it was Yasuo Kawakami who used high-resolution ultrasound, and showed us what is happening in the calf muscles, but also in the upper neurosis of the Achilles tendon when somebody is balancing. He showed us that contradictory to the expectation if somebody is balancing at the resonant frequency, where the balancing feels effortless, then the muscle fibers do not change their lengths very much doing the balancing. They are almost like only isometrically stiffening, and the Achilles tendon and the upper neurosis they are doing like an elastic yo-yo. That was the beginning.

Robert Schleip:

After that lecture several of us, we said, "Should we get together and discuss whether a fascia-oriented movement education would make sense?" I invited two dozen people and we met. Tomias was part of the original group, James Earls, several people and we met for almost two years to discuss seriously does it make sense that we enter the fitness market, the movement market with Yoga, Pilates, from a fascia-oriented? We have other things to do, does it make sense? Isn't there enough already? We realized after several rounds, yes, it makes sense to ask the question that if I guide movement not to train our muscles optimally, or not to train our mind ideally or the cardiovascular system, but what is good for the fascia.

Robert Schleip:

Then we rediscovered balancing, it was known before. In Swedish gymnastics, they did this effortless movement and that became fascial fitness, and we wanted to register it as a brand and become billionaires but we decided, "No, let's put it out." So there are many, many people teaching fascia-inspired Pilates, Yoga, etc. I think every massage practitioner, every manual therapist needs to have friends and collaborate with them regularly, what's new in their fascial fitness or fascia movement field.

Til Luchau:

I agree with your point, Robert, that movement is so important to getting effects or the change we want to have in our own bodies, in our clients bodies, [inaudible 00:12:27], and you've been an inspiration to see how, as the years have gone by you've done even more and more movement. Every time I see you and have a chance to visit you that's a definite thing on the list no matter. I think last time you had a cold, and you still got out and did an amazing bike ride with me, and things like that. The movement becomes such an important part, I've seen, of your life, but also of your approach, and I think you're teaching more ... Would you say you're teaching more movement than manual therapy these days? Is there a shift in that direction too?

Robert Schleip:

I tell you a secret. I do the teaching only to create money for research, so I do as little as it's required to get the most income for my research, that is my main profession. Then whoever invites me for a big event, whether it's Pilates or Yoga, I look at them, is their work respectable in my opinion, and I sing their song. I say, "Osteopathy is the best thing since ice cream was invented," or Yoga, or whatever. Recently, you're right, I get more invited by the Yoga, Pilates people than by my old friends, the osteopaths, and the structural integrators, but I cannot predict what it will be in two or three years.

Til Luchau:

This is a little bit of a tangent, but I just want to somehow give voice to the body workers who don't see movement as part of their scope or practice, or something they're particularly good at. I know in the physical ... in the manual therapy space when physical therapists, and Rolfers, and massage therapists get together it's almost a little bit like high school where the athletes became the physical therapist, and the people that weren't athlete became the body workers or the people that sit and do their work more. I think there's a place that I want to just stand for that says, "Maybe I'm not going to be an athlete, and yet I can still do effective manual therapy." Actually, there's still things in your cool book that I find inspirational, even just for my table work, as well as of course all the movement inspiration as well.

Robert Schleip:

You are hitting something, but let's not get there for the whole time. Because we have been moving together, and I'm sure, Whitney, you too, but Til and I have been doing that since several decades, if you go to a Feldenkrais convention or to an osteopathic convention you have different smiles, you have different hugs, you have different handshakes, and many other bodily, physical, social expressions which are very different than if you go to a fitness convention, even the body types are different. In the Feldenkrais field for a long time they didn't look very fit and sportive, they had different clothes, and they are more for quiet approaches, and in the fitness world you get, "Hey, Robert, let's do it. It's nice to see you." I see value at both of them, and so I wouldn't say to the Feldenkrais people, "You should go up and do push-ups, and you should do screaming karate from now on and forget your meditation," because the mindful listening quality is very valuable.

Robert Schleip:

If you don't pay attention, and you suddenly do push-ups and jumping, and playing on the children playground like we do as many of our causes, I look where is the children playground and we do upside down swinging, etc. You may lose some of that mindful listening quality that people who practice manual therapy, which is for example Feldenkrais, individual work, or Bowen massage, they have ... osteopathic people, they have that mindful listening quality, and I think you don't need to give it up when you enter the fitness field from a fascial fitness-oriented perspective. We also voted very early on we will not allow, at least for competitions, because it would be great for the field if we do a European competition on who has the fascial fitness just like in CrossFit where you give a wall, etc. So then people train in order to get in the wall, and the whole field flourishes, and we decided together with Tom Miles and James Earls, "No, a competition is not good."

Robert Schleip:

We don't want to focus on performance. We have people overdo their training in the preparation, we want to allow for this listening mindful quiet attitude, and so I think that's common for most people who orchestrate movement training with a fascial orientation, and that is one of the chapters that we should talk, fascia is a sensory organ.

Til Luchau:

That's the one I just flagged here on the outline. That's one of the ones you choose to write yourself in the book. I think you have 50 something authors, but a few choice chapters you chose for yourself and that was one of them, fascia is a sensory organ. Can you tell us what that means? How is fascia a sensory organ?

Robert Schleip:

Wow, that was the big surprise to me, as it was to many manual therapists, it's an old hack to Rolfers, an old hack to most massage therapists and probably osteopaths, that fascia has much more biomechanical functions than the classical medicine we used to assume. That was an old hack to Moshé Feldenkrais, to Ida Rolf, to many of these people, but now the new discovery is that it is much more richly innervated than Moshé Feldenkrais or Ida Rolfer were aware of. Yes, in the late 90s of the last century they discovered a few nerve endings in the knee joint capsule, and that was important that we have mechanical receptors in fascial tissues, and since then the surgeons are doing it different. But now, we are learning, almost every month, how rich and how important fascia is a sensory organ based on the richness of the innovation in it.

Robert Schleip:

That was a big inspiration for me in the preparation of this new addition here. I got together with scholar to collaborate with a German scientist, Martin Grunwald. He is one of the world's authorities on haptic, on touch quality, whether you can train your touch perception, whether it's true that women have a better one, whether osteopaths have a better touch refinement, than taking a go at people that's sitting on the desk, whether it declines with age, if you want to know that you will have to read Martin Grunwald and his group. He had done a calculation how many millions of receptors we have in the human skin, and he based that on histological sections, and then the calculation of the total mass of the human skin in three dimensional space, and he came to a 100 million.

Robert Schleip:

Then we got together with him and said, "Can we do your calculation and include everything we know about the human fascial net?" Based on the new nomenclature recommendation that Carla and I had worked on in the Delphi process over more than four years, where we include in the term the fascial net, also the loose connective tissue under the skin, that is very important because it is the richest, so the fat layer, but also the loose connective tissue around the visceral organs, and also the tiny envelopes that we call intramuscular connective tissue, that you only see in the microscope around the individual muscle fibers. Then we work on that for several months with the same mathematics, and we came to the incredible number, and this book is one of the first sources that we published it, that the human fascial net has 250 million sensory nerve receptors.

Robert Schleip:

It could be [inaudible 00:21:01] as you need to do as a scientist, you share exactly each calculation step so if somebody has other numbers they can do the calculation again. But based on these new calculations we are now completely sure that this is our richest sensory organ, the human fascial net.

Whitney Lowe:

I first encountered this concept I think in one of the articles that you did for the Journal of Bodywork and Movement Therapies about the new neuro biological perspective. I guess that was around the early 2000s when the-

Robert Schleip:

I remember. I remember.

Whitney Lowe:

The article first came out.

Robert Schleip:

But it didn't have the calculation then.

Whitney Lowe:

It didn't have the calculations at that time. I'm curious about these calculations because this is really fascinating. When they were doing the calculations did you account for diversities in concentration in certain areas? For example fingertips being far more sensitive let's say than the skin of the back, because there's so much more rich innervation for those kinds of tissues to pull in, are those included in the calculations when you figure out and extrapolated to the whole body?

Robert Schleip:

Martin Grunwald certainly did, because he is one of the best resources how rich is your density of refinement in the skin of the fingertips. He did, he certainly included that, and then he made some kind of transparent assumption what is the average density, and then he included the whole surface of the skin. He did that in the skin, and Carla and Martin Grunwald, and we, we tried to do it in a similar way for the human fascia based on what we know. We know for example that there are some fascial tissues, this is very interesting, in the retinaculum, that have a higher innervation than other tissues. We included that based on the knowledge that we have.

Whitney Lowe:

Because one of the things that struck me about this, it's a fascinating question that maybe you don't have the answer to this yet, and this is something I can maybe encourage a question to be explored is. When you think about fascial structures in comparing the skin to some of the underlying fascial tissues, in the back for example, we are using that as an example, the skin innervation is not really high in the back in terms of two-point discrimination, and being able to make the distinction between those points, but it seems like the fascial tissues in the back would be far more densely innervated because of the importance of all the crucial proprioceptive information about upright posture and movement that would be necessary in the back as opposed to in the fingertips for example. It seems like a lot of the fascial tissues may not need to have as much input, it's almost like there'd be an instance to where it would be reversed.

Robert Schleip:

Based on the model from Carla Stecco, the skin is more for external reception. So with your fingers you try to find out as much as possible for the tissue that's touching you on the outside, and you're not so interested to know in terms of proprioception what is the exact angle at your joints while you do that. The skin seems to be more external reception, but the question now also about the lower back is, "What are these rich nerve endings that we have in the lower back, but also in other areas?" Part of it is proprioception, but this is a very interesting point, Whitney, because I went around the planet, made a lot of money for my research, talked about fascia as a sensory organ, and showed them some Rolfing-inspired loosening techniques, and how important the proprioception in the lower back is. But now, [inaudible 00:24:50], in his latest publication he said he only found one Ruffini endings in hundreds of sections, he found lots of free nerve endings with potential nociceptive capacity, but it seems to be very poor in terms or proprioceptive, and that's not what I wanted to hear from him. Basically-

Whitney Lowe:

It happens in science.

Robert Schleip:

Yeah. So fascia is there for pain-related body perception, of course pain is not only created in fascia, your whole brain is involved and your expectations, but let's say for injury-related body perception, whether something is dangerous for you or not, and they seems to be very, very rich in fascia, and then less rich is the proprioception. Where am in space? Is my weight mostly on the right foot? Do I have low doses while I bend forward? We all know how important that is, and for lower back pain as you pointed out, the two-finger discrimination which is a haptic test, you measure the sensitivity of the skin, but it seems to go one ... it goes very much hand in hand based on your proprioception. When we do proprioception studies for the lumbar pelvic movement we do the two-point discrimination on the skin because it's cheaper to do than reposition, and all those other experiments that we have. So that's a little dive on the fascia as a sensory organ, but I think it's the most interesting chapter, and that's why I picked it for Carla and me to co-write it together, and I learned a lot.

Whitney Lowe:

Yeah, so many potential applications for us all, I think.

Robert Schleip:

One aspect that we only included in several paragraphs is the interesting relationship of these millions of free nerve endings that are not related to proprioception to the autonomic nerve system, and there is a rich connection there. The highest number of nerve endings of a single type are not Ruffini endings, as much as I love them, they are not Substance P positive free nerve endings associated with nociception, but they are the sympathetic nerve endings. This is the richest type of all the fascial innervation types, and that is very interesting to us. They seem to be also related not only with microcirculation, how much choosiness, how much ground substance water, how much blood do you have in the tissue, and how stagnant is it, that mostly will influence by the sympathetic nerve endings, but they also seem to communicate with the immune system. I need to share this story, and then I try to shut up.

Robert Schleip:

We had a COVID-related big event last year in May when everybody was locked in their houses, at least here, so we did a two-day online conference, Fascia Online or something like that. We got all the scientists to participate for free that we wanted because they were in the houses, and none of them was fed up, there's too much Zoom conferences yet. It was a big success, we had over 2,000 participants, and we made a lot of money by it, and we donated all the money to Padova University on this favorite subject of mine. So that was one of the happiest moments in Robert Schleip's life, when we donated a €35,000 check to Padova University for a research we are now ... Caterina Fede, one of the best scientist from Carla Stecco's group is now obliged, but heavily obliged to work together with Carla, me, and Professor [inaudible 00:28:49] Hoover to learn more about the connections between the autonomic nervous system and fascial properties. I can't wait to hear the results.

Til Luchau:

But just to connect one dot, the autonomic nervous system, would you say it's most likely that those are involved in ... Well, actually you said microcirculation, I was thinking about their role in vasoconstriction and vasodilation.

Robert Schleip:

Yeah, that's it.

Til Luchau:

You said, right?

Robert Schleip:

So that's it, yeah, yeah, yeah.

Til Luchau:

Maybe the fascia is a circulatory structure or a fluid regulated structure, as well as a sensory one.

Robert Schleip:

Yeah. We have big discussions here in Germany whether drinking more water will make your fascia less dry, because as we age we get drier, and should you drink six liter on a normal day or only one. Also, if foam rolling, which has a sponging effect, we have shown that in two little studies, so if you use the right amount of pressure on the foam roller, and you roll it slowly in multiple directions immediately after it you have lesser water content in it. But then, of course water comes back, some of the old dirty water comes back, but also new fresh water comes out of the blood plasma, and that doesn't have yet pro-inflammatory cytokines included. It does not yet have the free radicals, which are kind of a waste product.

Robert Schleip:

For that renewal, I think more than the sponging effect that Ida tried to describe, and more than flushing down water your digestive tract, and that doesn't influence much how much water goes into your Achilles tendon, because the water in your Achilles tendon does not come from the drinking water, it comes from your blood. Your blood, hopefully you will not try to dilute it by drinking more water, and have more water included, that has a constant water proportion, but then you want to know how much microcirculation is in the tissue. Then, probably better than drinking water, I exclude all people, yes, they need to drink more, would be how can we influence our autonomic nervous system, and that is a very important dimension there.

Til Luchau:

So that by influencing our autonomic nervous system that we actually help our tissue be more spongy, help it be more profused, or help that flip turnover you were saying?

Robert Schleip:

Yeah. So that would be something after sports. You want to have a higher microcirculation in your tendons and other fascial tissues. There was a very nice study that is included in that book as one of the example, where they followed in Copenhagen 200 students who were regular joggers on a level, I think they jogged more than four times a week, so most of them everyday for two years. As you would expect, a high proportion, I think 11% to 18% had Achilles tendinitis as regular joggers have. So if you go jogging everyday per week for a long time, you have a higher likelihood of sitting in the waiting room of an orthopedic doctor than your couch potato brother, which is not the reason why you started doing it, but it's the truth. If you only go jogging two or three times per week you will be less often in the waiting room of an orthopedic doctor than your couch potato brother.

Robert Schleip:

So that is one, but you go jogging not to avoid the orthopedic, you do it for other reasons, to get into nature, to be a more gentle person, have a clearer mind, to live longer in terms of cardiovascular health, but that is one of the trade offs if you are a regular jogger. They wanted to find out is there any predicting factor that makes certain people more prone for Achilles tendinitis, and they looked at age, they looked at body weight, they looked at pronation, etc., all the biomechanics, and they only found after two years, two factors.

Robert Schleip:

One, was female gender, and that was known before. Female athletes need to be more careful about their tendon than comparable males, for reasons which are very interesting, which are also covered in the book here based on hormonal factors, how estrogen is influencing the architecture of the fascial tissues. For example if you are a female athlete, the injury rate is much higher during the ovulation days, six to eight times higher in jogger players. So that was one predictor, and the second one, and then I'll try to shut up, would be the microcirculation in the Achilles tendon after jogging. Those people who had a strong increase in microcirculation, and we now have measuring tools based on ultrasound doppler that can calculate not only the large circulation, but the smaller vessels, they were immunized against overloading injuries. Now the big question is, "What stretching can you do? What foam rolling can you do? What heat treatment can you do or other conservative manipulation to treat your Achilles tendon after jogging, that you are immunized against overloading?" That's a very interesting question for us.

Til Luchau:

Just to step back, you mentioned sympathetic, did you say stimulation?

Robert Schleip:

Yeah.

Til Luchau:

For improved ... the microcirculation?

Robert Schleip:

Yeah.

Til Luchau:

Okay. Is that movement? In the case of foam rolling, direct pressure? How do we stimulate? How do we do that sympathetic stimulation that improves microcirculation?

Robert Schleip:

It would go in a completely other direction, so more rigorous movements can get the sympathetic nervous system activated.

Til Luchau:

Okay, so it's parallel to fight or flight then I understand.

Robert Schleip:

Yeah, a little bit.

Til Luchau:

All right, does that mean [crosstalk 00:35:21] for relaxing people if we're focusing in parasympathetic effects that we're inhibiting that? Are we working against ourselves?

Robert Schleip:

Yeah. Probably the best thing would be to get people out of stagnation. As a housey child during the day you have hours where you are napping and completely relaxed like a cat in somebody's lap, and then you have hours where you're screaming and pretending to be robbers and policeman, and you are a bit adventurous, and then when you go to bed you're really sleepy. So you have peak ups and downs, but none of the ups and downs takes you out of your balance forever. As an adult you had several traumatic injuries, I had several of them in my life, and then following the great teaching of Stephen Levin ... no, or Stephen Porges and Peter Levin, we know that these traumatic incidents can lower your resilience. You become more controlled because it happened to you several times in your life, that you were so much out of yourself that you were injured, and that you were not able, so that is a healthy sports.

Robert Schleip:

You would do some very quiet exercises, that's what we do in fascial fitness now, where you do very meditative ... you focus on your breathing and the pauses in the breathing after the exhale, and then you have other minutes where you're jumping and screaming just like in the old dynamic meditation of OSHO where you jump, "Hoo, hoo, hoo, hoo," and you make fear sounds, and then you go into quietness again. So that would be one way how you can activate both the sympathetic, but also the parasympathetic nervous system.

Til Luchau:

Okay, so it's not simple as parasympathetic, bad, sympathetic, good, in terms of circulation, because if it was I pictured a prospective study back to my high school analogy. We should look at the people that got involved in active sports back in high school, and then look at all those people sitting around who got involved in meditative mindful bodywork, and now do a high school reunion 50 years later or whatever, and see how [crosstalk 00:37:43].

Robert Schleip:

See of them who is more healthy now [inaudible 00:37:44], right?

Til Luchau:

Interesting.

Robert Schleip:

Very interesting.

Til Luchau:

Yeah, would be.

Whitney Lowe:

What you may find too is certain types of things, like certain portions of those groups have good cardiovascular fitness because they're very active, but they have chronic overused problems, or something like that, and another group has some different type of result.

Robert Schleip:

As a scientist [crosstalk 00:38:05] I would say that's a nice study, but it would not prove anything, because you didn't control people who are good in sports, they will decide. It's fun if they invest more into sports because they get more recognition, but if you're a grown up with a body that is frail, where you are always the lowest one being picked in football games because you are born in an unhealthy body, you will become a meditation teacher because people will say, "This is great, Robert. Keep on teaching more." You will not get the same resonant if you go become a fitness person or an athlete.

Whitney Lowe:

That's right. That's right. We need a crossover study where we directed half of the jocks in the meditation, and half of the freaks into sports.

Til Luchau:

That's great. Well, you mentioned Stephen Levin ... sorry, Peter Levin and Stephen Porges and their work around the vagal tone, and the regulation of trauma as being influential that will bring something that you were paying attention to, that's such an interesting area too. I'm just brainstorming a little bit, and I think in both of their models they're thinking about this range more than saying, "Let's be sympathetic," or, "Let's be parasympathetic." They're thinking of this adaptability across the entire spectrum.

Robert Schleip:

Yeah. That is something that goes beyond the book, but of course we covered it in the book one several times, so what we can describe is the resilience, why can you go out of your normal lukewarm comfort zone, and be able to recover? That is an important dimension we know in fibromyalgia. It's the best questionnaire to find out if you're prone to fibromyalgia, not to ask him about, "How depressive are you?" Or anxiety, but there are several scales, psychological questionnaires on resilience, and it has questions if something goes wrong, if you spill the coffee cup, what is your inner dialog, do you say, "Oh, shit, this doesn't fit," or do you say, "I knew it, today is a bad day. My mother told me, Robert, you will be a loser," and now it starts. So there are certain questions.

Robert Schleip:

When you're out of balance what good mechanisms or bad mechanisms do you have to recover? That ability to recover, and in sports it's very important that once a while you go out of your comfort zone, but to a level where you then watch your organism to catch up your breath. For most people, not for all people, it would be good that once a week you jog so fast that you cannot breathe through your nose normally, where you lose your breath, and your heart is pumping, and then you stop and realize, "How long does it take me to come back into a balanced body sensation again?" I have to be careful because the Nazi philosophy of my parents and grandparents went in a similar direction, "What doesn't kill you, Robert, makes you stronger." I didn't like that attitude.

Robert Schleip:

I do not like it, and that's why I became a Feldenkrais practitioner and meditation junkie, but now we learn something similar from Ben Hoff and other people, or from Kneipp, that it's very good once a while to take a cold shower before you go back in the lukewarm water, or into comfortable warm water. That is something also for the fascia, that you go beyond your comfortable range of motion, that you stretch a little bit further than you would normally do, and explore how that is influencing you, but you don't do it too often, and you know that the body takes time to adapt.

Til Luchau:

I'm curious, and Whitney, I just want to cue you up to see if some of your questions are [crosstalk 00:42:30].

Whitney Lowe:

Yeah, I didn't know if you wanted to go through the other things there, I do have a burning question that I want to-

Til Luchau:

Yeah, go for it.

Whitney Lowe:

To dive into, if that's okay. Robert, this is something I've been dying to ask you for a long time so I want to delve into this a little bit. When I hear, at least in the ... I'm most familiar with the massage therapy community because that's where I live, and when I hear the people in our community speak about fascial work, it seems like they're mostly thinking along the lines of the ... a lot of the former mechanical or biomechanical models of elongating fascial tissue with manual therapy by what we do with our hands. As we know, a lot of the biomechanical research has not really supported that idea very strongly, that we're able to do that especially with the dense connective tissue, in terms of elongating that fascia. What I got a lot out of looking at things in the book seemed to indicate that there's all kinds of physiological responses being mediated by a lot of these other aspects of like the loose connective tissue, and other aspects of what we consider now to be the broader fascial network.

Whitney Lowe:

My question really is, is there something that we can call fascial work, where you can specifically target a particular type of fascial tissue, or should we really be looking at more of the global effects on the large scale fascial system from any type of manual therapy might include a wide array of all these different types of things, but it's particularly difficult to say, "I'm going to target this particular fascial tissue with my manual therapy, and do this thing to it and make it change this particular way."

Robert Schleip:

Let me start with what you said at the beginning, and assume that everybody knows that, and I would agree. Let me come back to you first mentioning that most manual therapists think they know that you cannot change dense fascial tissues like the IT band. From traveling internationally, as much as, Til, as you are doing, this is a North American social media phenomenon. It's a gossip that I hear again and again in North America, and they think this a common state. If you find out where those people who say you cannot change dense fascia, they usually refer to the IT band, and I say, "Do you have studies to quote?" They come back to a paper that I co-published with Hans Chaudhry and Tom Findley, that we did diligent measures. How much newton per square centimeters are necessary for a plastic deformation on a meat butcher level? With fascia being put as a dead piece of meat on the table, how strong do you need to push or to squeeze the Achilles tendon to yield to a plastic deformation?

Robert Schleip:

There we came to the conclusion, "Yes," for the IT band more newtons per square centimeters are necessary, then we have in the Rolfers elbow. For the loose connective tissue, the Rolfer's pauses would be sufficient, but we also concluded in the same paper, and that gets overlooked, that the human body is not butcher's meat. Our fascia is connected with an alive organism via the nervous system which is cut, so you can definitely stimulate some Golgi receptors in the IT band, where then the tons of fascia lata, all the gluteus maximus, all the vastus lateralis, changed, they are EMG muscle tone notes, and then the fascia gets significantly softer, and that is something that you can measure. We finished the article by saying it's still possible for a fascia that is connected with a living nervous system, and a living autonomic nervous system that changes the hydration to have a profound effect on the stiffness. It was also showed.

Robert Schleip:

One of the best studies now is that people with low back pain, their fascia is more densely adhered to each other, and to the musculature underneath than comparable healthy people who do not have low back pain. That was clearly showed, and now the question is ... Our force is sufficient to loosen that, and I was a mentor of a study that is now published for the second time because it's a different protocol, that normal foam rolling pressure, which is not as skilled as a Rolfing pressure, is sufficient to increase the shearing mobility between the first layer of the lambda fascia, and the second data exactly where people who have chronic lower back pain have their adhesion. So that means we'll be certainly using unsophisticated tools as foam rollers, able to change fascial properties, and architecture, so there is no question about it, and whether you call it psychotherapy or not that's often a medal of sale point.

Robert Schleip:

In Germany, phone rollers are used as fascia rollers, as if they target the fascia specifically, and not the skin or the muscles, and the same thing a Rolfer could be also called a lymphologist. So it's not what you do and how much data you have, but which tissue you want to use in your narrative to convince your clients.

Whitney Lowe:

It sounds like it's in some respects a lot more complicated than people might be making it appear, because your example with the iliotibial band is really ... involves a lot of the neurology of decreasing the activity of the attaching muscles, gluteus maximus and tensor fasciae latae, that allowed for a greater degree of pliability in the iliotibial band. But it wasn't necessarily the work that we did on the band itself that elongated that particular band, it was really the neuromuscular components attached to it that decreased its stiffness, is that accurate in that instance there?

Robert Schleip:

We haven't measured that, so what we measured was not the stiffness change, and also not in the IT band, but it was the level of adhesion or the freedom of mobility, of shearing motion between the first layer of lumbardorsal fascia, and you can compare that with the IT band certainly. There it was clearly shown that you have an obvious change.

Whitney Lowe:

So it seems then that a lot of the manual therapy techniques and approaches that people are using are probably targeting, or taking advantage of that physiological effect of enhancing, sliding and gliding between adjacent tissues, and that's what might be getting perceived as the beneficial effects.

Til Luchau:

I want to tease, I want to jump in and tease those apart for a second, because we mentioned two things. One, is the relaxing of muscles that attach to the connective tissue structure, and the other is the change in hydration, the shearing and sliding. Is that right, Robert?

Robert Schleip:

So that was my state of two years ago, but now I'm a constant disciple of all the other friends out there. Now, I think there could be a third component, it maybe more than the first and the second, that we change hyaluronan, and that is basically Carla's brother Antonio, her brother, and they showed how important hyaluronan is for how choosy the tissue is, and how much adhesion you have or how much ... most likely the change that I described in lowering the adhesion, this foam rolling between the first and second layer of the dense lumbar fascia was not that Collagen Type 1 fibers were broken up or were plastically elongated, that would be hard to believe for me. But the hyaluronan, which is part of the half-watery, jelly-like round substance, that can change into a less viscous binding condition within a few minutes of adding mechanical perturbation, or adding warmth to it so it comes back to the [inaudible 00:50:55], which is not changing the fiber, but changing the ground substance. We didn't know that a lot of that depends on the hyaluronan in the connective tissue.

Robert Schleip:

Healthy hyaluronan forms very small molecules, and they allow slippery gliding, but unhealthy hyaluronan, maybe that's not the correct term, but under certain pathological conditions, particularly in an acidic environment, hyaluronan can assume a super molecule of a binding state, and then becomes a sticky glue, and then if you have that two surfaces next to each other it prevents a shearing gliding motion, the same stuff. Then the question is, "How can we use our hands to break up the super molecules into smaller pebbles again?" The Steccos were able to show that, no, they didn't demonstrate, but they showed indications for it because you cannot film the hyaluronan, but they did a rigorous manual running, and afterwards you seem to have the more less viscous, more slippery hyaluronan in the connective tissue. That would be a third hypothesis, and maybe in five years we have another one.

Til Luchau:

Yeah. So that was going to be ... One thing that I wanted to get clear on, because I know a lot of people want to know, are there particular techniques or approaches that are better at this than others, in terms of enhancing that particular effect?

Robert Schleip:

Movement. We have been talking, the three of us, you see how little movement we do, we have been talking for the last half an hour at least talking about manual therapy. In the last study from the Steccos, they were able to do a histological investigation which fascial tissues have a higher density of hyaluronan, and to my surprise they found out, of course that there are differences, some fascial tissues have more or less, but I was not surprised for the magnitude of difference. They showed there is not a 15% variety, but 15 times more hyaluronan in certain fascia than in others, and that is much larger than I expected. What they showed ... and then it's very typical to do because to measure a hyaluronan ... our lab could not be doing it because in a few minutes of air exposure you change everything. You have to do vert, very detailed work there, but they were able to do it, and they showed these fascia at the retinaculum where you have a lot of shearing motion in the immediate neighborhood.

Robert Schleip:

So underneath the retinaculum of the hand ankle, of the wrist, you have tendons sliding 10 millimeters in one direction, and 10 millimeters in the other. There the body feels like a lot of lubrication is needed, and they found the right cells, they are called fasciacytes, and apparently they could use more gliding substance where more shearing motion is happening. The other tissues that had the least amount of shearing motion is the epimysial around the upper trapezius or the deltoid, and that, if you try to move them in relationship to the tissue underneath, which are the muscle fibers, you can do that with any kind of meat on your kitchen table, not any kind but just most of them, the epimysium doesn't have much sliding mobility, maybe one millimeter that's most. Their conclusion is if you have a fascial tissue, and you only move with one millimeter in relationship to the tissue underneath you will not have much hyaluronan, but if you do large angular movements as you do in your wrists you will have a lot of hyaluronan.

Robert Schleip:

Now, tell me, what can we do for our faces if we want to have more hyaluronan? I have many clients in my unique practice who go twice per year for hyaluronan injections, and then they have a younger skin, but it costs a lot of money. I know exactly because I collaborate with one of the dermatologist, but the body is not supposed to need injections because we have our own pharmacy inside which are the fasciacytes, they are specialized not on collagen production, but on hyaluronan production, of the slippery quality. Now the movement application would be you would need to yawn more often, or to laugh more often so that the temporal fascia and the [inaudible 00:55:46] fascia get not only one millimeter shearing motion, but 10 millimeter shearing motion.

Robert Schleip:

So Large angular stretches would be ideal, and there would be a study to find people who are only laughing and yawning on one side of their face, and then we do photographs of them, of course that's not possible, and then compare it with the other face, or we do it for a couple of months, and then compare it with the hyaluronan. Please do more a lot variety stretching movements, and that should give you more of the slippery hyaluronan condition based on this latest indication from the Stecco investigation.

Til Luchau:

I see a potential for a fascial fitness coming down the pike because that's what they need.

Robert Schleip:

That is a nice toy. I think I've shared it with you because I love it so much, that many years ago I had a client, and in one of the cosmetic surgery she went to the best in Valeria from his reputation. He cut one branch of the facial nerve here, that happens in one of a hundred people or so, and that was a disaster for her because she's in public life, and needs to do public appearances, but with spit dripping out of the right corner of her mouth she said, "Robert, I do everything to speed up the recovery." She booked two laughing Feldenkrais sessions per week with me, and did many other things. I gave her some books on face building. I told her the recovery is better if you keep the microcirculation active, that you do muscle exercises in your face. She went with this book where you stretch your orbicularis oris, and then you put your nose and wrinkles, but then I told her about the work of Stephen Porges, that our facial motor capacity is driven by social activity.

Robert Schleip:

She read everything she could get from Stephen Porges. She's a very smart woman, and she loved the material. She could tell me any part I had missed, and then she went to a friend who had a baby at the age where they cannot work anymore, where they ... one year or half a year, and she communicated for 60 minutes per day with the baby. What do you do when you're communicating with your baby? You make big eyes, and you say, "Hoo," and "Woohoo, hoo," and afterwards she looked in her face, and she could see immediately one hour of communication with the baby, if you have any kind of motherly instincts left, and she did, had a much more rejuvenating effect on her than doing the face building mechanical exercises she had been doing. That's what she did everyday until she was complete, and then she returned the baby and went back into political life, but I think it did-

Til Luchau:

Baby therapy.

Whitney Lowe:

Yeah.

Til Luchau:

That's great. Well, so movement is your answer. Movement, you say, is what helps restore that sliding. I know some of us, myself included, are really experimenting with these ideas, and using them, maybe we could say metaphorically because we don't have research to back it up, to see if we can think about restoring glide, about changing hydration, about the new metaphors that this brings about like the bottle brushes and the mosses, and the precipitation more than fibers and stretching, or about fluffing things up or squeezing the sponges, those kinds of things, certainly influencing us on a metaphorical level.

Til Luchau:

Just to backtrack one thing, you mentioned the retinaculum, that's one of the things that really surprised me from the book too, is how much hyaluronan there was in the retinaculum, which I think about as a pretty stiff dry tissue, and that makes me realize that my image has probably come from preserved dissections and pictures. That your point too, about how it changes so quickly, I remember some of your dissection with rats. Gil Hedley talking about this, other people talking about how quickly the fascia changes when you actually have ... or [inaudible 01:00:18] lifting up living skin on his hand surgeries to show us all of that goo and slippery liquid right under the skin, how different it is on a living body than a preserved one.

Robert Schleip:

As a massage therapist, which maybe majority of your audience, don't rely on images from anatomical books because they are very misleading, rather remember the [inaudible 01:00:42] videos, because the body that is under the skin is much more juicy, it is more like an octopus. The majority, even in old people, even in very stiff tendons is water, so you're touching a watery fish animal that has learned to walk on land, but still the majority is different, bound water or unboud water, and hyaluronan is a major component. I think our massage should not address only muscles and bones, and sore joints, but how do I influence the water? How do I squeeze it in one direction more? How do I influence the water binding? How do I influence the hyaluronan with my manipulation? Then also, how does this person move outside of the treatment room?

Robert Schleip:

I think every practitioner, this does not seriously meant you should have a spy window where you look out how did they go to the parking place and enter their car, because in your room they walked very gracefully and you said, "Oh, Suzy, your whole gait has changed, etc." Then you see her later going to the car with her smartphone on hand, and she is as crunched as she was 10 years ago when she came to you for the first time. So I think we need to instruct our movement to do joyful movement, not so much performance-oriented movement that you did more push-ups than your brother can do, but elegant movement, a variety of movement, fun movement, and this is not new. This is the quality of many Yoga, Pilates, dance instructors, that you get a better sensation of your vitality, also of the social dialog if you're going to face, and neck expression.

Robert Schleip:

I think a good manual therapist is only one who inspires and transpires fun fascia-oriented movement with the client. If you say, "Okay," you find out what fits you, I'll give you some addresses, but they see immediately this is not your forte, and you are much more inspired about training the tactile sensitivity than you are bound to doing trail running barefoot in the swimming pool, or a children playground, or out in nature, or whatever, or dancing, but if they see you talking with beaming eyes how much fun you are having in your latest Pilates or barefoot running class, and then you ask them, "What do you have fun in?," and find out what they are inspired, I think then you are in a good direction.

Whitney Lowe:

Yeah. Do you think this is so challenging for all of us from an educational perspective across the multiple professions because we tend to live in such silos in our education? We don't learn what Feldenkrais practitioners do, and we don't learn what an Aston-Patterning person is doing, and that would be so valuable to be able to have exposure to those things to really give us a better sense of how we would encourage people to pursue those things outside of it because we know a little bit more about them. That's something we got to fix in the future, I think, not today.

Robert Schleip:

One of my favorite is to go in the stairs. So you practice at the stairway outside, of course not in underwear, most of the practices that would be [inaudible 01:04:11], but with decent clothing. I leave 15 minutes or 10 minutes at the end of the session, not in the first session but maybe in the ninth Rolfing session or something like that, and we do stair dancing together. I show them how muscular stair climbing upwards is doing, and also downwards where you go, "Bump-bump-bump," and then I show them the panther style, where you go gracefully up like a cat. Ideally on wooden stairs, because they can realize if they go into this pretension mode, if they lengthen their neck before, if they land with a barefoot kind of sensitivity they make much less noise also. Then I take their smartphone, and I videotape them usually from the back, never show their face on the smartphone that you give them because then immediately they don't see the rest of the body, they think, "I look like my mother," and that's it.

Robert Schleip:

So I usually videotape them from the back, in a nice angle of course, when they do the panther stair dancing. Before, I show them of course, I get closer, "This is your old walking style, and this is your fascial elegant walk," and of course they have fun doing that, but these are regular exercises that any manual practitioner can get from a fascial fitness instructor, Pilates instructor, Yoga instructor, that comes from a fun-oriented, not performance-oriented, a whole body perception fascial net oriented movement orientation.

Til Luchau:

That's great, Robert. It's always inspiring to have some time with you, and to reorient around, again what makes the most difference and what means the most, and it's so ... You're so consistent over the years that it often is what's most enjoyable, and what gets us to smile and move the most as well. Whitney, anything else you want to cover today before we ...

Whitney Lowe:

Well, there's a million things that I would love to continue going on and on, and on about here, but I want to ... Robert, thank you so much for you time. I know your time is precious, and these are fascinating discussions that we've gotten here, and hopefully you've given everybody else some interesting light bulbs to pursue, it certainly has for me too. I would like to just put in another plug to everybody, go out, take a look at this book because there are some really rich discussions of things from a wide variety of practitioners, and they're an excellent group of individuals that we've put together for the book, Fascia in Sport and Movement. Go get it, take a look at it there from Handspring Publishing.

Robert Schleip:

If you have the first edition you will hate us, because as soon as you pick up the new edition, "I hate these authors." If I have the first edition and then the new edition comes out, and I realized immediately, "Shit, I have to buy it again," because [crosstalk 01:07:03] has more than double the number of authors. The first edition was already translated into nine different languages all over the globe, it shows already why we were motivated to continue in this direction.

Whitney Lowe:

You know, you all know also as authors the challenge that we have is that you've got stuff that you put out there in print, and then things changes like, "Don't go read this, it's not accurate."

Til Luchau:

Well, I'm so pleased to see that you did take the time to double its size, and add a lot more illustrations, including some from our beloved bourgerie, I see in this book [crosstalk 01:07:45].

Robert Schleip:

Yeah, that was our other project, but we don't share now. We had a secret project where we went into the state library to look at the ancient old drawings, but that will be another topic.

Til Luchau:

Another topic to be talked about later. Remember you can get 15% off Robert's book, Fascia in Sport and Movement at handspringpublishing.com when you use the code TTP at checkout. Thanks, Handspring. Well, we have another sponsor, do you want to tell us about them, Whitney?

Whitney Lowe:

Absolutely. Our closing sponsor today is Books of Discovery, and they have been a part of the massage therapy education for over 20 years, thousands of schools around the world teach with their textbooks, etextbooks, and digital resources. In these trying times, this beloved publisher is dedicated to helping educators with online friendly digital resources that make instruction easier, and more effective in the classroom or virtually.

Til Luchau:

Books of Discovery likes to say learning adventures start here. They see that same spirit here on The Thinking Practitioner podcast, and they're proud to support our work knowing we share the mission to bring the massage and bodywork community enlivening content that advances our profession. Check out their collection of etextbooks, and digital learning resources for pathology kinesiology, anatomy, and physiology at booksofdiscovery.com, where thinking practitioners can also save 15% by entering THINKING at checkout.

Whitney Lowe:

We would like to say thank you to all our sponsors. Please do stop by our sites for handouts, shownotes, transcripts, and any extras that we have over there you can find that from my site at academyofclinicalmassage.com, and Til, where can they find that with you?

Til Luchau:

Advancedtrainings.com. Robert, do you have a site you want to mention at this point?

Robert Schleip:

Fasciaresearch.de is one of the more research-oriented, fasciaresearch.de for Germany, or somatics.de, both of them. I highly, also, recommend looking at the Fascia Research Society what a possible membership would offer, and also for the events that they organize.

Til Luchau:

Fantastic. We'll be sure to put links to all that in the show notes. So if there's questions or things you want to hear Whitney and I talk about, email us at info@thethinkingpractitioner.com or look for us on social media. Just search my name, Til Luchau, or how about you, Whitney?

Whitney Lowe:

Yeah, you can just search my name on social as well, and if you would, please write us on Apple podcast as it does help other people find the show, and you can hear us on Spotify Stitcher, Google podcasts, or wherever else you happen to listen, and please do share the word of our podcast, and tell a friend. If you're unable to find us on any of those locations you can always dial TTP on an old rotary dial telephone, and listen to us right there. That's it for our show today, thank you again, Robert, so much for being with us, and we will look forward to seeing you again here in a couple of weeks.