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Why Focus on the Nerve-Fascia Interface

When one uses a term like ‘neurofascia’, or professes to practice with a ‘neurofascial approach’, one makes peace with the fact that these are not in themselves very specific terms.

The Nervous and Fascial systems are everywhere in the body, and are both subdivided into every level of the body’s complexity. Therefore, any therapist could be doing anything and plausibly say they are working with nerve and fascia.

I paraphrase a cantankerous Leon Chaitow when I say:  ‘There’s only five or six things we manual therapists can do to the tissues.’  We can press down, we can percuss, we can scoop, stretch, twist, and pop. What matters is our intent.*

Put another way, what matters is not primarily the intervention we perform on the system in our care, but our interactions with that system. We need to ask the right questions of the body, and know the style of questioning that will most likely elicit a good response.

When I talk about working ‘neurofascially’, what I mean is that my bodywork intent is focused on three environments within the body:

1. The terminal receptors in the peripheral nervous system

Not your Grandma’s Golgi Tendon organ. Rat Achilles 162x (Bergman et al 1995)

These consist in the stumps of axons rooted in a connective tissue matrix. Sometimes this matrix is specially modified around the axon stump, to transmit certain kinds of forces and other stimuli to its cell membrane. The stump itself blooms with proteins linked up to this larger matrix, and ready to initiate a nerve signal with the right kind of agitation.

Every move in manual therapy agitates these receptors in different ways, depending on the force, the angle, the duration of the move. I’ve found it very helpful to imagine the specific tissue layer and the population of receptors upon which my work is emphasized.

2. The nerve trunk within the neurovascular bundle

There is now good evidence to surmise that a great deal of persistent pain and limitation is not primarily about the terminal tissues, but about an irritation or injury to the nerve supplying it.

Locating these irritated tracts of nerve tissue, and facilitating their healing, should be a basic skill in any manual therapy. Unfortunately most of us don’t graduate with a good model for nerve palpation, testing, or diagnosis. We need to invest some time in learning the anatomical course and mechanical behavior of nerves.

Doing so, we gain a powerful model for tracing patterns of inflammation, guarding, and pain in the body, and for creating meaningful change in those patterns.

3. The brain maps

When we image brains during experiences of pain, pleasure, and movement, we see a flurry of fuel consumption in cooperating brain regions.

A family of Sensory and Affective brain regions. -Wikipedia

To obscenely oversimplify, the nervous system is using the fascial system to feel its environment, and then deciding how to feel about it.

Some of those lit up regions are organizing incoming signals into dynamic maps of the body and surrounding environment.

Some regions are coding those signals with memory associations (when before?) and affective information (relaxing? invigorating? threatening? pleasurable?). And some are planning motor responses — autonomic and muscular — to this information.

When in bodywork, I get a state change in the system — A new range of motion, a favorable autonomic change, a decrease in pain — My next move is to involve the brain.

I ask the person to move the region carefully. Or I ask them to put language to what they are feeling. Or I ask them to breath into the region, or to project some artful imagery, or to picture a movement. The person on my table may not feel competent in these attempts, but asking them to try is what matters.

What matters is to get a change more robust than a couple of days. And the better the brain has made sense of its temporary relief, the more likely it will be to find ways of replicating it.

So when I approach the body ‘Neurofascially’, I am thinking about creating state change and behavior change at the above three levels — the receptors in tissues, the nerve sheath, and the brain maps.

Three key environments

(*We hope intention matters. When it ceases to matter, our work is ripe for robotization.)


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