Welcome to the ocean

I have a confidence problem.

Not so much around myself as a teacher, but in the nature of the knowledge I am delivering.  I don’t trust it.  Teachers and writers are emperors born naked.  The knowledge I offer is not a solid thing: just a way of perceiving.

Every workshop attendee deserves the most succinct and useful class that I can muster.  So I relentlessly knap at my lesson plans until they resemble something like clear principles and straightforward methods.  But I have a voice in my head that wants to scrawl in the margins, no don’t listen to me!  Don’t trust my skewed sampling.  Spend wakeful time with the primary sources — the literature and the body — and you don’t need me.

Ha ha, just kidding.  Please attend all my workshops.  You need me.

But seriously, you don’t.

Three Dimly Lit Neurofascists, Fitfully Making lists.

If you wanted to, you could venture deeply.  You could nibble on anatomy papers with your morning coffee, hang out with cadavers on some weekends, flip through Netter or Thieme on your lunch break.  If you did that, you would see how contingent my offerings are.  You would experience pangs of depression, as the seeming grandeur of your favorite teachers evaporates.  They were not kings with holy speech, but mottled apes making singsong.

Hold your course.  You will gain a kinship with those apes.  You will become a colleague, co-legit with your former heroes.  No royal sashes, no judicial robes.  Just us explorers, crisscrossing the inky sea.

This transformation is what I was hoping to initiate inside the minds of my crack squad of bodyworker-interns.  I needed three persons with enough grit to navigate the primary sources, enough perspective to notice themes emerging, and enough emotional resources to hear me talk a lot.  Those persons are Jenny May Peterson LMP, Roselie Rasmussen LMP, and David Robison LMP.

Our plan was ambitious:  create an open-access clinical reference tool for the nerve-fascia interface.  That meant churning through a small mountain of peer-reviewed papers, and excerpting each sentence or paragraph in which a neural structure is said to connect with, interface with, or innervate a fascial structure.  Once found, those excerpts can be organized into a static visual reference, like a wall chart.  It can also be built into a open-access app or website, with a dynamic branching display and the ability of users to upload their own peer-reviewed findings and their own case data.

Yes, it’s all connected. But some things more than others.

Why would I start such a project, besides my longstanding desire for co-explorers?  Because of the confidence thing.  Despite a plethora of manual and movement therapies targeting the nerve-fascia interface, and despite a ton of research asserting a physiologic relationship between nerve and fascial tissues, the actual anatomy of neurofascia is thinly reported and hard to depict.  If the neurofascial literature could be distilled and aggregated, it would immeasurably empower my work.  I suspect it would for others as well.

We began in November with a pile of 110 research papers.  Almost immediately, the process of collecting excerpts forced us to ask more questions:  By “interface” do we mean a firm connection between nerve and fascia, or could we include instances of sliding adjacent structures?  By “fascia” do we mean only membranous sheets, or all fibrous connective tissues?  What about the intrinsic fasciae that make up a peripheral nerve?  What about microscopic interfaces, like the capsules of mechanoreceptors?  What about interfaces that are not localized, but systemic?

We erred on the side of inclusion, but we added descriptor columns to our database.  A clinical tool would be useless if all these interfaces were treated the same.  We wanted to create a tool that would empower better clinical decisions.   If this pain is generated peripherally, where should I look?  What other tissues are sensitized?  What level of pressure should I use?   Which nerves are likely to be affected by this fascial injury, or visa versa?

Anatomical objects interfacing with each other can be modeled as nodes connecting to each other in different spatial dimensions.

As we gathered our excerpts, it became clear how complex a relationship we were trying to capture.  Sometimes nerves were described as perforating through fascial walls, or strung through fibrous tunnels alongside bones, or spreading out within a sandwiched plane until visually indistinguishable from surrounding tissues.  Sometimes a nerve and a fascial structure were multiply interwoven, displaying different relationships depending on where you looked.

We gathered the initial report of our work into a poster submission to the Fourth International Fascia Research Congress, and I’m proud to say our poster was accepted.  On September 18th and 19th, we’ll get a chance to bounce this idea off the other 400 people crazy enough to fly to Washington, D.C. to just to learn about fascia.

Check out this accepted abstracts page.  I hyperventilate with excitement every time I look at it.  For this team of neurofascists, this conference will be a good chance for us to learn through a brand-new lens, and gauge how potentially useful our project may be to others’ investigations.

We aren’t there yet.  We don’t even know where “there” is.  But we’ve pushed off anyway, and are rigging the first sail.


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