Fascial Manipulation - Stecco Method
The Method
Recently, I attended Fascial Manipulation - Stecco Method course lead by, none other than, Dr. Warren Hammer. It was a new language and approach to investigating soft tissue structures, most notably the fascial system. I’ve taken a lot of other soft tissue courses (e.g. ART, Graston, RockTape, FAKTR, ConnecTX) and this was the first to focus almost entirely on the fascial network.
The short version is that areas of tension can develop (deposition of hyaluronic acid(HA)) called “densifications” along pathways of force production/movement. The problem is that these areas restrict smooth movement of surrounding structures, most notably along these movement lines, which can result in irritation of nociceptive fibers in the connective tissue, reduced gamma activiation of motor units and reduced muscle contraction, ultimately leading to progressed compensations and more advanced pain syndromes. These areas can be seen using diagnostic ultrasound and are palpated and treated to breakdown the hardened gel-state of the HA.
Densification - Red arrow shows separation of deep fascia.
How does it compare?
Anyone familiar with Tom Myers and his book Anatomy Trains will see a lot of overlap. From an assessment standpoint, areas of pain are considered during examination of functional tests. (Take your pick here, there are some range of motion options specific to the technique, but I’ll likely be blending it more with an SFMA mindset). Exaggeration of pain or limitations in performance, as highlighted in a specific pattern/line/train, gives the doctor a starting point. This is very similar to other assessment methods (FMS, SFMA, MPI, DNS). The big difference is in the treatment approach. Where other methods typically leave docs to treat joints or muscles directly (in isolation), or full movement patterns with exercise pro/regressions, FM is manual therapy that attacks multiple densifications (then balances the line) then retests for improvement.
Another approach it’s similar to is DTM/YAP. Here, we see advanced principles being applied from Kibler fold test and skin rolling techniques. Where FM treats specific points, DTM may “release” an entire line and can use not only manual but also instrument assisted techniques (like cupping).
Myofasical Sequences of FM - See how similar in concept they are to other considerations of movement
The Verdict
Fascial Manipulation - Stecco Method puts a huge spotlight on an anatomical system that is often overlooked or not considered at all. There has been significant research and ongoing learning opportunities at Fascial Congresses internationally to evolve our understanding of fascia. For manual practitioners, it would be naive to ignore fascia when there continues to be growing evidence, whether pathoanatomically or pathokinesiolocally. Regardless of how it’s integrated into your current practice, it’s always great to have more tools in kit to treat patients, and FM is no exception.