The human fascial system and the Biomechanical Model applied in Fascial

Manipulation® by L. Stecco
Presentation by Julie Ann Day, Physiotherapist

When I was studying Physiotherapy in Adelaide way back in the mid 70’s, fascia was
never mentioned, let alone myo-fascia. When we were doing anatomy dissections on
cadavers we were told to simply cut the whitish tissue away so we could get down to what
was important, the muscle. One teacher, made the difference because she taught us
connective tissue massage and was adamant that we learnt it thoroughly.
That input and the usefulness of the technique itself put me on the trail to
find out more about connective tissue in general.
Today I am an instructor of the Fascial Manipulation method and a
founding member of the Fascial Manipulation Association whose prime
aim is to promote research about fascia in general. The motto for Fascial
Manipulation is the latin phrase “Manus sapiens potens est” which means
“a knowledgeable hand is powerful”.

Luigi Stecco, an Italian physiotherapist and founder of the Fascial Manipulation method,
often says preconceptions have probably slowed our comprehension of peripheral motor
organization: one preconception was that the muscular fascia was merely a container, or a
means of restraining tissues, passively giving form to muscles. This pre-conception has
been overcome mostly due to studies that demonstrate the importance of fascia in
musculoskeletal functioning.
As a student, Luigi Stecco was curious about the success rate of ‘bone setters’ working in
the rural area of Italy where he lived. Luigi started asking which tissue could be involved.
Learning connective tissue massage he found he got good results and decided fascia
might be the tissue to explore further.
He went on to develop his biomechanical model for the fascial system together with his
clinical practice and studies. He started teaching his method in 1995. Moving from a
segmental approach to a more global approach, considering acupuncture, myofascial
trigger points, postural control and carrying out comparative anatomy studies relating to
the evolution of movement, he was interested in the interaction between fascia, nerves,
proprioception and movement.
Since 2003, first Dr. Carla Stecco (specialised in Orthopaedics and Anatomy) and then Dr.
Antonio Stecco (specialised in Physical Medicine) began working closely with their father,
researching the anatomical and physiological aspects of his model and discovering
important new findings in their fields which have been published in numerous articles (see
references)..

Fascia is the soft tissue component of the connective tissue system. The fibres within
fascia are undulated collagen fibres and elastic fibres and are immersed in a watery,
extracellular matrix (ECM) known as ground substance and the organisation of the
fascial system is very complex.There are different fascial layers with different roles. In
general, superficial fascia is involved in thermoregulation, metabolic processes and it
cushions nerves, as well as blood and lymphatic vessels. Deep fascia has a mostly
mechanical function of force transmission and a potential proprioceptive role.
In general, the possible role of the fascia in musculoskeletal function has been neglected.
Stecco realised that if we want to include the fascia we have to change the way we
 consider the musculoskeletal system. The concept that our motor cortex
refers to muscles with origins and insertions that move bones is out
dated. It all required a new language.
To understand how the fascia works with the musculoskeletal system he
decided he could divide the body into 14 segments where the
movement of each segment is governed by what he calls myofascial
units.
To understand how a myofascial unit may work we need to just review
some aspects of muscle contraction. We know that a motor unit
consists of a single α-motor neuron and all of the corresponding muscle
fibers it innervates. When a motor unit is activated, all of its muscle
fibres contract. Groups of motor units work together to coordinate the
contraction of a single muscle when a particularly forceful movement is performed,
however, in daily movements it is more common that only parts of our muscles contract.
Just how many motor units are activated and in which part of the muscle depends on the
degree of force and precision required in a given movement.
Stecco noted that each joint is moved by a combination of parts of monoarticular and
biarticular muscles – in other words, parts of muscles that span one or two joints. By
breaking down our movements into pure movements on the three planes, then a pure
movement in one direction will be caused by the contraction of what we might call
unidirectional fibres or fibres that move a body segment in a specific direction.
Stecco suggests that a myofascial unit consists of
1. a group of motor units that move a body segment in a
specific direction by activating fibres (monoarticular and
biarticular) in one or more muscles
2. the joint that is moved
3. nerve components – receptors, efferents, afferents
4. the fascia that connects these elements together
Each segment is moved by 6 myofascial units, or 2 for each
plane of movement (sagittal, frontal and horizontal).
Each myofascial unit has its own Centre of Coordination
where forces would converge and a Centre of Perception
where pain is felt if the unit is not working correctly.
Centres of Coordination can form in the deep fascia
because of the unique anatomy of fascia - some fibres of most muscles originate from and
insert and into their overlying fascia. This is all well documented your better anatomical
texts however, until now no functional explanation has been given for these fascial
insertions.
This architecture of the Myofascial unit it repeats itself in all body segments and on all
planes of movement.
Of course, our movements consist of a harmonious flux of motor units firing and
myofascial units being activated and deactivated in rapid succession, as most of our
movements involve a combination of planes.
In fact, Stecco also identifies other points located on the periarticular structures, called
Centres of Fusion. These Centres of Fusion monitor movements in intermediate
directions between two planes and three-dimensional movements, interacting and
collaborating with Centres of Coordination according to the required movement.
Dissections of unembalmed cadavers by Dr. Carla Stecco have demonstrated that
biarticular muscles also have important myotendinous expansions or extensions of their
deep fascia. These expansions extend well beyond any bony insertion of the muscle,
forming a continuum with the deep fascia in adjacent
segments. The better known lacertus fibrosus of
biceps brachialis is a myotendinous expansion.
However, latissimus dorsi, deltoid, triceps brachialis
and extensor carpi ulnaris all extend myotendinous
expansions onto the deep fascia. Together with the
biarticular component of each Myofascial unit these
myotendinous expansions link Myofascial units into
Myofascial sequences.
Given the rich innervation of fascia Luigi Stecco
hypothesizes that while most contracting muscle fibres
move bones and joints,
a percentage tension
the fascia, providing important feedback about movement,
via stretch of the embedded mechanoreceptors.
This could be possible because as groups of motor units
are activated casuing muscle fibre contraction, specific
portions of the corresponding deep fascia are stretched
and different patterns of receptors are activated according
to the degree of joint movement
Whenever a muscle fibre contracts it inevitably stretches the fascia enclosing it. Free
nerve endings and other types of sensory mechanoreceptors and proprioceptors such as
Pacini and Ruffini corpuscles (in photo), and even Golgi tendon organs are embedded
between the collagen fibres of fascia. Many of these also have connective tissue capsules
in direct continuity with endomysium and perimysium. It is important that the fascia is
sliding and stretching freely to allow correct contraction of muscle fibres and accurate
sensory and directional feedback information from embedded receptors. Also muscle
spindles, important sensors of stretch that lie between our muscle fibres, have a thin
connective tissue capsule, which is continuous with the endomysium of the surrounding
muscle fibres. Any contraction of a muscle spindle will gently stretch endomysium. In turn,
tensioning of the endomysium can influence muscle spindle activity.

Any alteration in deep muscular fascia could modify the capacity of fascial fibres to slide
during movement. This can result in inappropriate tensional changes within a Myofascial
unit or along a related Myofascial Sequence resulting in changes in motor strategies.
While Myofascial units and Myofascial sequences are functional concepts they do have
an anatomical substratum of fascial continuity via the continuity of fascia with
mechanoreceptors, the muscular insertions onto the fascia, and myotendinous expansions
of the fascia from one segment to another.
Often our clients complain of disturbances in more than one location and this type of
biomechanical model of the human fascial system can help us to interpret extended pain
distribution and also to understand how previously unresolved musculoskeletal problems
could create compensations over time. These compensations within the rather elastic
fascial system can allow our clients to function well enough until a new, and perhaps even
minor, injury occurs, after which they just cannot seem to adapt anymore. For effective
treatment we always need to enquire about previous pain, injury, fractures or surgical
scars that may be impeding the inherent elasticity of the fascial system.
In this way, fascial anatomy can help as a map for therapists to interpret extended pain
distribution and to choose key areas for more effective treatment.
 References
Books:
[1] Stecco L (2004) Fascial Manipulation. Piccin, Italy
[2] Stecco L, Stecco C (2009) Fascial Manipulation: Practical part. Piccin, Italy
Articles:
1. Stecco C, Porzionato A, Macchi V, Tiengo C, Parenti A, Aldegheri R, Delmas V and De Caro R.
Histological characteristics of the deep fascia of the upper limb. Ital J Anat Embryol. (Firenze, Italy) 2006;
111 (2): 105-110.
2. Stecco C, Gagey O, Macchi V, Porzionato A, De Caro R, Aldegheri R, Delmas V. Tendinous muscular
insertions onto the deep fascia of the upper limb. First part: anatomical study. Morphologie 2007; 91: 29-37.
3. Macchi V, Tiengo C, Porzionato A, Stecco C, Galli S, Vigato E, Azzena B, Parenti A, De Caro R. Anatomo-
radiological study of the superficial musculo-aponeurotic system of the face. Ital J Anat Embryol.
2007;112(4):247-53.
4. Stecco C, Gagey O, Macchi V, Porzionato A, De Caro R, Aldegheri R, Delmas V. Anatomy of the deep
fascia of the upper limb. Second part: study of innervation. Morphologie. 2007; 91: 38-43.
5. Stecco C, Porzionato A, Macchi V, Stecco A, Vigato E, Delmas V, De Caro R. The expansions of the
pectoral girdle muscles onto the brachial fascia: morphological aspects and spatial disposition. Cells tissues
organs, 2008;188(3):320-9.
6. Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day JA, De Caro R: Histological study of the
deep fasciae of the limbs. J Bodyw Mov Ther. 2008;12(3):225-30.
7. Macchi V, Tiengo C, Porzionato A, Stecco C, et al. Histotopographic Study of the Fibroadipose Connective
Cheek System. Cells Tissues Organs. 2009.
8. Stecco A, Masiero S, Macchi V, Stecco C, Porzionato A, De Caro R. The pectoral fascia: anatomical and
histological study. J Bodyw Mov Ther. 2009;13(3):255-61.
9. Day JA, Stecco C, Stecco A. Application of Fascial Manipulation technique in chronic shoulder pain--
anatomical basis and clinical implications. J Bodyw Mov Ther. 2009;13(2):128-35..
10. Stecco C, Pavan PG, Porzionato A, Macchi V, Lancerotto L, Carniel EL, Natali AN, De Caro R.
Mechanics of crural fascia: from anatomy to constitutive modelling. Surg Radiol Anat. 2009; 31(7):523-9.
11. Stecco C, Lancerotto L, Porzionato A, Macchi V, Tiengo C, Parenti A, Sanudo JR, De Caro R. The
palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis. Clin Anat.
2009;22 (2):221-9.
12. Pedrelli A, Stecco C, Day JA. Treating patellar tendinopathy with Fascial Manipulation. J Bodyw Mov
Ther. 2009;13(1):73-80.
13. Stecco A, Macchi V, Stecco C, Porzionato A, Ann Day J, Delmas V, De Caro R. Anatomical study of
myofascial continuity in the anterior region of the upper limb. J Bodyw Mov Ther. 2009 Jan;13(1):53-62.
14. Stecco A, Macchi V, Masiero S, Porzionato A, Tiengo C, Stecco C, Delmas V, De Caro R. Pectoral and
femoral fasciae: common aspects and regional specializations. Surg Radiol Anat. 2009 Jan;31(1):35-42.
15. Stecco C, Macchi V, Porzionato A, Morra A, Parenti A, Stecco A, Delmas V, De Caro R. The Ankle
Retinacula: Morphological Evidence of the Proprioceptive Role of the Fascial System. Cells Tissues Organs.
2010 192 (3), 200-210.
16. Natali AN, Pavan PG, Stecco C. A constitutive model for the mechanical characterization of the plantar
fascia. Connect Tissue Res. 2010
17. Borgini, E., Stecco, A., Day, J.A., Stecco, C., How much time is required to modify a fascial fibrosis? J.
Bodyw. Mov. Ther. 2010;14 (4), 318- 325.
18. Benetazzo, L., Bizzego, A., De Caro, R., Frigo, G., Guidolin, D., Stecco, C. 3D reconstruction of the crural
and thoracolumbar fasciae. Surg. Radiol. Anat., 2011 33(10):855-62.
19. Stecco, A., Stecco, C., Macchi, V., Porzionato, A., Ferraro, C.,Masiero, S., De Caro, R., 2011a. RMI study
and clinical correlations of ankle retinacula damage and outcomes of ankle sprain. Surg. Radiol. Anat. 33
(10), 881- 890.
20. Stecco, C., Stern, R., Porzionato, A., Macchi, V., Masiero, S., Stecco, A., De Caro, R., 2011b. Hyaluronan
within fascia in the etiology of myofascial pain. Surg. Radiol. Anat. 33 (10), 891-896.
21. Day J.A., Copetti L, Rucli G., From clinical experience to a model for the human fascial system. J Bodyw
Mov Ther, 2012 16, 372-380