The Thinking Practitioner Podcast:
Episode 76: Fascia Research Congress Highlights (with Whitney Lowe & Til Luchau) 

Whitney Lowe:

Welcome to The Thinking Practitioner Podcast.

Til Luchau:

A podcast where we dig into the fascinating issues, conditions, and quandaries in the massage and manual therapy world today.

Whitney Lowe:

I'm Whitney Lowe.

Til Luchau:

And I'm Til Luchau. Welcome to The Thinking Practitioner.

Whitney Lowe:

Welcome to The Thinking Practitioner. The Thinking Practitioner Podcast is supported by ABMP, Associated Bodywork and Massage Professionals. ABMP membership gives professional practitioners like you a package, including individual liability insurance, free continuing education, and quick reference apps, online scheduling and payments with Pocket Suite, and much more.

Til Luchau:

ABMP's CE Courses podcast and Massage and Bodywork Magazine always feature expert voices and new perspectives in the profession, including articles by Whitney Lowe and by self, Til Luchau. Thinking Practitioner listeners can save on joining ABMP at abmp.com/thinking. Well, hello Whitney. How are you?

Whitney Lowe:

I'm doing well, sir. How are you today?

Til Luchau:

I'm pretty good. Nice to be here with you again. Last time I saw you, it was in person.

Whitney Lowe:

That was so wonderful. It was great to get a chance to hang out with you and spend some time here. We haven't really had a chance to do that much at all before, in our history.

Til Luchau:

No.

Whitney Lowe:

That was delightful, there at the Fascia Research Congress in Montreal.

Til Luchau:

Yes. Surprise, surprise, you came along. I was so glad you did, and not only did I get to enjoy the event, but I got to bounce things around with you, and now we get a chance to talk about it, share our takeaways, that the dust has settled a bit. That was at this point a week or two ago, when we were there.

Whitney Lowe:

Yeah.

Til Luchau:

So I look forward to that. Should we jump right in? Where do you want to start?

Whitney Lowe:

Yeah, so we decided we wanted to have an episode to recap some of the key things that were present for us, and we both wrote down some specifics on here, but I also want to make a couple of general comments, I think in terms of my impressions of the event. A number of my students have asked, "Tell us what it was like, tell us what it was about, what did you learn?" And all this kind of stuff.

Til Luchau:

Hey, I think I've been getting so many of those Facebook messages and texts from friends that hear I'm there. They want to know what I think, what are the takeaways, what are the goodies? Yeah, so this is a chance to, en masse, list those out, so we can just send that out to all of our friends or whatever.

Whitney Lowe:

Exactly, yeah. A couple of general impressions that I had were, this is my third event, third Fascia Research Congress. You've been to all of them, is that right?

Til Luchau:

I missed one, but I've been to five out of the six.

Whitney Lowe:

Yeah, okay. I would say that consistently, and this is something I heard from a number of people there, that I still feel like there's a kind of a theme, a running theme, from the organization trying to bring researchers and clinicians together to look at these things-

Til Luchau:

That's the stated purpose, yeah.

Whitney Lowe:

That's the sort of stated idea. My personal impression is I still feel like we're falling short of really getting a lot of attention equally to those kinds of things. There seems to be still a pretty strong emphasis on a lot of delivery of research results in most of the presentations that were there. And I heard a number of comments from clinicians feeling like they still wanted something that they could sink their teeth into or wrap their hands around to really figure out what is this change about what I do in the treatment room? And that seemed to be a theme that I still heard a little bit. We're still not quite a balance yet, I think maybe.

Til Luchau:

Oh, okay. So you were looking for more hands on applications or more practitioner presentations or more applications than you got, you're saying?

Whitney Lowe:

Yeah, and I was talking to somebody about this. They had an interesting perspective. And again, let me also say, for me, there was just absolutely tremendous benefit in the outside of presentation conversations I had with colleagues and people that I have long admired, wanted to ask them questions, went and talked to lots of folks. Those are some of the most valuable things about being at these sorts of events with people.

Whitney Lowe:

But I was talking with somebody, I can't remember who this was saying this, that researchers and clinicians really have different ways which they would approach being at an event like this and what they get out of it and what they're looking for here. Because a researcher can go to a presentation or deliver a presentation and get asked questions and say, I don't know, we should go back and look at this again. And in two years they come back with another tweak to study of something looking at these different things. The clinician is trying to serve people who come to them in the clinic and want some kind of immediate result, something to change in their life with why they're coming to see you.

Til Luchau:

That's right-

Whitney Lowe:

And as clinicians, we don't have that freedom or liberty to just go say, "Well, I don't know. I'll give you two years to figure this out."

Til Luchau:

Give it to ourselves as much. It's not quite the same that your client says, "Hey, my back hurts." He says, "Well, yeah, further research is needed on that."

Whitney Lowe:

Exactly, yeah.

Til Luchau:

No, that's true. We're very results oriented and action oriented as practitioners, and practical people. That's why they call us practitioners. No, I think I know what you're talking about. And in terms of that balance, it was certainly was a lot more research than practice, but they've all been like that. They've all been like that. And I don't know if there's ever billed as an equal time for each as much as a chance for practitioners mostly to learn from researchers and for researchers to get together and talk to each other. But no, I know what you're saying. And that was the theme of most of the past events. And the questions will come, "Okay, so how does this apply? But how can we actually use this?" And that's where you and I come in. That's where you and I help to get the help translate a little bit of that.

Til Luchau:

But I got to say, I know some of the reasoning behind that, as I understand it too, was political, in that there is also a tradition in academia of exchanging ideas and comparing notes and getting together and trading collaborative insights and forming new partnerships. We unfortunately don't have that much of that tradition in the practitioner world. We are more competitive. And when they started looking at who are we going to bring in as practitioners to present in this prestigious conference, it got really political really fast, who was being left out. And so initially there was a really clear decision, let's not even have it about practitioners, let's have it about their research.

Til Luchau:

Now, some of that's trickled in, and I was really honored to be one of the pre-conference presenters. I got to present my stuff for a day as well as a few other people. So I think they're finding ways to work that in around the outside, but you're right, it's very much a research conference for practitioners as well. And with me being there and presenting the first day, I got to say that that was the big event on my horizon, both preparing for that and being ready for that. And then the delivery of that took a lot of my focus. And so by the time that was done and I jumped in the conference itself, I was just so relieved that that was behind me, that I sat back in my chair and let the reams of information just wash over me.

Til Luchau:

And so I have a few pages of notes here, but I wasn't mining it for the same pithy takeaways that I maybe have in the past when I was writing it up for massage and body workers, something like that. They are, by the way, I know that they are going to write up a takeaways article from various people that were there, massage and body work well, place to go to get some of that. All that aside, you said it was nice to get together with people. That's always the most heartwarming part of it for me too, is coming together with people that I hadn't seen in a long time. And I got a lot of history with some people in that world, so just seeing old colleagues and friends and mentors like Robert Schleip, like Tom Myers, like Sharon Wheeler, going on down the list.

Til Luchau:

And then also getting to have conversations or see in person or ask questions of researchers that I have a lot of respect for, like Stewart Miguel, like Helene Langevin, Ana Peter Friedl, all these people whose work I've been following and learning from, getting to actually go up to them and thank them for that, or actually ask them a question too. Or there was that lunch when we're sitting there during, well it wasn't a lunch, it was at Helena Langevins presentation, chit-chatting with our table mates, and during her presentation about inflammation, one of my favorite topics, she says, "Oh, and there's this really interesting paper by Patricia Houston about the network analysis of systemic influences of inflammation." And Patricia Houston and was the woman that was there at our table we were chatting to. Surprise, surprise. She had to stand up and take a round of applause for her work. It was just great to rub elbows with the people actually on the ground asking the questions, doing that kind of work.

Whitney Lowe:

I think that's absolutely true. And in particular, your point about being able to ask some of these researchers more specific questions about what they're doing and see them light up a little bit sometimes and recognizing some of the clinical applications of their work and everything was really fascinating. I had an interesting conversation with one of my dinner colleagues on Monday evening, and she is a researcher in the UK doing some work, especially with athletics, the athletic population and Fascia research. And she said something really interesting to me. She said, the university where she is, when she initially proposed what she was doing, there was a fair amount of support for it saying, "This sounds really interesting, you're really into this Fascia stuff. Let's see, tell us what you want to do. And she wrote up this conference of her proposal and was getting this support from everybody in the department.

Whitney Lowe:

And then they said, "Well, so when do we start doing the injections?" And she said, "No, we're not actually looking at injections, we're looking at manual therapy." And it was like all of a sudden the blood just rushed from their faces like, "Oh, we're not really interested."

Til Luchau:

Well there's that-

Whitney Lowe:

Because there's financial ramifications of things like that, with injection therapies and things like that. And the point that was brought up was just that a lot of the things that we're particularly interested, are still stymied by the economics of the research world of what people can get funding to look into. And to be honest, manual therapy just doesn't rank really high on the list because it's not something that companies can make money from.

Til Luchau:

Well, that's an interesting point. Yeah, I would say the practitioners there, I didn't do a poll, but my impression was they were maybe evenly split, at least 60 40 somewhere, manual therapy to movement therapy. So there's a lot of applications now in the fascia research world to movement therapies. And as we're learning, those things really need to work together. We need to be moving as well as getting our body work to have a change in a lot of symptoms. But it's the same challenges there. And then there's also just, it's some of it's delivery mechanisms, some of it's financial incentives, some of it's just paradigms and university institutions. But I think there were quite a number of people, at least in my one day workshop and inflammation, quite a number of people that were hands on practitioners working in different academic settings, either doing research themselves or involved in that. So that was really, it was cool to see too. But you're right, we are in the fringe in terms of the medical world.

Whitney Lowe:

Yeah.

Til Luchau:

Yeah.

Whitney Lowe:

So let's drill down into some specifics here. What are some specific takeaways for you? What really-

Til Luchau:

Let's get to the takeaways.

Whitney Lowe:

lit your bulb, so to speak.

Til Luchau:

The stuff people were texting about. "So, Til, tell me, what do I need to know about this?" I have them, I'm still a little bit here because the overall impact of the event really was the breadth of the field and the ways that the different disciplines are coming together and interacting, and everything from oncology to tissue science to physics to exercise and to rehabilitation to movement, people doing research rather on the results of Botox injections, on and on down the list of the ways these things influence fascia and as resulting rehabilitation or pain related questions. So the takeaways that I was looking for were, again, things that I can apply in my practice and I got to hand it to my friend, colleague and mentor Robert Schleip. If I could, I would have him on every episode of this podcast. I'm glad you stopped me from that. And he just stops me as well.

Whitney Lowe:

Well, maybe I shouldn't stop you. I would love to delve into those conversations too. My list of questions that I wanted to ask him got longer and longer as we go.

Til Luchau:

And he's been in the background, he's on the selection committee and on the board of directors of this event. He doesn't take a front row seat in the presentations. He sits right up front listening to the presentations, but he doesn't get up on the stage that much. But the one time he did, which was actually in a breakout, he gave a little overview of some of the most interesting research happening on a small scale now in the fascia world. Well then one of those was a study on tissue stiffness as correlated to depression scores on a depression instrument.

Til Luchau:

And I have to drill down and get the reference a little better. He mentioned it in his recent Massage and Bodywork article as well, which is actually, I want to just recommend, it's a really good overview of both some of his historical thinking and the research he's been working on for a couple decades. But then the most recent updates, he did a great job of encapsulating that, again, in the most recent article of Massage and Bodywork, which I'm looking for and I do not have here at my desk to give a date, but I'll bet you could find that pretty easily. It's on their site and I know you can access it for free, even if you're not a subscriber.

Whitney Lowe:

Was that in the recent fascial special that they did?

Til Luchau:

It was their special fascia edition. He wrote a feature article and in that article he mentioned this research where they were using an indented meter, a little device that measures the liability and elasticity and stiffness of the tissues. And they measured a standardized place on the body and then they scored people on a depression instrument answering questions. And sure enough, the people that answered with more depressive scores had stiffer tissue, go figure. Now what that means, it needs to be unpacked. Do we get depressed because we're stiffer or are we stiffer because we're depressed? All those kind of questions. But it's unusual in that it is a correlation across this body mind continuum that we know about that seems intuitive to us and that we kind of assume is there, but it's rarely researched and rarely actually measured, the ways that the study he was laying out was.

Whitney Lowe:

I can't remember. I think I was in that presentation, I can't remember if somebody asked him for thoughts of what that potentially might mean. Just simply what comes to mind is maybe people who are depressed are a whole lot more sedentary because they don't want to get up and do anything.

Til Luchau:

Oh, the mechanisms of why that comes about.

Whitney Lowe:

That may be what leads to that.

Til Luchau:

We could speculate about any number of mechanisms. There are inflammatory patterns that involve a kind of reactivity that are involved in depression and involved in tissue stiffness. So there's some shared mechanisms just that go across the bio psycho barrier. So there could be all kinds of things happening there. But yeah, for sure levels of activity, all those things would need to be considered. And then it becomes what can we do to change it? In other words, if we change the tissue stiffness to someone's score change or the other way around. And I think one of my most interesting, or most enjoyable, I got to say conversations with him was on the dinner cruise out on the water there where we're talking and socializing and someone started playing the music and he says, "You know it's a proven fact that you can't frown and bounce at the same time." So there's a whole group of us bouncing up and down there on the deck trying to keep our frowns-

Whitney Lowe:

And bounces.

Til Luchau:

Yeah, so we're jumping up and down, trying to frown. And there's something to that where it's just that that state of mind shifts is when you're changing your state of movement as well.

Whitney Lowe:

Yeah, interesting.

Til Luchau:

Unscientific study.

Whitney Lowe:

Right.

Til Luchau:

All right. How about you? What's one of yours?

Whitney Lowe:

Yeah, so boy, there's quite a number of things that pinked my curiosity, but I'm a biomechanics geek. So I was going to a lot of the presentations that were around this. And one of the things that struck me as kind of a theme, this was actually across a number of different presentations that I think is really relevant for a lot of massage and soft tissue manual therapy practitioners, especially those who are working with active populations like high level athletics and things like that. This concept and idea about tissues working in series together and elastic recoil in the connective tissues. And in particular what we're talking about here is, I think it might have been Stuart McGill's presentation where he initially talked about this, but this was also in Mark Driscoll's keynote as well, looking at the role of the lumbar dorsal fascia in forced transmission across the spine.

Whitney Lowe:

But he gave an example of a kangaroo as an animal, which has a tremendous amount of power generated to be able to lift its body weight and hop like it does. And same thing with an antelope. They don't actually have the muscular strength to make those kind of leaps and jumps that way that a lot of what is happening there is that there is muscle contraction, but the tissues are because they are in series. And what that actually means is, we're talking about imagine you have two tissues end to end. Just to simplify, grossly oversimplify this, muscle blending in with the fascial connective tissues of the tendon and then to the bone. We consider those being in series as opposed to tissues that might be two muscles running right next to each other. Those are considered tissues that are in parallel. So there's not as much force transmitted between tissues that are in parallel position as those that are in series connected to one another.

Whitney Lowe:

But the tenderness tissue, in particular in individuals has a property known as elastic recoil in the connective tissue in the fascial connective tissue of the tendon, which can store kinetic energy essentially. And so the slight pre-stretch that happens on those tissues when you jump down and land is in recoiled out of there to elevate you and push you and propel you forward during the jump. And so Stuart McGill and had a slide that he put on the screen of a guy who had won one of the basketball slam dunk competitions and he said the guy could jump up so high, like he had half his body above the base of the backboard in the basket. He was just incredible jump height. And they showed this guy super high on the treatment table and said, "Look at what he can do with straight leg rays with his hamstrings." And they got his leg elevated about 45 degrees off the table.

Whitney Lowe:

You think, "Oh man-"

Til Luchau:

Flexibility, yeah.

Whitney Lowe:

"Somebody can jump that high. They must have incredibly flexibility to their body." No, he could only lift his leg 45 degrees off the table. That's because the myofascial chain for him is such a precision and highly tuned spring to be able to allow himself to do this. And this is where you translate these concepts into maybe working with high level athletics. We're always trying to get people looser, saying, thinking this idea like, "Oh, we should loosen them up so they can have great flexibility and perform better." That may be really an impairment to their function in certain instances, especially when you're talking about explosive level athletic forces needed at high, very high performance levels, getting somebody's hamstrings loosened or whatever might actually slow them down and impair their performance. So that's a really interesting concept, important to think about. Because I think there's a whole lot of emphasis that we always hear and put on getting people looser and that's not always the thing that needs to be done.

Til Luchau:

No, that's a really good point. It's a fundamental one to understanding of how our models are evolving because in the simplest level, a lot of massage therapists learned that if I can make it softer, people feel better. And so we maybe unconsciously applied that principle to everything and it seems to work for a lot. But no, you've just given an example where we don't want to make everything softer all the time, and especially people involved, like you said, in rebalanced activities. But all of us, to some extent, our tendons are springs, our muscles are tuning the preload on those springs and the loading and unloading of those springs is what helps us move, especially when we're bouncing along and without a frown on our face.

Whitney Lowe:

Exactly right. Yeah.

Til Luchau:

So I got one.

Whitney Lowe:

What else you got there?

Til Luchau:

Well, a somewhat related concept, this was a Dr. Tina Wang, who I hoped to get on our podcast. She said she wants to come talk about it because she was blowing my mind. She did a research project on people with Ehlers-Danlos syndrome, which is a connective tissue disorder characterized by really super flexible joints. So no elastic recoil, just people famously can bend their fingers back to their elbow kind of thing with EDS. So she did a study of them involving Botox injections to work with their, again, I'm going to say it wrong, so you need to get her on the program to explain her study to measure the results of that. And some of her findings were just so counterintuitive that I was like, "Wait a minute, did I write this down right?" And I'm not sure I have yet. So again, I'm reluctant to go into specifics, but one of our findings that I wrote down was that EDS folks have less glide between their layers, not more, even though their tissues tend to be much softer, much more elastic in a sense, there's actually less glide overall.

Til Luchau:

And that glide is emerging as one of the key concepts. We don't want to mash things and make them soft, but we do and we assume so far, want them to glide. And that is one of the things that manual therapy seems to be particularly effective with is helping there be differentiation glide between layers, through dehydration mechanisms, things like that. But in the case of EDS, where there's already a lot of movement, turns out they had less glide and 90% of people with that diagnosis deal with some sort of mild fascial pain, meaning pain that seems to be related to their tissues, soft tissue based pain. And so she's actually is a manual therapy practitioner herself and has some interesting ideas about how this applies to manual therapy with people with hyper mobility syndromes, which is a big frontier for us to understand better. And her research is, like I said, counterintuitively mixing us up. You got to figure out what this all means.

Whitney Lowe:

And an important caveat with thinking about this in relation to manual therapy, many patients with EDS can't take pressure work.

Til Luchau:

Yes, thank you for mentioning that.

Whitney Lowe:

So if what we might be able to do might, for example, help encourage some gliding between those more superficial layers where there is such rich sensory innovation, those could be some of the best strategies for working with some of those kinds of people.

Til Luchau:

That's right. Or the plot thickens where they can take deep tissue work, they won't even want it because they feel stiff and feel painful. But there's very often an extreme reaction afterwards. A lot of people are in pain and feel stiff to themselves even though they feel soft to our hands and they're very flexible and will guide their practitioner to deeper and deeper work, and then the next day just be destroyed from it. So that's the classic EDS track.

Whitney Lowe:

Yeah, that's a good thing to remember. My mother had EDS and she could just accidentally bang her hand on the table or something like that, not necessarily feel extreme pain or discomfort or anything like that at all, but the next day it would just be absolutely blown up with swollen and bruised, incredibly capillaries just breaking down everything. And so she had some issue issues early on, I think. Well part of this is that they didn't really know a lot about EDS when she was young, and so she and her brother who both had this, frequently were having problems with trying to figure out what was going on with him and everything, but-

Til Luchau:

Oh bad-

Whitney Lowe:

But I remember-

Til Luchau:

Still trying to figure it out.

Whitney Lowe:

Yeah, there was some things, I remember when my mom told me one of her very good friends came up to her one time, she came into work with some really bad bruise on her face and blood vessels broken in her eye and she's like, "Do you need me to help you be safe at home," kind of thing. Because she had this perception that maybe there was some domestic abuse-

Til Luchau:

Some battering going on at home.

Whitney Lowe:

But she said, "No, no, this is not the issue here."

Til Luchau:

No, it's a puzzle. It's a big puzzle. I forgot about your background there, but again, that's going to be a line of inquiry for me, I can tell, in the coming months or years.

Whitney Lowe:

Yeah, indeed.

Til Luchau:

So what else you got?

Whitney Lowe:

Yeah, well this is kind of along the same lines, and this is something I also think came out of Robert Schleip's presentation and just also not only here at the congress, but reading a lot of his work and some of the things in his book and papers. But for me, just a further kind of refinement and understanding of how critical and valuable is this relationship understanding between the extremely rich sensory innovation to fascial tissues and the proprioceptive information that we're getting through our bodies based on tension pressure, stresses on those tissues and how that plays a role in both creating more efficient movement, dealing with pain problems and that sort of thing.

Whitney Lowe:

And recognizing that this extremely richly innovated connective tissue is something that has a whole lot of impact on the way in which people are doing things and well or manual therapy might be doing with them as well. So that was just a more, so I'd say a refinement of things that I've been thinking about, thinking a lot about exploring. And thinking about that, I wanted to ask you a question about this because this question was balance or bouncing around in my head in the manual therapy worlds.

Whitney Lowe:

Do you feel like that we can say that there is something that we would consider fascial work, meaning that we can target that tissue specifically? Or is it really something maybe where we might be more inclusive thinking about just the fascial ramifications of anything that we do in a wide variety of different implications? So a question more about can we target that tissue?

Til Luchau:

I know that's a question that it came up on the criticisms of fascial approaches in the pain science world. Why do you think you can just work on fascia? And I don't know that, my own tales opinion, I don't know that we can or need to or should, to think, say we're just working on fascia, that fascia is just it. And certainly fascia worked its way, myofascial worked into the way, into the name of my book. And so the work I teach, but honestly, if I could, it would probably be about 18 syllabus long, it be neuro-osteo, psychosocial, bio fashion, everything would be in there. Because no, we're not just targeting fascia, and they're conceptual models. As you know, Whitney, I don't know any empirical or objective test that can show that we're able to touch anything other than skin.

Til Luchau:

And there's debates about, say the frictionless interface idea, things like that, say how much can we affect anything under the surface? But in my mind, it's not so important that I just touch fascia. It's not what I'm trying to do. It's not what I'm trying to do at all. I am feeling things under my hands and I'm responding to what I feel and I am asking and finding out what my client feels. And together we're working on those things. And that makes sense to me based on the learning I've had done in this field and others that we're getting a lot of sensation from what we call fascia, a lot of the nerve endings are embedded in different fascia layers so that our brain is getting more bandwidth from those layers and probably any other structure with the skin coming close. But there's a slight numerical edge, I guess, for the fascia over the skin.

Til Luchau:

But that aside, no, I don't think it's so possible to say we can work just on fascia or that we need to, or that we should be. Maybe as a therapeutic narrative, just like chiropractors work on bone or acupuncturists work on chi or something like that. It's like a model we use. But is that objectively the case, who knows? Who cares?

Whitney Lowe:

Yeah.

Til Luchau:

What do you think?

Whitney Lowe:

Well, for me, I know that I'm overly analytical about a lot of different kinds of things, but I like to know why things work, what's happening. And so for me, it plays into the whole narrative of trying to figure out what are the physiological effects of soft tissue manipulation. And in order for me to think about how do I maximize certain effects for certain types of things where I'm trying to help somebody this way or certain types of things where I'm trying to help somebody another way. So for me, I think it's more of falling under the umbrella that I don't really have a strong sense of feeling like we can really target that tissue there. And again, this is of narratives of some different types of technique approaches, and I think a lot of them are older narratives that we don't hear so much.

Whitney Lowe:

So I don't think it's so much about targeting that particular tissue as it is having a better understanding of the systems that are around and the way in which, especially if you look at Schleip's work, it's very difficult to talk about facial tissues without talking about the neurological system, because they're just so enmeshed with each other. So it's almost like you said, it's the neuro myofascial osteo, whatever kind of things.

Til Luchau:

That whole lymphatic system, yes.

Whitney Lowe:

And so it becomes extremely difficult for us to really separate those things apart. And so I am intending to really think now more about, if we have to look at these categories, these are some of the more muscular oriented effects of this type of work. These are some of the more maybe neurological aspects of what happens with this particular type of work. And these are some of the more effects that we might be able to be generating or paying attention to what's going on with facial connections here or something like that. I try to look at it more, I think, as sort of an overarching umbrella of those different approaches without really thinking about targeting it a particular tissue.

Til Luchau:

Well, yeah, fascia's role in the body as connected tissue has length at the theme of connecting and integrating too. So when we talk about a muscle, another term for muscle is a myofascial unit, it's almost impossible to talk about muscle separate from its fascia that invests it and forms it. And the same is true for a nerve, the same is true for a blood vessel, the same is true for an organ. They're all fascial structures with different specialized cells and structures within their fascial envelopes. So in that sense, anytime we talk about something fascial, we're talking about something else. And anytime we talk about something else, it includes a fascial, a connective tissue, a collagen based structure there as well.

Whitney Lowe:

Yeah. And I think there have been some gross oversimplifications of some of these concepts and ideas as they entered into our world. People saying things like, "Well, fascia is everywhere, so it does everything." It's just like that's just a gross oversimplification of some of those facets of anatomy. But also saying, Well there's a study that says we can't mechanically elongate fascia, so there's no point in talking about it. So there's different sides of the pendulum-

Til Luchau:

Well, it's irrelevant because- Yeah, that's right. No, that's true. And the pendulum is swinging around and it goes from like, "Wow, fascia is amazing, it's so cool," to, "Fascia is totally irrelevant." And they were both true. They're both true. It all depends. And again, the title that's on this conference we went to, it's the Fascial Research Congress, and that was the unifying theme. But in Berlin, back four years ago, really the theme that was emerging is it's less about the fibers in this tissue and it's more about their fluid interactions. And that theme continued here where it was becoming less about this stuff and more about what it does, more about the ways it interacts and more about the processes that are going on within it. And I'm almost always amazed too, one of the presenters I was most looking forward to, Peter Friedl, we just got a little bit of him in Berlin, the last one.

Til Luchau:

This time he had a whole morning, a whole longer keynotes presentation where he was sharing his amazing images of cellular motility within fascia, within the layers of the connected tissues. Most of his research is around oncology and tumor spread. So he was showing the ways that cells move in that situation. But it applies to wound healing and it applies to new tissue formation and all kinds of things, how the fibroblasts essentially tunnel, find their channels through the tissue and weave together the fabric of the tissues based on its fluid channels, and also do their inflammatory effects of inflammatory resolution and turning down inflammation by going places in the tissue. Is it time for his headline? Should we go into like-

Whitney Lowe:

I think it's definitely time for that, yes.

Til Luchau:

Yeah. Well, his presentation was spectacularly visual. He had these amazing micrographs where he'd show real time living tissues, that the cells moving around in them. And one of the questions, him as a cancer researcher gets is, "Should we be massaging tumors?" And there's various lines of thought around that. But he said, let's say, so he got a rat specimen with the tumor and took a probe and starts massaging it and is able to photograph tumor pseudopods, this parts of the tumor spreading out into the channels around the tumor. And the room was of course, silent. We were shocked to see, okay, here's somebody massaging tumors out into the tissue. And then his next slide was, "Don't massage tumors." That was his takeaway. "Thank you very much, everybody. Have a good day." That was the end of the presentation.

Whitney Lowe:

And there were a lot of jaws laying all over the floor after that.

Til Luchau:

That's right. Because it's been such a battle in the oncology massage world to say, "Listen, just because someone has a cancer diagnosis, we shouldn't be afraid to touch them. We shouldn't be afraid to give them the benefits that they get from hands on work." And of course, you take his final slide, don't massage tumor to its logical conclusion and that complicates that question quite a bit.

Whitney Lowe:

And you and I were talking about this immediately afterwards and just noting that we got to be really careful about blanket generalized statements about that, because that is, in essence, not necessarily what you need to take away from that research right away, because we got to talk about exactly what did he do, and maybe because he used a little tool that he was using there. And do we know, for example, that the same thing happens with manual therapy that happens with this little tool that, there's just a bunch-

Til Luchau:

Do we know the same thing happens in humans, as is in rat models, etc, etc. And he himself said, "Well, this is maybe accelerating a process that was happening anyway. Maybe we push some of the pseudopods out there one week sooner than they would've got there on their own." So there's lots of questions there about even his conclusion, don't massage tumors. But I think most of us would agree if we know there's a tumor there, we don't want to go massage it for goodness sake. But it does raise some questions that I think are going to be reverberating for a while about this. How do we reconcile the benefits that people get from the work with the theoretical risks that he was able to show in the laboratory?

Whitney Lowe:

Yeah.

Til Luchau:

And again, to put even more disclaimers on it, we don't know what this means. It's one study in rodents. It's one slide in one conference. There's been a couple decades now of people looking very hard at this question. And the existing takeaway is, you can safely work with people with cancer, for sure. And there's so much benefit that comes from the work we get.

Whitney Lowe:

And very important to remember, in the process of research that oftentimes there's a debate between individuals who somebody may find something completely different, and maybe there were just some odd things that happened in this particular group of specimens that were being studied until that is replicated a number of times, or there's some other things that look into it more specifically, I think the caution that we were talking about with a lot of people afterwards is like, "Well, let's don't just freak out about this yet, in terms of completely altering what we think we know."

Til Luchau:

I hope to get him on the program and talk to him about this really interesting work, about this cellular motility idea. That idea in particular, but also the implications for wound healing and the understanding of how fibroblasts work, how they decide where to lay down tissues, that the active involvement of individual cells in that whole process. And the effects of mechanical forces on them. Of course, that's in the back of my mind is what does this mean for me in my hands on practice? He's measuring the effects of mechanical forces on at the cellular level.

Til Luchau:

Jules Mitchell referred to this when we talked to her about her stretching book, Yoga Biomechanics. Jules Mitchell talked about, "Well, there's all these effects we know mechanical forces have on tissue, but then there's cellular effects as well." And it turns out that the cell function, especially fibroblast and Helene Langevin mentioned in this too, we're just beginning to understand how mechanical forces like loading and perhaps like massage or mental therapy changes the way the cells function. And phases the way they lay down collagen or the way they deal with inflammation, the way they do their jobs.

Whitney Lowe:

Good stuff.

Til Luchau:

You got any more?

Whitney Lowe:

I think those were really the key points of things. I kind of wrapped up several things together in my key point takeaways there. So I think that's a good overall summary of the big things that were pertinent for me. Anything else that you have that you want to-

Til Luchau:

No, there's so much. I got pages and notes, like I said. But I think those were the ones where the pink highlighter came out and go, this is the one that has a really clear application.

Til Luchau:

And It's got to keep settling out. This is what it was like for me after the previous ones too, that these ideas sort and sift. And I find myself actually thinking about them in the practice room in ways that I didn't anticipate, that I didn't anticipate at all. So you're already trickling into my thinking and my teaching and my work.

Whitney Lowe:

Again, just in terms of a retrospective, also of just looking across the decades. I would just also want to say that I find it both remarkable and just inspiring and invigorating to see the interest in manual therapists having about science and research and learning more about what we do. And the flip side of that, researchers having interest in what happens in manual therapy approaches as well. And it's really, yeah, we got a long way to go in terms of getting those places connected, but I remember what it was like, and I'm sure you do too, of the early days when we were just in a whole lot more in silos without having a lot of connection with those types of things. And to me, it's both inspiring and exciting to see the connections that are being built, and the bridges that are getting built and the ability that we have.

Whitney Lowe:

Well, for example, like you said, for us to sit at the table and talk with Patricia Houston about a lot of these fascinating things and have a conversation with all these other folks about seeing the interesting places where our work intersects and collides with other things that people are doing and see like, "Wow, I never really thought about this."

Til Luchau:

Or just poster presentations, couple dozen maybe, posters of people in the midst of various research projects and just the creativity and the breadth of the questions people are investigating. I think everything from breast cancer to the Botox I mentioned, on and on, down the list. Yeah, lots of interesting things coming up.

Whitney Lowe:

So speaking of things coming up, you got some stuff still coming up here too.

Til Luchau:

Well, that's nice of you to mention that. Yeah, this is right after this episode airs, I'll be starting my Principles course in the Illia and SI joints. We've been pitching this every episode for the past few episodes. And this will be the final pitch. It's not too late to join live if you're listening to this before October 5th, 2022. Or it's available later by recording. But I hope you do come jump in live. You can just listen to the lectures or you can do the whole package of options, of learning options, including small groups, practice periods, recordings, on and on.

Til Luchau:

Again, October 5th. This ID the first lecture date. Advancedtrainings.com is where you go to find out about it. So thank you for mentioning that, Whitney. That's my little advanced training sponsor pitch. And then I also want to thank our other sponsors and ABMP was our opening sponsor. Our closing sponsor today is Handspring Publishing.

Til Luchau:

It was nice to meet them there to actually get, you know, Jessica Kingsley, and their people were there with their handspring collection. It was great to get to know them and talk to them there at the Fascia Research Congress. And the little story I tell us that they were the ones that I decided to go with when I was looking for a publisher. Even though I had an off, much bigger offer from a much bigger publisher, I went with Handspring who was just four people in Scotland. And to this day, I'm glad I chose to go with them because they helped me make the books I wanted to make. And their catalog continues 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:

And I would also just like to say that while we have seen some of the other big publisher players on the field cutting back their manual therapy catalogs, Handspring is one company that has been continuing to expand this. And it's just been very impressive to watch the growth and diversity of titles and things that they bring in there. I think it elevates the profession significantly. So recently, as you mentioned, joined with Jessica Kingsley publishers, the Integrative Health Singing Dragon Imprint, where their impact will continue. So head on over to their website at handspringpublishing.com to check out their list of titles and be sure to use the code TTP at check out for a discount. And we thank again, so much, Handspring for sponsoring the podcast. So thank you to all of our sponsors and of course to you the listeners, thanks for hanging out with us here today. You can stop by our sites for show notes, transcripts, and any extras. You can find that off of my site at academyofclinicalmassage.com. And Til, from yours, where can people find that?

Til Luchau:

advanced-trainings.com. I should mention that the next Fascial Research Congress is going to be 2025 in New Orleans. August 2025, New Orleans.

Whitney Lowe:

New Orleans.

Til Luchau:

Yeah, so that'll be fun. Put that on your calendar. Hope to see you there. If there are questions or things you want to hear us talk about on the podcast, Whitney and I, just email us at info@thethinkingpractitioner.com, or look for us on social media, just under our names. My name is Til Luca-

Whitney Lowe:

How many names do you have?

Til Luchau:

Yeah.

Whitney Lowe:

So yes. And you can find that also under mine @WhitneyLowe on social media as well. You can rate us on Apple Podcasts as it does help other people find the show, that's quite important. So take a moment to do that if you can. You can also hear us on Spotify, Stitcher, Google Podcast, or wherever else you happen to listen. And please do share the word and tell a friend about it so they can learn from it as well. So thank you very much, sir, for that recap. Once again, it was great to hang out with you in three dimensions over there in Montreal for a little while and we'll look forward to-

Til Luchau:

It was nice to debrief as well. So we'll look forward to our next conversations, wherever they may take us. Some of these are going to be part twos. I got my wishlist of people to talk to from that conference and I know we'll be finding more interesting things to talk about as we move forward.

Whitney Lowe:

Yes, indeed. We did plant some seeds with quite a number of people there, that we said, "Hey, we got to have you come talk to us because our listeners want to hear some more about what you're up to." So those will be some other interesting topics we'll get to hear shortly.

Whitney Lowe:

So until then, we'll see you all again in two weeks.

Til Luchau:

Bye for now.

Whitney Lowe:

Okay.