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The Thinking Practitioner Podcast:
Episode 15: Robert Schleip: Talking to Fascia, Changing the Brain, 20 Years Later

Broadcast date: 6/3/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

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:

I'm Til Luchau.

Whitney Lowe:

Welcome to The Thinking Practitioner.

Til Luchau:

Welcome to The Thinking Practitioner.

Til Luchau:

Hi, this is Til Luchau. Today's episode is sponsored by Handspring Publishing. Handspring did a superb job when they published my own Advanced Myofascial Techniques books, specializing as they do in unique titles for physical therapists, massage therapists, osteopaths, and other professionals who as they say use touch or movement to help clients achieve wellness. Their impressive catalog features, FASCIA in Sport and Movement edited by my guest today, Dr. Robert Schleip. They've recently launched a series of free webinars, featuring its authors called Move to Learn with conversations, active demonstrations, and Q&A sessions. Sign up @handspringpublishing.com. Check out their great books and be sure to use the code TTP, like The Thinking Practitioner at checkout for a special discount. Thanks, Handspring.

Til Luchau:

In today's episode, I am talking with fascia researcher, Dr. Robert Schleip, who took some time out from his very busy schedule to chat with me from his office in Munich, Germany. Robert, thanks for joining me on The Thinking Practitioner podcast. You've been a mentor of mine, an inspiration, a fact checker, and a friend for many years.

Til Luchau:

Just before we got on the call this morning I went and looked on the internet and your various internet biographies describe you as a human biologist and psychologist with an area of expertise in fascia. You are the research director of the Fascia Research Group at Ulm University and the German research director at the European Rolfing Association. So, people know you as a fascia, a writer, thinker, networker. You've put some amazing people together and catalyzed some amazing events over the years. Some people also know that you have a background as a hands-on practitioner. What did I leave out, or what would you like people to know about you, or what context should we start with about who you are for this conversation?

Robert Schleip:

Well, first of all I've been a mutual inspirating exchange partner of yours Til Luchau. I wouldn't say I have been your mentor. So, then we have been mutual mentors. Both of us have been associated with a somatic body work for several decades. That's how we know each other. I came from psychology originally, but then I went into what was called body work very early on. I was the first German Rolfer in 1978. Stayed with rolfing mostly for three decades, but also became a Feldenkrais practitioner. Then after 30 years of hands-on enthusiastic practice, I turned more into a laboratory science.

Til Luchau:

Yeah. My first contact with you was probably the late 80s. I was trying to think back when it was. I couldn't remember the exact year. It was at the Rolfing Institute. My memory is that you were already questioning our existing ideas as Rolfers, especially about the role of tissue, and the role of the nervous system. Is that accurate? Would you say that too?

Robert Schleip:

Yeah, I think it was in the late 80s I started writing about it in a provocative style, mostly inside of the Rolf Institute publications in the early 80s.

Til Luchau:

In your biological explanation.

Robert Schleip:

Yeah, and my reasoning at that time, because I didn't know how to do experiments, was based on Peter Levine, who many of our colleagues know as the founder of somatic experiencing, body-oriented psychotherapy. He used to be a Rolfing colleague of ours. He was invited in one of the faculty meetings, and there he told them that he did some mathematical calculations, how much kilograms or pounds per square centimeter, would be necessary for the gel-to-sol isotropy explanation that we had taken over from Dr. Ida Rolf, the founder of the Rolf Institute.

Robert Schleip:

He came to the conclusion that it is beyond the forces that we have. So, it would be like 80 kilograms or more. That led me to ask, maybe we are doing something more, but I never got him. I chased him for several years, please give me the mathematics. If you tell us that you did the mathematics, that is not reliable, you need to get them, but he never managed to get them. They were in a drawer, in a box, etcetera.

Robert Schleip:

Then years later I did the mathematics myself with colleagues, yeah. It basically started in the late 80s and early 90s, me, but I was not alone. I was probably most prominent within the faculty to question the old plasticity model of Rolfing and to say, “We need additional models that include the nervous system.”

Til Luchau:

Yes. That's my memory. I remember you raising those questions. I remember you writing. I remember, I was probably a student at the time, that you were becoming a faculty, a full faculty member at the Rolf Institute.

Robert Schleip:

I was existing when I was staying at your house Til.

Til Luchau:

Okay. That's what it was, but I remember. I remember Peter Melchior telling me that there was actually some pushback. You coming in, wanting to be on the faculty, had these ideas and people were saying, “I don't know if that's the right thing.”

Robert Schleip:

They were not open at that time, yeah. I don't blame them. I can understand it.

Til Luchau:

What do you think the objections were? What do you think their hesitation was?

Robert Schleip:

First of all, if you have a model that makes you superior to other competing manual therapies, that Rolf was a lot stronger, and therefore they were deeper and more profound. Other therapies can change the brain. Other therapies are even better in knowing how to change the body schema as one of the brains representation. For example, Feldenkrais. Other therapies are better at relaxing muscle toners, but Rolf was change collagen tissues.

Robert Schleip:

I could understand that if you take that unique selling proposition away, that it was not so very well enthusiastically greeted.

Til Luchau:

You were questioning our identity as being unique, but also our basic explanations for what we were doing.

Robert Schleip:

Yeah, but now I think they are very thankful to me and that's what I get, because another emphasis that Ida Rolf had, more than anybody else, more than Andrew Taylor still, was that fascia is the most important and most powerful tissue as a focus for the attention of the myofascial therapist for body a worker, rather than the skin, or the muscles, or the lymphatic flow, or anything else.

Robert Schleip:

Now, I have been very involved in research, together with Tom Findley and others, fascia research has taken a prime time development in scientific research, and Rolfing is profiting from that.

Til Luchau:

Yes, that's right. I mentioned Peter Melchior. To be fair at that time he said, “He's the kind of guy I want on the faculty. I want him there. I want him helping us think these things through.”

Robert Schleip:

Yeah. It was published then. I actually just got the publication back, yesterday. I published something talking to fascia, changing the brain in the late 90s, and it included me writing to all the faculty members. At that time there was no internet, and saying, “What is your response to little experiments I had done in Australia?” Where I tried to Rolf people under anesthesia, and also to check their range of motion under anesthesia, and I discovered something that should not be possible, based on the Rolfing model. So, I questioned my colleagues. Peter Melchior, together with one other person, was the only positive response to that.

Til Luchau:

Tell us what you discovered that shouldn't be possible.

Robert Schleip:

Yeah.

Til Luchau:

What did you discover that shouldn't be possible?

Robert Schleip:

The first thing was to the range of motion restriction in the shoulder joint. Many people if they lie on their back and you take the arm, and put the upper arm next to the ear in a straight upward elevation, and you check that they are not muscularly restricting by wobbling a little bit. In a flexible dancer you can extend, elevate the arm all the way, a 180 degrees, so that the upper arm is next to the ear lying on the table. With many more restricted people the arm is hanging there in the air, and you check whether the muscles are relaxed, and you think they are relaxed. Then our model was if it's not the muscles, then the fascia is stiff.

Til Luchau:

If the muscles aren't tight then it's the passive stiffness of the fascia.

Robert Schleip:

Yeah, and so I only had three patients at that time. I should have better prepared. I would have done the range of motion tests, and would have had a force meter, that I use always the same force to pull etcetera.

Robert Schleip:

In the three clients, in one of them, there was no restriction, at least not a 180 degrees, but in two of them the arm was hanging in the air before the anesthesia, in a way where I would have thought it is not muscular restriction, because if you wobble there was no visible restriction. As soon as the anesthesia kicked in, the arm dropped all the way. That was not happening with the ankle joint, for example. It means that in many people, in the shoulder joint, the restriction is some non-voluntary, not EMG related … Probably, It is EMG … I don't know, but it seems to be independent of fascia also.

Til Luchau:

Yeah, something that the anesthesia affects, probably the nervous system.

Robert Schleip:

Yeah, and nobody believes that anesthesia effects collagen fibers, or the viscosity of the ground substance within a few minutes. That would be a huge surprise. Anesthesia, is usually specialized to influence the nervous system, and particularly the muscle toners. That's the least thing you want. They can get conscious under anesthesia. That sometimes happens in one out of a 1000 cases, that they wake up and they experience what is happening, but they should never move while they are under surgery.

Robert Schleip:

All the different anesthesia drugs, they inhibit muscle toners, and that is the most traumatic one, but nevertheless it meant that some of the movement restrictions, of the chronic movement restrictions are not only fascia properties. I wanted to find out which and how can we separate them.

Til Luchau:

Yeah. Is that what took you into your doctoral work? When I visited you last year, I asked you how old you were. I forget now, you were in your 50s when you decided to go back to graduate school and dive into research. Was that the question that was motivating you? Is that what was-

Robert Schleip:

It started the question. Before I did the experiment in Australia, I had a chance with some German doctors who were experimenting with ketamine, which is an aesthetic drug, how my subjective Rolfer experience, if I Rolf somebody's leg in normal conditions, and when the person is under ketamine anesthesia, I realized that there is something missing. You don't get a specific response that you are used to. Then I tried it with very fresh meat from the slaughter house, in which the animal had just been living two or three hours before and it's still warm, and I got a similar sensation. That was for me a more stimulating question. Also, when you work with people who are half paralyzed you-

Til Luchau:

Let me see if I understand. So, with the ketamine you didn't get back the response you were used in the work.

Robert Schleip:

Yeah.

Til Luchau:

In fresh meat from the slaughter house you did get more of that?

Robert Schleip:

No, I also didn't get it.

Til Luchau:

Also, did not. Yes, okay.

Robert Schleip:

Yeah. So, in both cases something is missing.

Til Luchau:

Yes.

Robert Schleip:

Of course, you do get a response similar like if you lean on a piece of bread, or anything other, that's pliable and not animated. The basic question that has been inspiring until today is, what is the difference between live tissue and not alive tissue? That is a very philosophical question. It comes back to what is life in a living body. If you take some of the elements of life away, for example, I mean if you kill the animal, then the animal was dead, but some of the cells are still living. The muscle cells can still twitch for three, four hours. If you wait 10 hours, then all life is gone.

Robert Schleip:

Under ketamine, some life is gone, and the life that is gone is not the fibroblasts, and not the muscle fibers, but the connection with the central nervous system.

Til Luchau:

Yes.

Robert Schleip:

That also you get, not with the whole central nervous system, but with a big part of it in people who are half paralyzed, who had a stroke, where one side of the body is normal, and the other one the connection with the central somatic nervous system is cut off. If you work with one side you get a different tissue response, than if you work with other.

Til Luchau:

I see. So, the difference in working the two sides in someone with a stroke, or with some paralysis on one side, was confirming what you were finding in those other cases.

Robert Schleip:

You have it when you work with a client. You get to a piece of their body and you feel nobody at home. You'll have some clients where you get slightly bored, because wherever you work you think you're working on a piece of meat. Then you get the next client and wherever you touch her you go, “Holy cow. Somebody is in there.”

Til Luchau:

Yes, I'm right with you.

Robert Schleip:

Yeah. So, these questions have been inspiring me. Why I took the sabbatical was based on that. I never expected that I would enter the field as an active researcher. It started when I took a sabbatical to write the paper for Leon Chaitow, the editor of the Journal of Bodywork and Movement Therapy. He could really push your buttons, because I vaguely told him I want to write down the results of what I had done before in terms of how does connective tissue, or how … On flesh plasticity, so what other explanations besides skeletal could account for the palpable tissue response that we have.

Robert Schleip:

I did that, and I interviewed several scientists. That was a big tweak that I discovered. I'm still doing it sometimes today. People now do it with me, that you try to interview a famous scientist, and you say, “I would like to meet you and interview you for 20 minutes, when you have time, and I would be willing to travel to your city, or fly in.” Then of course, they say, “They are too busy, too busy.” Then you say, “I can do it in March. I can do it in April.” Then just out of politeness they have to give you a date, or their secretary gives it to you, and then they don't cancel if they know you are traveling for several hours with the train, or with the plane to visit them.

Til Luchau:

I'm taking notes. I'm taking notes, because-

Robert Schleip:

Yeah, then you do it like you are doing now, you are recording it, and on the train ride back you try to summarize it, and check the sources that they gave to you. That's what I did with several of them, and I wrote it together, what can we as manual therapists, mostly we Rolfers at that time, learn from these laboratory scientists. That had been a project of mine, and I used my sabbatical for it. Then I got into some of the new research that really electrified me.

Robert Schleip:

Basically, I got two papers on my desk. One was from. He had discovered smooth muscle like cells in the fascia cruris, in the lower leg fascia, and also sympathetic nerve endings. He came up with the theory that fascia may have its own tonicity. It's a live contractile ability, independent from the somatic nervous system, driven by the autonomic, the sympathetic nervous system, but he wasn't sure about it. He found the cells. He found the innovation, he thought, but he didn't know if the cells are numerous enough or powerful enough to have any significant effect.

Robert Schleip:

Then I found a paper that he was not aware of from a completely different field, from biomechanics, where they had found a contractile response in fascia, but they couldn't account for it. They were suspecting it could be contractile cells, but they suggested somebody should do that. Then I thought, “Wow, there we go.” I could earn the Nobel Prize by spending a few months only with the support of to take some fresh pieces of fascia, put it in organ bars, and put some adrenalin, and then make it contract and film it and become famous and happy.

Til Luchau:

Give fascia, grow it in a culture dish, give it some sympathetic stimulation through adrenaline and watch it contract.

Robert Schleip:

Yeah, and make it contract. Yeah.

Til Luchau:

Yes.

Robert Schleip:

Actually, it wouldn't contract.

Til Luchau:

It would not, you say.

Robert Schleip:

No, no. On one day it did, but the next day it didn't. On one day I already opened a bottle of champagne, but if you are doing stuff science, not to prove what you believe in, but if you're really modest and careful with your results, that you double check it, then you realize on the next day it goes up and down. It's just the temperature in the room that makes these tiny changes in the tonicity, not the agent that you put in.

Til Luchau:

Okay.

Robert Schleip:

Then later, we found out, yes fascia can contract, but it takes a long time for any significant contractions. So, within a few minutes it's only milli newtons. It's not even sufficient power to lift your small finger one millimeter.

Til Luchau:

That takes several minutes you're saying, even to generate that much.

Robert Schleip:

Yeah, but if you then add up and that's what life does with a frozen shoulder, or with Dupuytren contracture, you use that cellular contractility, and you give it weeks of time, then you can get such a powerful frozen shoulder adhesion that it takes more than 10 kilograms to open that up.

Robert Schleip:

Years later, in our laboratory, when I already was professional scientist, and not only a part-time scientist, so for many years I did two hours in Rolfing sessions per day in order to finance my expensive hobby over the days. Already when I had given up being a body worker, we found a link to the sympathetic nervous system, but not via adrenalin in the first case, but via TGF-beta, which is a more general substance. It's not a hormone. It's a cytokine.

Til Luchau:

Not a hormone, but a cytokine.

Robert Schleip:

Yeah, so it means it's not produced by a grand. It's produced by the fibroblasts themselves. They are responsive to influence from the sympathetic nervous system. Yeah, but it's a much slower response. I think, we Rolfers can influence that, but it doesn't account for the immediate palpable response that you get when you lean with your elbow on the lumbar fascia for 20 or 30 seconds at a time.

Til Luchau:

All right, so your research uncovered these mechanisms. They are weaker and slower than you expected.

Robert Schleip:

Yeah.

Til Luchau:

You did find some ways that they are relevant to the body, you believe, and some interesting links to immunological function through the cytokines and the fibroblasts themselves.

Robert Schleip:

Yeah.

Til Luchau:

What do you think explains the changes we feel? I mean there's all this interest now in mechanisms. What do you think the mechanism is of the change we feel when we're working on people as a hands-on therapist?

Robert Schleip:

Long-term change, the contractility can certainly account for that, if the client over several weeks gets more flexible, and the tissue gets more elastic. However, when you want an explanation that you work with your fingers in different directions, and you find a direction that seems to work, and then you get a melting response. I think the contractility that our laboratory is focusing on is not the best explanation. They are, I think, more the work from Carla Stecco, a very highly esteemed colleague of mine at the University of Padova about hyaluronan or hyaluronic acid, is your old description of that substance, expression in the ground substance is a more likely candidate.

Robert Schleip:

For example, in one study that I supported, they showed just a few minutes of a foam roller application that is not completely comparable with Rolfing. You don't have the interpersonal relationship. Even the mechanical focus is different, but in both cases you have the compressional focus on the connective tissue, and the magnitude of the forces is pretty comparable to myofascial release in Rolfing. In that study they showed that the shearing motion of one layer of the lumbar dorsal fascia in relationship to the next layer under it is increased after a few minutes of foam roller application.

Robert Schleip:

Most likely that is due to hyaluronic acid, but we don't know for sure. That is the best explanation. Apparently, it is possible to change hyaluronan from a more gluey condition in which it's more large super molecules, so it's more in a viscous condition, and you can change it into a more liquid condition with the forces that we are using. That I think is a more likely candidate.

Til Luchau:

Hyaluronan, changes in molecular state.

Robert Schleip:

Yeah.

Til Luchau:

So, is this the old melting model? Is this thixotropy?

Robert Schleip:

Yeah, but you could call it thixotropy, but in a more specialized. Thixotropy, it would be a reversible condition. If you heat up a cold sugar or ketchup, it gets more liquid, and if you stop moving, or if you decrease the temperature, it gets as stiff as before. That would be the conventional gel-to-sol model. With hyaluronan, you change the chemical condition of one substance in a long lasting, more sustainable manner. I think it's a better model.

Til Luchau:

Well that's one of the questions about the gel-to-sol model is how long does it last? Is there duration there? Is it short-term only?

Robert Schleip:

The thixotropy model.

Til Luchau:

Yeah, or let's say hyaluronan. Let's focus on-

Robert Schleip:

Hyaluronan, yeah. So, nobody knows, but I think in a few years we will be able to know, how long this increase in shearing motion lasts. It was not possible to study that, but now with the high resolution ultrasound that we didn't have in the 80s, we didn't have it in the 90s, it's just getting available in last few years and I think it's very exciting.

Til Luchau:

So, high resolution ultrasound, being able to see more precisely what is happening at those layers and then-

Robert Schleip:

Yeah, and to measure it.

Til Luchau:

Measure it and track it prospectively at times, and see what's happening.

Robert Schleip:

Yeah. Also, probably the expression of hyaluronan by the newly discovered fascia sites, so this is a new type of fibroblasts that Carla Stecco discovered. They have a different form. They have different contents than regular. So, they don't produce much collagen, but they are specialized on producing hyaluronan. Most likely they respond to shear motion more than to straightforward tension or compression. That would mean I'm not just leaning with 90 degrees down pressure on the IT band. I would work more with tractional forces in addition to the compression, if that is true. We will probably know in two, three years.

Til Luchau:

Okay. Well, in the meantime a lot of us are experimenting in our work, or trying those explanations on for size, and there's lots of debates about the mechanisms involved.

Til Luchau:

You just told me a story where you started with the miracle of life and touching life, and then where we got to is fairly technical and tissue based. In these debates that go on, you often end up being the one people target, or you end up being the one who defends, or makes the case for tissue effects. You know what I'm saying? I'm just wondering if you see any irony in that, that your motivator is really the life involved, and your work and the role that you play in our field is so much around the tissue effects.

Robert Schleip:

The recent debate with a neuroscientist on Facebook and in social media.

Til Luchau:

That's a recent debate. Yeah, there's a post I made recently where I asked the question, when does the tissue matter? You gave a very precise answer. You said, maybe in the case of Dupuytren contracture, a couple others, but it turned into something 200 and something posts with people debating back and forth.

Robert Schleip:

I think your question was great Til. It was interesting that most people said it never matters, or it always matters. There was almost no constructive discussion happening between the two groups. You had warned me about that last time we met face to face that in the United States there is almost like a split. My impression was it may be similar to the schism you have between different societies and Democrats and Republicans. If you belong to one group, you don't do productive conversations with the other one.

Robert Schleip:

We don't have that yet here in Europe. I don't see it in other continents, and I started to ignore it. These people are only losing social media, scientific debates happens on different forums. That was the first time I think you've managed to pull me into that. I was amazed how the response was, that people are not so open to say it could be a multi-dimensional soft tissue pain. People said it's either only the nervous system, or tissue always matters.

Robert Schleip:

I think, and maybe there is a commonality when I suggested to the Rolfers 20 years before, maybe it is the nervous system that is included. That we should be able to question our simple monocausal explanations and say, “Maybe it could be different. Maybe it could be more complex.”

Til Luchau:

Yeah. We have polarized quite a bit, in this country I know, and in other conversations around the world. I know it's also a fairly hot polarizing topic in Australia, say where is it the nervous system or the tissue effects that are explaining what we do?

Til Luchau:

I sent you an email saying this, but you were quite masterful in your ability to shift the debate from, which is it to the questions about certainty. About how can we be certain and is the certainty itself maybe part of what's polarizing?

Robert Schleip:

Yeah.

Til Luchau:

Well, you actually invited a point of view that says, “Well, could be maybe, maybe not,” but what if we actually say, “We don't know.”

Robert Schleip:

Yeah. Many things in life are multi-causal. You start with one thing, it triggers the next thing, and the next thing, which is a consequence of the first one becomes itself something that stabilizes the whole system, and then often it doesn't matter how it started. That's often the case, and so I think we should be open to look at different factors.

Robert Schleip:

For example, the people in the neuroscientists group, they also strongly believe, like me, that nociception and proprioception are in a mutually inhibiting relationship very often. If the brain is in a protection mode, it drives proprioceptive acuity down and vice versa also. Now, if as Helen Langevin, and other colleagues have shown chronic low back pain goes along with a gluing together with an increased adhesion between different layers of the lumber dorsal fascia. Whether that's causative or effect is another question.

Robert Schleip:

If it is there then it is quite likely, but we have to show that, that that is itself a factor that inhibits proprioception, because most of the proprioceptive nerve endings are in layers where you have relative shearing motion, that has been shown. If then your lumbar dorsal fascia glues together the golgi receptors, also the muscle spindles, all of them are located in fascia tissue. If the perimysium, or the layers between two fascia where some of the Golgi's align is stuck together, you won't have any movement there. No matter how much your brain is interested in picking it up.

Robert Schleip:

Then you could have a multi-causal relationship. Your brain is in a protection mode, that drives down your daily movement. Due to the lack of daily movement, your fascia glues together, and due to the gluing of the fascia, your proprioception goes down. Then maybe because of a new girlfriend, or of a new sports you have, you are out of protection mode in your brain, but still your proprioception is inhibited. Then you will still be not able to replace the previous pain perception with a useful functional proprioception from your lower back.

Robert Schleip:

I think we should work hand in hand, the people who work with the brain and the people who ask how is the local tissue behaving, and feeding into that.

Til Luchau:

Let's pause to hear from our halftime sponsor Books of Discovery.

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Drew Biel:

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Til Luchau:

Thanks Drew Biel, and to Books of Discovery for their support for our podcast. Be sure to check out. They're a great offer.

Robert Schleip:

Right now we are developing instruments. That's our focus this year. If you need better instruments, the ultrasound we are improving. I developed together with indentometer that you don't need to rely on the perception of your fingers. Of course, you want them but you cannot quantify it. If you don't see the client for the next three weeks and his tissue gets 15% softer, will you be able to detect that when you're palpate his upper trapezius? Probably not, because you have seen a 100 clients in the meantime.

Robert Schleip:

If you have an instrument to measure the stiffness and he is 12% soft or stiffer, you can say, “Wow, we are in the right direction. Whatever you have been doing, let's continue it.”

Til Luchau:

A meter that measures tissue stiffness used as a clinical tool to help you track the results of your work and to show the client a change over time.

Robert Schleip:

Yeah. That's the only for vertical pressure. Similar, like if you press with your thumb into the tissue and say your trapezius on the upper right is stiffer than on the upper left neck, on the same place.

Til Luchau:

The left neck on the same place. Perpendicular pressure, stiffness.

Robert Schleip:

Yeah. That is more easy. We have an instrument already, but now we are looking for shearing motion. If you push the skin with a 100 grams, how far does it move before it starts?

Til Luchau:

Yes, and you say the promise there is ultrasound, being able to visualize that and see that, at least in a research context.

Robert Schleip:

Yeah, but we also have mechanical tools where you can do that. Yeah. A big interest now is also not in passive manual therapies, where the client lies on the table and lies still and a Rolfer leans on his tissue, but when you get the patient, and I think that's in many cases more valuable, to move in a fascia friendly manner during the week before they come back.

Til Luchau:

Fascia friendly manner.

Robert Schleip:

Yeah.

Til Luchau:

What's a fascia friendly manner Robert?

Robert Schleip:

For example, to move your hip joint in more than 90 degrees, during an average day in a normal couch potato. When you stand and walk, you have zero degrees in hip joint. Then when you sit on the couch, in the car you have 90 degrees, and that's all. You never go into external. If you advise them to sit on the floor once a while, to swing their legs, to kick somebody's ass, to go into different meditation poses then I think that is more fascia friendly, because we know from animal experiments, that lack of movement can change the architecture, and make it stiffer and more fibrotic.

Til Luchau:

Yes, and then you mentioned Langevin of her work showing that the application of mechanical tension or stretch actually has immunological effects, has effects on tissue repair and healing.

Robert Schleip:

Immunological, I'm not aware from her. I know that from others. On your topic-

Til Luchau:

On inflammation.

Robert Schleip:

On inflammation, yes. That's your specialty. I think that is a very fascinating new topic, how different mechanical stimulation's triggered different pro and anti-inflammation cytokines in a different temporal sequence.

Til Luchau:

If I remember right her research was with mice. It was 10 minutes of stretching, maybe a couple of times a day. She showed a decrease in inflammatory cytokines and an increase in resolution markers, if I remember right.

Robert Schleip:

Yeah, it was with rats.

Til Luchau:

It was with rats, okay. That's fascinating.

Robert Schleip:

Yeah, that is very fascinating, yeah.

Til Luchau:

Because some of the debates in the yoga community are things like, “Well, oh, we shouldn't be stretching it if it's inflamed, if it's painful.” Our old model was let's just stretch it better. Now there's lots of questioning of that understanding like, well actually I can keep things inflamed and maybe the stretching itself might be an injury of mechanism … Sorry, injurious mechanism.

Robert Schleip:

Yeah.

Til Luchau:

That's the puzzle that her work presents, is what role does stretching and that tension have on a inflammatory resolution.

Robert Schleip:

Yeah, so even with mild mechanical stretch stimulation, you increase immediately one day afterwards, the pro-inflammatory cytokines. If you don't want that, you should not do anything probably. The question is there any mechanical stimulation that hinges a biochemistry that does not start initially with some mild pro-inflammatory response?

Til Luchau:

Yes. Even mild stretching increases the inflammatory markers a little bit and there might be times when we don't want that at all.

Robert Schleip:

Yeah, but maybe you want that in a certain manner where you kick off the pro-inflammatory cycle, but in a way in which they trigger, as a cascade, the subsequent release of anti-inflammatory cytokines.

Til Luchau:

Pro-resolution processes, yes.

Robert Schleip:

She showed that with her rat experiments. That was then the sustaining, the long lasting effect, was an anti-inflammatory one. That's your topic on inflammation.

Til Luchau:

I could go way down that rabbit hole. Yeah. What would you say about your interest in the insular and interception, because you've been talking about those for a long time.

Robert Schleip:

It was a topic I stumbled into in 2011, in writing for our textbook in Fascia, the Tensional Network, which is still the leading academic book, general book, on fascia. I volunteer to do something on fascia and the nervous system. I had known, as a psychologist, that they are now differentiating between proprioception and interoception in a much more detailed manner than I had learned when I studied psychology at Heidelberg University for five years, 20 years before.

Robert Schleip:

I got into interoception as an academic researcher by reading what is out there. Then I got really intrigued in writing that chapter. I think that chapter also inspired many other people subsequently because in the body world community, at that time, the whole focus was mostly on proprioception, at least in the Feldenkrais community nociception, and interoception.

Robert Schleip:

Many body workers still think any internal body sensation is interoception. Then my advice is please do your homework, read some of the literature that has been published in the last 10 years about interoception.

Til Luchau:

Make the distinction for us, if you will, how is interoception different than internal body sensation in general?

Robert Schleip:

Interoception is sensations associated with your body that are related to homeostasis, those physiological needs.

Til Luchau:

Processes, yes.

Robert Schleip:

Do you have enough food, hunger? Temperature, is it too warm? Is it too cold? Do you have enough oxygen? So, things like do you have too many … The acidity in the muscle, for example if you have sore muscles that is not proprioception. That is too much of certain acidic elements. It's more physiological. They showed very clearly that it's not only different nerve endings. All of them are free nerve endings. A lot of them are in the viscera, but they are also processed very different in the spinal cord.

Robert Schleip:

All of them go to the laminar one in the spinal cord, and they project primarily to the insular and the cortex. They are not processed in a similar way as normal proprioceptive body sensation. It's projected via the pyramidal tract to the somatosensory cortex. This is very intriguing. They also showed that there are different pathologies. For example, whiplash and low back pain, they are clearly associated with proprioceptive dysfunction. Of course, not chicken and egg answer, it would be both.

Robert Schleip:

Anxiety, and depression, and posttraumatic stress disorder often has no inhibition of proprioception. There could be the most precise dancer in the universe. However, when you ask him, are you hungry or not? How is your temperature? Which leg do you feel more at home at? They have big difficulties in answering, because they are insular. It has a disturbed relationship with their gut feeling, for example.

Robert Schleip:

That was a big discovery. Also, because it resonated with my non-scientific values in life as somebody who has been doing lots of meditation, and somatic practices, and continual movement. I can close my eyes and I don't need to take any drugs and dive into my body and my guts. I think interoception is a big contribution to body workers. For example, if you're working with somebody who has an interoceptive associated dysfunction, for example, post traumatic stress disorder, you would ask very different questions. You would talk slower. You would touch them in a different way, and you would do a different yoga class.

Til Luchau:

I'm thinking about how in English we conflate feeling and all those different senses. We have perceptive feeling of sensation. We have the feeling of emotions. Is it too simple to say that proprioception is what we feel and interception is how we feel?

Robert Schleip:

It's partly right. Proprioception, doesn't need to have an effective quality.

Til Luchau:

Yeah, an emotional quality. It doesn't need to have an emotional, or affective quality.

Robert Schleip:

Interoception, always has an effective emotional association. If you change the temperature in the bus stop, you can always say it gets more pleasant or less pleasant. With proprioception you're often not able to say that.

Til Luchau:

That's it. So, there's an interesting link into pain too. Where pain becomes an insular phenomenon, where we assign pleasantness or unpleasantness to a sensation.

Robert Schleip:

Yeah. Pain as a perception is one subcategory, but very, very special, clearly of interoception.

Til Luchau:

Yes.

Robert Schleip:

I like that whole field. Recently, in the last two or three years interoception it's a big move in psychology also. Many of them are into Lisa Barrett Feldman's concept of predictive coding. Where the insular often creates or supports certain perception. It doesn't create it, but it support certain perceptions in a selective processing that have nothing to do with how cold your feet are, but how cold you expect them to be.

Til Luchau:

Yeah, predictive processing.

Robert Schleip:

Yeah, and that is apparently very, very in interoception. Of course, everything in life is creation, and even proprioception is based on your expectations, but much more is interoception. It means as a therapist what you do the peripheral tissue is relatively unimportant, but the expectation you create, that this is now something very pleasant or something very interesting. So, the storytelling you do in interoceptive disorders is much more important than when you work with a dancer who has proprioceptive dysfunctions.

Til Luchau:

Fascinating.

Robert Schleip:

Yeah.

Til Luchau:

Fascinating. Wrap up questions, and by the way, those have been really big inspirations for me in my own inquiries, those questions you're asking, and your mentions of those. They've really set me off on all of the paths I'm on.

Til Luchau:

You mentioned our common interest in say body or in psychotherapies that was a background of mine way back when, but that's the questions I'm still asking myself as a practitioner is like, how do I touch that living person, living force, living entity, living organism, that includes all of those feelings, all of the pleasant, unpleasant, as well as sensation, all the valuing and experiencing? Certainly there's some clues there in the things you've mentioned, and some interesting models to try on in the hands-on work. It's like you said, in creating expectations in the interactions as well. Yeah.

Robert Schleip:

I'm now very strict with our … I'm supervising several doctoral and master's thesis. They want to compare one treatment with another treatment. Often they do a sham treatment where you just lay on hands without doing Rolfing or something like that. I'm very almost militant. If you want to have a control group, you need to make sure that the client experience is with the same degree of connectedness with the therapist, and was the same degree of expectation that this may help them.

Til Luchau:

If you really want to measure the mechanism as opposed to the context, then you need to have the same context, including expectations, etcetera.

Robert Schleip:

Plus we know different expectation creates very, very different ... We don't need to do experiments to prove that, but often these master thesis are done is beyond the pure placebo effect. We all know how strong that is. That anybody's saying it's just placebo hasn't done any reading in the last 10 years. Often, the placebo is more powerful than a pharmaceutical substance, many times more powerful. It's not just a plus 20%. It's plus 800% in many of them.

Robert Schleip:

Often they do these studies, foam rollers studies, etcetera, Rolfing studies to find out is there beyond the expectation factors, mechanical specific factor of the treatment. Then you really need to have the same degree of connectedness. So, if you do the studies, you need to give a patient a questionnaire. How do you rate the relationship with the therapist? one to 10. You feel connected, we're on the same lens, I feel warm, etcetera. They are very well developed questionnaires. You can also ask him, what is your intuitive sense that this treatment will help you? When you have that equally on both groups and still you get a difference in the effect, then that is more meaningful.

Til Luchau:

Then it points toward the mechanism, because both of those things you mentioned, the expectation and the connection with the therapist have been shown. We know them to be really significant predictors of outcome. They have a strong effect in and of themselves, you're saying?

Robert Schleip:

Yeah.

Til Luchau:

Well, what would you say, Robert, some ways that your work over the years is commonly misunderstood, because you really have inspired a lot of people to dive into the world of fascia and bodies place in our work? How does your work get misunderstood, would you say?

Robert Schleip:

I don't like the question so much, because I'm often surrounded by people who have that as a life script, I have been misunderstood. The overlooked hero, and they die with it. I have had a very lucky relationship in the last few years in which I realized if you become a better networker, people support you. That has been more of my life story. Of course, they support you for the wrong reasons, but if you want to be an unsung hero, I told you 20 years and nobody listened to me. That is of course, something you can go to grave with and say, I'm one of the biggest overlooked heroes in the history.

Robert Schleip:

What we found out and I was very positively surprised in doing that, and it became one of our slogans. Maybe towards the end of this interview, I can get this slogan on, that we developed, as our small factual research group at Ulm University, we developed a slogan for us. If you want to understand fascia as a networking organ, it works very well if you work on your own personality, on your own communication structure to become a good networker yourself, more than in other areas of medical science.

Robert Schleip:

In science, often competition is the name of the game. You don't share your insights until the right moment, because other people could steal them and protection of mental property is important. I'm doing the opposite in the last five or 10 years. I display all my values, and my jewels, and people can steal them, but many of them give me something back. I can highly recommend that. If you want to understand fascia, if you want to become a good therapist, first of all pretend to be more humble than maybe sometimes you'll feel. That you don't say, “I have the answer and everybody else is an asshole.” You say, “I have a tiny contribution to make. What do you think? What can I learn from you?”

Robert Schleip:

People appreciate that. It means you also expose from whom you have learned and you describe what you discover as a hypothesis. It could be that way and further research is needed. That works very well. We have been doing that in the last years. I would answer your question the other way that where have I misunderstood things in the past and where am I learning to be a better networker in the presence?

Til Luchau:

That's fantastic. Thank you. Thanks for the reframe.

Robert Schleip:

Yeah.

Til Luchau:

Yes, thanks for that.

Robert Schleip:

Good question. You're doing that very well Til. Also, you're doing that podcast with me. That's a very nice learning. I will copy that.

Til Luchau:

Okay. Well, I'm learning as we go. I mean, that you've been a mentor in this way, including the networking, because that's one of your gifts, is both bringing people together, but getting us to think beyond the polarities, that we can inadvertently set up. There is so much cultural force, in this country for sure, but I know elsewhere in the world too, around polarizations. It's so easy to slip into those ways of thinking, and comparing, and juxtaposing.

Til Luchau:

Your answer, just now, is another example of how thinking beyond that, thinking okay, so let's share. Let people think what they want. Let people use what we do, and the humility of the place to come back to that ends up interconnecting us all even more, and it makes us all richer.

Robert Schleip:

For a therapist it's sometimes not so easy to stay humble, because the client often favors full of themselves, evangelistic therapists who say, “My method works, very simple, and it always works. I know what's wrong with you, and I'm sure I can fix it in three sessions.” If you say, “Honestly, I don't know how your pain is created. I don't know how my therapy works. I have been helpful in 78% of the cases, and I don't know why, I couldn't help the rest of them.” The client may not respect you as much in the beginning.

Til Luchau:

Well, I'd say the same forces are true as a teacher, as an educator too. The market doesn't … Well, the market encourages us to make big claims and people will respond to certainty and to dramatic claims. People don't get as excited when the answer is well, it's really actually pretty complicated, and that we're still learning, we're understanding, but that's the honest answer, and actually opens up even more possibilities.

Robert Schleip:

Yeah, but 10 years later it looks the opposite. Your colleagues respect you more if you have been more humble in your claims.

Til Luchau:

What questions do you think we should be asking as manual therapists? Is it tissue? Is it nervous system? Should I make claims? Should I not make claims? What mechanisms? What do you think we should be asking?

Robert Schleip:

My question with the client is what factors am I not yet seeing, that are right in front of my nose, and I ignore them? Maybe it's in the relationship between the two of us. Maybe it's how the client smells. Maybe it's something he just told me, and I ignored it. For me, that is … Is there anything outside of my main focus that may be a very important key? I think that's a great question. You will never be bored when you touch or meet a client.

Til Luchau:

Talking about open awareness and a willingness to be surprised, or to perceive things you weren't expecting, as well.

Robert Schleip:

Peter Melchior had that. Very often I learned that, a lot from him. It comes back to … We had that also at the recent conference in Netherland just a few days ago, where you will want to go back to Hippocrates. He was a very influential healer in old Greece, but he was a very modest man. He advised his doctors that he trained to rather stay with uncertainty, than with false certainty. I think that is a very nice attitude that we should also have too. That as a healer you are more modest, and you're try to serve the client in his self-healing the best you can.

Til Luchau:

Modesty is the way to balance our uncertainty with our need to take action.

Robert Schleip:

Yeah, but many of our colleagues they say, “I don't need to understand the mechanism as long as it works. That's all that matters.”

Til Luchau:

Well, what do you think?

Robert Schleip:

I think that's not completely true, because if you understand more correctly, you can use it very different, and there are many examples. The example I used in the Facebook discussion is a story of one of the most successful substances in pharmacological medicine, the story of aspirin.

Robert Schleip:

Already Hippocrates, used not aspirin, but Willow tree extract, that is basically a similar, but not as precise. It's also an anti-inflammatory cocktail. They used Willow tree extract when they created aspirin in the first years. When they created aspirin, they knew it was anti-inflammatory, but they couldn't explain why. They had the wrong explanation. They thought it works via the central nervous system, and they treated successfully for a 100 years with the wrong explanation.

Robert Schleip:

Then they discovered that it is a prostaglandin inhibitor, and it works on the peripheral tissue, and that the pathway is a very complex pathway. You can draw it with six arrows and names, around hyaluronic acid, and prostaglandin, etcetera. There was a Nobel Prize even for the complex dynamics, that they very detailed unraveled. With that unraveling, they were able to develop better drugs with less side effects. Even now you use aspirin in cases that you wouldn't have used it before, because you understand it better. I would do the same thing.

Robert Schleip:

Hopefully, we will have it also with myofascial therapies. If we know to what degree is the brain interacting with your emotions of a certain cytokine expressions in the ground substance, and it may be more than five or six arrows, similar like the prostaglandin inhibition. Then we may develop different myofascial therapies for different purposes. We may use myofascial therapies in cases where we haven't used it before, but first we need to do our homework and understand more correctly.

Robert Schleip:

If we work with the old Greek model that for body humors, and that Willow tree extract gets it more into one direction, maybe we also are still in a Hippocrates state, or maybe in the a 100 years back where they thought it's the central nervous system only. Maybe in a few decades, whether there is a Nobel Prize or not involved, we will have the more exact pathway. Not only as a maybe, but something that you can prove and fortify. It's pretty clear how aspirin works now. Nobody questions that anymore. So, maybe we will have something similar with myofascial release.

Til Luchau:

Maybe over time, we'll understand the mechanisms even better. We'll find out things we assumed may or may not be true, but that better understanding will allow us to use it even more precisely, more flexibly.

Robert Schleip:

Yeah, and then you may sometimes just touch and use a gentle voice and tell the client, “Close your eyes and feel what's happening inside.” In other times you may not need to do that. They can talk on the phone with their wife while you do a Rolfing treatment on them. I hope I won't be doing that, but for some conditions that may be sufficient. We could go on for hours.

Til Luchau:

We could. Anything else you want to make sure that we get? Anything else you want to make sure we include?

Robert Schleip:

We have touched many subjects.

Til Luchau:

We have touched many things. It's fantastic. Robert really, really enjoyed it. Really enjoyed it, and again as always I learn things, and I recognize in what you're saying, some of the influences that have been so important to me, and some of the possibilities that you're opening up into further learning, both in terms of knowledge, but also in terms of the outlook and the attitude that you bring to the work. So, thanks for taking this time.

Robert Schleip:

Thank you, Til.

Til Luchau:

Thanks as always to our sponsors. Stop by our site for the show notes, full transcripts references and extras. That's thethinkingpractitioner.com, or my site advanced-training.com, or Whitney's site … Whitney will be back next episode, Whitney's is academyofclinicalmassage.com. If you have questions, topic requests, or suggestions for us, email us. Love to get your emails @infoatthethinkingpractitioner.com, or look for us on social media. Please rate us wherever you listen to us. Rate or review us on Apple Podcasts, Spotify, etcetera, and tell a friend, and be sure to tune in next time.