Mysterious, complex, and unyielding in its reach, fascia is a beautiful thing. And now, thanks to the work of French surgeon Jean-Claude Guimberteau, MD, we are all afforded a glimpse at this seemingly delicate, structurally verbose underlying fabric that is the subject of his book Architecture of Human Living Fascia (Handspring Publishing, 2015).
What we see in the book’s photographs and accompanying videos is both simple and complex; chaotic, yet organized. It’s fascia in its living form—much different from the often minimalistic illustrations depicted in most anatomy books or its hardened and lifeless form seen up close in cadaveric explorations. The results of Guimberteau’s look at “living” fascia are forcing clinicians and researchers far and wide to think differently about this mysterious tissue. Fascia—once considered a nuisance to anatomists who would discard it in favor of getting to the “more glamorous organs, muscles, nerves, etc.”1—is now the sweetheart of manual therapy research.
A Closer Look
Guimberteau, a past president of the French Society for Plastic and Reconstructive Surgery, has spent four decades learning the workings of the human body. But it was his curiosity 20 years ago that propelled him to look closer at the tissue he was addressing in the operating room. With his patients’ consent, Guimberteau started using a digital endoscope during surgical procedures to see and record exactly what was happening with the tissue he was working through and around. The resulting photographs and videos are groundbreaking in their depiction of the living fascial system and the body in motion. They were also what forced Guimberteau to challenge his own certainties of anatomical order and enter a world of “fractals and apparent chaos.”
The response to his work from clinicians, educators, and researchers was immediate. Bodyworker Thomas Myers noted that seeing Guimberteau’s “new system” forced him to rethink some fundamental premises, and that not only have his ideas and teachings changed since, but so has his “touch.”2 James Oschman, PhD, says Guimberteau’s work is “taking us on an unbelievably exciting voyage into a new and uncharted world” that is an adventure “as thrilling as any experienced by the great explorers of new continents.”3 And noted researcher and biotensegrity expert Stephen Levin, MD, says: “What Dr. Guimberteau describes in the constantly changing microvacuoles and microfibers is entirely consistent with the biotensegrity model and is occurring at every level of organization, at every scale and across scales … I see nothing but tensegrities in Dr. Guimberteau’s marvelous endoscopic demonstrations; he has breathed life into a theoretical model.”4
Some of the insights of human fascia gleaned from Guimberteau’s work include the premise that everything is connected, that there are no empty spaces, and that cells are not found in all places. Further findings show that connective tissue does more than just “connect” things—it’s actually constitutive: a premise that takes us away from merely hanging tissue on the skeletal body.
What Guimberteau has found is not simplistic in either its implications or its comprehension. “I have a lot of anatomic training, and I still struggle to understand Guimberteau’s beautiful photography,” writes noted fascia researcher Thomas Findley, MD, PhD, “particularly the dynamic nature of his video records as we see fibers moving, dividing, crossing, with consequent changes in the spaces these fibers define. My anatomically correct brain still resists the notion that these structures can change in front of our eyes. After all, I learned my anatomy from a cadaver and a book, and neither one moved while I was studying.”5
In a recent exchange with Guimberteau, he explains that what’s exciting for him is the dichotomy of what fascia presents: efficiency and apparent chaos. “It is this observation of an apparent fibrillary chaos that is responsible for more efficient mobility that opens the spectrum of your thoughts and takes you out of your reassuring rationality,” he says.
What Does It Mean for You?
What does this all boil down to for massage therapists and bodyworkers? First, many believe a manual therapist’s touch can’t help but become more engaged and intuitive after witnessing Guimberteau’s video imagery. But this new reality goes much deeper, literally and figuratively, than that.
“It is clear that manipulation of the skin and underlying tissue influences a cell’s shape and position, and the mobility of the fibrillar system responsible for our architecture,” Guimberteau says. “The videotaped sequences leave no doubt. Any gesture of manual therapy has an impact at the cellular level. However, the nature of this mechanical consequence and its therapeutic effect, for now, cannot be demonstrated and appreciated quantitatively and qualitatively.”
When asked what’s the most important thing manual therapists can take away from his book and research, Guimberteau answers: “The most important, for me, is that now we can say that the effect of manual therapy is mechanically observable, indubitable, and undeniable on both the extracellular fibrillar system, but also on mobility and cell shape.”
A Long Road Ahead
Despite the last two decades of fascial inquiry, and a pinpointed focus on the topic since the inaugural International Fascia Research Congress in 2007 (in which Guimberteau was first broadly introduced to the fascia community), there is much we have left to learn about connective tissue.
Guimberteau tells us that we are only at the start of this line of inquiry and that much work remains. “We are at the beginning of the exploration. With new digital and filmographic technologies, the following generations of surgeons and scientists will show in a clear way this tissue continuity up to the level of the cell nucleus and, therefore, chromosomes. It will certainly demonstrate the importance of epigenetics on the protein production and the different modes of adaptive responses. Epigenetics will take a major place without nevertheless evicting chromosomic reality. It will have, as a consequence, an influence on philosophical and metaphysical aspects.”
Sharing the work with others has been a guiding principle for this fascia guru. “To discover the beauty of the living body has been fundamental for me,” Guimberteau says of his work. “The beauty imposes upon us its power and is combined with a surprising, unexpected mechanical behavior. How do I keep this to myself? How do I put all these images in a drawer and not share them? It would have been a real failure. The beauty must be shared.”
Notes
1. Leon Chaitow, Fascial Dysfunction: Manual Therapy Approaches (Edinburgh: Handspring Publishing, 2014): ix.
2. Jean-Claude Guimberteau, Architecture of Human Living Fascia (Edinburgh: Handspring Publishing, 2015): 57–58.
3. Ibid, 111.
4. Ibid, 140.
5. Ibid, ix–x.
Karrie Osborn is senior editor at Associated Bodywork & Massage Professionals. Contact her at karrie@abmp.com.