HEALTH PROFESSIONALS, HOW DOES BOWEN THERAPY/FASCIAL KINETICS WORK?
A Hypothesis by Kyle Grimshaw-Jones ND, RT www.conscioushealing.com.au
1. Rather than a purely mechanical intervention, Bowen Therapy can be seen as stimulating complex internal self-regulatory processes in the body/mind of the client, including in particular the self-regulatory dynamics of the Nervous System affecting Myofascial Tonus and Blood/Lymph/CSF interchange(*Erlingheuser) (Fluid Interchange), and also potential Neuroendocrine effects. This increased Fluid Interchange leads to increased cellular oxygenation of nerves, muscles, and other tissues.(*West) Schleip has noted that experiments in treating anesthetized people (with very similar results to that noted when manually treating very fresh pieces of animal meat) have shown that without a proper neural connection, the tissue does not respond as it does under normal circumstances.(*Schleip 1989)
2. The transverse push and pull action of the Bowen Move stimulates Intrafascial Mechanoreceptors. These include: Ruffini Endings, Pacinian Corpuscles, some of the Interstitial Receptors, plus possibly some Intrafascial Golgi Receptors and nearby Muscular Spindle Cell Receptors. These relay sensory information influencing the Autonomic Nervous System (ANS) and altering the proprioceptive input to the Central Nervous System (CNS).(*Schleip 2003 both) The Bowen Move, with its transverse, cross-fibre or lateral emphasis has a particular affinity for Ruffini stimulation. It is of interest to note that Ruffini endings are specially responsive to tangential forces and lateral stretch (Kruger 1987) and that stimulation of Ruffini corpuscles is assumed to result in a lowering of sympathetic nervous system activity (van den Berg & Capri 1999).(*Schleip Jan 2003)
3. In response to this altered input (point 2), the CNS changes tonus regulation of Skeletal Motor Units associated with the manipulated tissue, producing changes in Striated Muscle Fibre tonus. It seems likely (from measurements on the effects of mechanoreceptors of the knee joint ligaments) that this is mostly from Gamma (rather than Alpha) Motor Tone Regulation. This suggests an effect on more global and unconscious postural organization of antigravity extensor muscles and chronic musculo-emotional attitudes rather than on volitional and precise movements of the extremities.(*Schleip Jan 2003 referencing Glaser 1980, Henatsch 1976, Juhan 1987)
4. In response to this relayed sensory information (point 2), the ANS modifies efferent information transmission (*Whitaker 1997) back to the tissues (including fascia and all tissues/organs affected by the ANS) in several Neural Reflex Arcs.(*Schleip Mar 2003) These produce 3 direct effects: (points 5, 6, and 7)
5. Local Vasodilation is modified, palpably changing the pressure in local Fascial Arterioles and Capillaries, influencing Plasma Extravasation and changing the system of Ground Substance Regulation (points 11-13, 36-39), while modifying the Extracellular Matrix.(*Schleip Mar 2003) The ANS controls the Blood Supply to every tissue in the body.(*Cynthia Tucker) See points 10 onwards, below, for follow-on and associated Lymphatic and Rehydration effects.
6. Vagal Tone is increased predisposing to more Trophotropic (anterior lobe) tuning of the Hypothalamus, resulting in global Neuromuscular, Emotional, Cortical and Endocrinal changes related to deep healthy relaxation. This opens the doorway to a host of potential Neuro-Endocrine effects.(*Schleip Mar 2003)
7. The tonus of recently discovered Intrafascial Smooth Muscle Cells (Myofibroblasts which contain smooth muscle Actin Fibres and can therefore actively contract) involved in regulating Intrafascial Pre-tension is modified.(*Schleip Mar 2003, Schleip, Klingler & Lehmann-Horn 2004, Schleip, Klingler & Lehmann-Horn 2005, Schleip, Klingler, Naylor, Ursu, Melzer, Wilke, Zorn, Lehmann-Horn 2005)
Follow-on/associated effects from this include: (points 8, 9, and 10)
8. The modification of Vagal Tone and ANS effects may also produce changes in respiration consistent with a Relaxation Response. This may modify Respiratory Acid/Base Balance of the bloodstream which in turn modifies Smooth Muscle Contractility, affecting VasoConstriction/Dilation and Fascial Smooth Muscle Cell tonus.(*Schleip Mar 2003)
9. Improved Respiration from the Relaxation Response increases Lymphatic and Venous Return.(*Tortora & Grabowski, West)
10. Recent Lymphatic System research has revealed that the Precapillary Sphincters secrete chemicals which modify the 4-6 cycles per minute rhythmic contraction of the Lymphangion Smooth Muscle Cells responsible for creating pressure differentials which stimulate Lymphatic Return. Any influence which modifies VasoConstriction/Dilation will therefore also likely modify local Lymphatic Drainage. As these smooth muscles are also innervated by the Sympathetic Nervous System, any reflex changes of the ANS will also likely modify local Lymphatic Drainage.(*Allen)
11. The capacity for fascia to transform between a glued state and a more fluid state is called Thixotropy'. Being a liquid crystal, or gel, the Ground Substance is similar to maple syrup or egg white in consistency. Its structure solidifies as it dehydrates, making the tissue stiffer and more resistant, and predisposing to a gluing' of the Collagen bundles.(*Juhan, Sturgess) Chemically this begins as multiple localised hydrostatic bonds. Later this can transform into a covalent bond, and still later it can crystallise or calcify completely, becoming chronic. At this stage ossification ensues with the laying down of hydroxyapatite crystals.(*Sturgess) These glued and crystallized areas are blockages to nerve supply, and energy, blood, lymph, and CSF flow. The immune function, neuro-transmitters and nutritional and waste transit routes become compromised.(*Sturgess) This may help to explain some of the common symptoms of diseases like Ross River Fever, EB Virus, CFS, and arthritis to name a few.(*Sturgess)
12. On a mechanical level it has been said that the Bowen Move compresses the crystalline lattice of the dehydrated Ground Substance and Connective Tissue, increasing its electrical potential through the Piezoelectric effect, attracting water molecules and thus re-hydrating it.(*Sturgess) I suggest that this re-hydrating effect is also intimately associated with the Blood flow and fluid movement changes mentioned in points 1, 5 and 9, 10 above. Basically I don't believe this re-hydrating effect will work on a recently killed piece of meat devoid of actively circulating Blood and CSF, actively draining Lymph, and proper Neural connection. Even anaesthetized interference with the Neural connection seems enough to modify tissue release responses, and this occurs in tissue which still has some Fluid Interchange although anaesthetized.(*Schleip 1989). I believe the sensory stimulus of the Bowen Move reminds the body via neural reflex arcs to keep rehydrating the area via changes in Blood Circulation and Fluid Interchange as part of a complex self-regulatory process.
13. So, the Bowen Move separates the Bundles of glued' Collagen in the Fascia, restoring their fluidity/mobility. With the Ground Substance rehydrated, the Critical Interfibre Distance between the collagen bundles is restored,(*Sturgess) allowing vectors of motion between them that were previously restricted. This restored mobility, through fascial continuity, can dramatically alter biomechanical efficiency, by changing the balance of both the Structural and Kinetic Forces through and around the fascia, joints, muscles, tendons, ligaments, and bones.(Neuro-Myo-Fascial-Skeletal System)
14. Nerve Supply to the tissues is potentially modified as these Structural and Kinetic relationships change. Nerve functon is also dependent on adequate hydration and oxygenation.(*Batmanghelidj)
15. The Connective Tissues, with the fluids they contain, aid the weight-bearing capabilities of the spine. According to fascial theory, the reason why the discs develop problems in the first place is because the weight bearing which is normally borne by the Hydrostatic Pressure' of the Connective Tissue has been compromised. It is now mostly on the discs which were never designed to take that much weight. As such the discs begin to degenerate.(*Sturgess) Your intervertebral discs are only ¼ as effective at cushioning your vertebrae and spinal nerves if they dehydrate.(*Batmanghelidj)
16. Adequate daily hydration is critical for everyone. When there are abnormal mechanical stresses being exerted on your body, it is able to absorb more stress and strain through having properly hydrated connective tissue, which instead of tearing or breaking will absorb the stress. Even a small degree of dehydration will bring susceptibility to injury to the connective tissues, and modify their weight-bearing capacity. Compare a green tree branch with a branch that has dried out.(*Sturgess)
17. This explains why clients who do not maintain a Positive Hydration Balance in their daily living get poor results with Bowen Therapy.(*Sturgess)
18. Changes in hydration are evidenced in the sort of reaction clients experience after or during their treatments. These include sweating, thirst, frequent urination, perspiration, flooding menses and diarrhoea.(*Sturgess)
19. While clinical results clearly demonstrate them, it is not yet clear to this author how much of the Structural and Kinetic changes can be attributed to:
(i) the changes in Neural Regulation of the tonus of Striated Skeletal Muscle Fibres and Fascial Smooth Muscle Fibres (MyoFascial Neural Tonus),
(ii) modified fluid interchange including Blood supply and Lymphatic Drainage,
(iii) the rehydration of the Ground Substance, and
(iv) other above-mentioned, and as-yet-unmentioned/undiscovered influences.
20. By neural stimulation to the body's complex self-regulatory processes, Fluid Interchange of Arterial and Venous Blood, Lymph, and CSF is restored to the cells and tissues of the body, boosting oxygenation. The Ground Substance and Connective Tissues are Rehydrated, restoring fibre fluidity/mobility and the Critical Interfibre Distance. Both structural and kinetic relationships between the various body tissues are improved as a result, favourably affecting Nerve Supply.
Here follows basic anatomical information which may help to clarify the above:
21. The four tissues types of your body develop from three primary germ layers: Ectoderm, Mesoderm, and Endoderm. These four tissue types are: Nerve (from Ectoderm), Muscle (mostly from Mesoderm), Epithelium (from all three), and Connective Tissue (all from Mesoderm).(*Tortora, Sturgess)
22. Connective Tissue has five main functions: Structural (absorb shock and transmit mechanical force); Gliding/Lubricating; Protective Physical Barrier; Protective Cellular Elements; and Nutritional/Energy Storage.(*Sturgess)
23. It exists throughout the body in three forms: Special-Propertied (blood, lymph, mucous, adipose, elastic), Structural (bone, cartilage), and Proper.(*Tortora, Sturgess)
24. CT Proper can be categorised into both Regular (tendon, ligament) and Irregular (Deep and Superficial Fascia), and Loose and Dense forms.(*Sturgess)
25. The Fascia (Dense Irregular CT) is composed of several different Cells, and its Extracellular Matrix.(*Tortora, Sturgess)
26. The Extracellular Matrix is composed of Protein Fibres, Ground Substance, and Fluid.(*Sturgess, Tortora)
27. The Cells include: Standard Cells (including Fibroblasts, Osteoblasts, Chondroblasts, Odontoblasts, Reticular Cells, and Phagocytes), Macrophages, Mast Cells, Adipocytes, Lymphocytes and Melanocytes.(*Sturgess, Tortora)
28. Fibroblasts manufacture both Protein Fibres and Ground Substance and are derived from Mesenchyme, a subdivision of Embryonic Mesoderm.(*Juhan, Sturgess, Tortora) It is these Fibroblasts that can transform into Myofibroblasts (Smooth Muscle Cells) which are present in Fascia and can actively contract.(*Schleip Mar 2003)
29. This same germinal layer of embryonic cells produces: blood; lymph; endothelium of blood and lymph vessels; parts of the eyes and middle/inner ears; skin dermis; the surface linings of the body cavities, kidneys, ureters, gonads, genital ducts, and adrenal cortex; bone; red bone marrow; periosteum; cartilage; joint capsule; ligament; all skeletal and cardiac muscle and most smooth muscle; tendon; and fascia.(*Juhan, Tortora)
30. All body structures, from dermis to periosteum, are interconnected, enveloped, defined and tied together by this almost ubiquitous and continuous Connective Tissue, within which they all grow.(*Juhan)
31. Connective Tissue is composed mostly of Collagen, and also Reticulin and Elastin Protein Fibres.(*Tortora, Sturgess)
32. Molecules of Collagen form hollow Fibrils (through Hydrogen Ionization Bonding), which form Bundles of Fibre, which should be separated by a Critical Interfibre Distance.(*Sturgess)
33. CSF was found inside the hollow Collagen Fibrils (*Erlingheuser) and they are thus seen by some researchers as another circulatory system, distributing neuropeptides and other brain chemicals to the cells of the body.(*Ray)
34. Collagen is manufactured from amino acids in the presence of Vitamin C, and constitutes about twenty-five percent of all body protein.(*Juhan, Sturgess, Tortora)
35. The Fascial Sheets are formed from these Protein Fibres, and have a potential tensile strength of over 2000 psi! which is stronger than steel. Therefore fascial imbalance appears to be responsible for many pain syndromes.(*Sturgess)
36. The Ground Substance is what fills the space outside of the Cells and Protein Fibres. Its consistency (fluid, semi-fluid, gelatinous, or calcified)(*Tortora) and chemical composition varies in different areas of the body, and it might best be called the Ground Substances' (plural).(*Juhan) Its basic make-up consists of about 70% fluid, and several types of large molecules, many of which are complex combinations of proteins and polysaccharides (hyaluronic acid, chondroitin sulfate, dermatan sulfate, keratan sulfate). These are referred to collectively as Glycosaminoglycans (GAGs).(*Tortora)
37. Excepting hyaluronic acid, GAGs are associated with proteins called Proteoglycans (PGs). PGs form a core protein, and GAGs project from this like the bristles of a brush. GAGs trap water, making the Ground Substance more jellylike, and modify their shape when dehydrated,(*Tortora) compromising the Critical Interfibre Distance' and reducing transit routes in the extracellular matrix.(*Sturgess)
38. It is into this Ground Substance that the capillaries feed and draw the nutrients and waste, and it is from this Ground Substance that the lymphatics also draw fluids and waste. This Fascial Extracellular Matrix is the medium through which cells are able to communicate with each other.(*Sturgess)
39. Understand clearly that the immediate environment of every cell in the body is composed of these fluid (or crystallized) Ground Substances. They directly influence the passage of gases, nutrients, wastes, hormones, antibodies, neuropeptides, and white blood cells between the capillaries and collagen fibrils, and the tissues they irrigate.(*Sturgess, Ray)
Allen, N. Personal Communication 2005.
Batmanghelidj, F., M.D., Your Bodies Many Cries for Water
Glaser V, Eutonie. Karl F. Haug Verlag, Heidelberg, 1980
Henatsch H-D, Bauplan der peripheren und zentralen sensomotorischen Kontrollen. In: Physiologie des Menschen, Vol. 14. Urban & Schwarzenberg, Munchen, 1976
Juhan, D., Job's Body, Station Hill Press, Barrytown, NY, 1987
Erlingheuser, R.F., The Circulation of Cerebrospinal Fluid Through the Connective Tissue System, in the Academy of Applied Osteopathy Yearbook, 1959
Kruger, L., Cutaneous sensory system in: Adelman G. (ed.). Encyclopedia of Neuroscience, Vol 1. Birkhauser, Boston, pp 293, 1987
Ray, J.W. Personal communication 1993?.
Schleip, R., A new explanation of the effect of Rolfing, Rolf Lines 15(1): 18-20, 1989
Schleip, R., Fascial plasticity - a new neurobiological explanation: Part 1, Journal of Bodywork and Movement Therapies, Jan 2003
Schleip, R., Fascial plasticity - a new neurobiological explanation: Part 2, Journal of Bodywork and Movement Therapies, Apr 2003
Schleip, R., Klingler MD, W., Lehmann-Horn Phd, F. Active contraction of the thoracolumbar fascia - indications of a new factor in low back pain research with implications for manual therapy. 5th Interdisciplinary World Congress on Low Back & Pelvic Pain. Melbourne, Nov 2004
Schleip, R., Klingler, W., Lehmann-Horn, F. Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Medical Hypotheses 65: 273-277, 2005
Schleip, R., Klingler, W., Naylor, I.L., Ursu, D., Melzer, W., Wilke, H.J., Zorn, A., Lehmann-Horn, F. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Medical Hypotheses preprint posting for peer review purposes, www.harcourt-international.com/journals/mehy/default.cfm), 28/7/2005
Sturgess, Russell, Fascial Kinetics Student Manual
Tortora and Grabowski, Principles of Anatomy & Physiology 10TH Ed. John Wiley & Sons, Inc. 2003.
Tucker, C. Personal Communication 2005.
Van den Berg, F., Cabri, J. Angewandte Physiologie Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Georg Thieme Verlag, Stuttgart, Germany, 1999
West, Samuel C., The Golden Seven Plus One
Whitaker, J.A. The Bowen Therapy; a gentle hands-on healing method that affects the autonomic nervous system as measured by heart rate variability and clinical assessment. Paper presented at the American Academy of Environmental Medicine at La Jolla, CA, Dec 1997