The explosion in fascia research over the past couple of decades has been nothing short of spectacular, as is the breadth of research reaching practitioners through seminars (now webinars), the phenomenal Fascia Research Congresses, and translations of clinically applicable methods. It is hard to believe that in the space of a few short decades, research—and practice—regarding the tissue once destined for “the cutting-room floor”¹ has multiplied exponentially whereby the understanding of therapeutic approaches to dysfunction and homeostasis is undergoing a radical paradigm shift that looks set to continue.

Practitioners—and students of osteopathic medicine in particular—may feel gratified by what appears to be a confirmation of sorts, of the prescience of the profession’s founder, Andrew Taylor Still, in stating that “the fascia is the place to look for the cause of disease, and the place to begin the action of remedies.” Still and his early successors may not have fully understood the mechanisms and pathophysiological processes via which this occurred, since his approach was rooted in a rather different—some would say outdated—model of health and disease without the benefit of modern research methods and technology. Nevertheless, Still had a point that modern research is now beginning to bear out. Namely, that the entire body is interconnected by a physical matrix, the distortion of which can lead to disease and dysfunction.²

It is for the experts in this field to provide the fine detail of what the study of fascia entails, as they are already doing. My interest, and the focus of this article, lies in using the evolution of our understanding of fascia as a case study to look at the evolution of how we think and learn—as a society and as therapeutic professions—about health and disease, and what insights the story of the evolution of this field can offer.

Why Fascia?

Since the evolution of all medical fields has followed a similar trajectory (up to a certain point in time), some may wonder, why choose fascia? Fascia specifically presents a unique case, because unlike studying in cardiopulmonary, vascular, or orthopedic fields, it has the rather inconvenient—until recently—quality of interconnecting all of the bodily systems, while its stimulation or dysfunction can also have a psychological effect, autonomic or otherwise. Not only that, but the understanding of fascia carries with it a set of roots firmly embedded in vitalism, as did the whole medical profession until about 300 years ago. But these roots were firmly severed with the advent of the modern scientific method.

Biomedicine, based on mechanistic and physicochemical explanations of physiology, took primacy over all other interpretations, and vitalism became a dirty word in early modern scientific circles. The same has not occurred in many of the branches of the integrative health professions, where particularly osteopathy, chiropractic, massage therapy, and other subdivisions retain elements of vitalistic thought—some overtly and others less so. Yet, it remains a subject of often heated debate even within naturopathic circles.

Vitalism is an ancient perspective on the living organism whereby life itself and organic processes result from a nonphysical vital force within that organism. Some call it “energy,” others simply “the life force.” In traditional chiropractic, vitalism was once known as “innate” and “universal intelligence,” while in naturopathic medicine it has been referred to as “the healing power of nature” (vis medicatrix naturae), a perspective that goes back to ancient Greece.³ It is at once a philosophy, a worldview, and an ideology—and they are not the same.

Generally speaking, vitalism is no longer seen as acceptable within scientific discussion, and unfortunately this has partly come about as a result of careless misuse of terms without an understanding of their context. Understanding the evolution and the quality of this thought process is not about chewing over dusty historical narratives and circular debates, but it isn’t about applying arbitrary definitions either. The tensions that led to that evolution are still ongoing within current debates on technique, evidence (or the lack thereof), and most in the overall approach to well-being and healing.

Practicing a therapeutic profession is not simply a matter of showing up and working. The education, therapeutic alliance, and clinical reasoning that practicing entails rests on a philosophy that is too often forgotten, or becomes so deeply embedded in one’s psyche that one can lose sight of it. Whether or not it is spelled out in introductory courses (and it should be), every practice rests on a philosophy, and that philosophy has a history. Knowing what has gone before, what impact it had, and why, allows one to understand and reflect on the context, gaps, and potential of one’s own practice. Most importantly, as established by other researchers currently reexamining the role of vitalism in integrative medicine,⁴ there is a critical difference between perceiving a given philosophy (whether vitalistic or mechanistic) as dogma intertwined with professional identity, and perceiving it as a lens through which to reflect, consider, and evolve.⁵

All too often, overspecialization—and too much focus only on practical considerations—can lead to a failure to grasp the broader, messy, uncertain reality surrounding practice. In medical education this is becoming ever more evident, and the solution that educators in the medical community are beginning to apply (with spectacular results), is the integration of the interdisciplinary approach known as the Medical Humanities, which incorporates history, philosophy, and even literature into medical school curricula so as to better contextualize and ground student learning. In fact, it is now taken for granted that “biomedical reductionism” is no longer acceptable in modern medicine, which suggests that those who criticize the biomedical fields might wish to explore this rapidly evolving interdisciplinary development further.⁶ This article is written based on those same principles.

Vitalism’s fall from grace began with the scientific revolution around the turn of the 18th century when a widespread intellectual movement known as the Enlightenment began to discredit all perspectives that could be associated with superstition, spirituality, or speculation.⁷ The reasoning was that this would do away with the bloody religious warfare that had ravaged Europe for centuries, and idealistically usher in a new Age of Reason in its place. This led to the wholesale rejection of whole swaths of worldviews and forms of expression and belief that ended up in what scholars have called “the wastebasket of history.”⁸

Despite the manifold gifts of this dawn of reason, its more problematic legacies include a devout focus on mechanistic interpretations of natural processes, both environmental and physiological, and a strong tendency toward what is known as presentism, which is a tendency to uncritically interpret past events in view of present-day values. But what does that mean in practice, and what does it have to do with fascia?

The Life Force

In all likelihood, if someone spoke of the zoodynamic life force today, they would be summarily dismissed as spouting “woo”—for want of a better term. The phrase was used in the early 20th century by Dr. Andrea Rabagliatti (1843–1930) when describing connective tissue as a matrix transporting and supporting both structure and function of the circulatory and lymphatic systems.⁹ In short, zoodynamic life force is a different term for something that today has received new nomenclature that is more accurate within the framework of our current common scientific language. He was talking about fascia.

Though Rabagliatti used strange vocabulary, he was not only heading in the right direction, he was also an important link in a chain of practitioners to whom we owe many aspects of integrative health and manual therapy techniques. In the 1930s and 1940s, Dewanchand Varma (died ca. 1946) and Randolph Stone (1890–1981) respectively influenced diverging branches in the evolution of manual therapies. Varma taught his ayurvedically inspired “pranatherapy” based on the principle that disease is caused by obstructions to the free flow of the internal vital force—which he called prana—and developed manual techniques to release these obstructions. Stone, also influenced by more esoteric currents, including theosophy, Rosicrucianism, and Paracelsianism, developed what is known as polarity therapy, with clear roots in mesmerism—all theories long consigned to “the wastebasket of history” until just a couple of decades ago, when they became objects of historical research.¹⁰

Subsequent work by Stanley Lief (1892–1963), Boris Chaitow (1907–1995), and the eventual application of modern scientific methods by Leon Chaitow (1937–2018) and colleagues led to the development of European Neuromuscular Technique.¹³ In every introduction to his version of NMT, since 1980 and up until 2018, Leon Chaitow cited and built on these early references to fascia, tracing this evolution to demonstrate that Rabagliatti’s zoodynamic life force, Varma’s prana, and so many other names used for the concept of an interconnected, self-regulating, physical matrix, may be referring to one and the same thing, which now has a host of images, three-dimensional models, and robust research to support it.

Rabagliatti’s explanation is over a century old, based solely on empirical observation. It was through his work that Lief discovered Varma, who used an ayurvedic conceptual framework to describe and work with the same precise entity: fascia. Lief and Boris Chaitow reinterpreted this from a Western perspective, albeit one imbued with the concept of “innate physical intelligence” deriving from chiropractic. One may wonder, at this juncture, whether it is possible to speak of a form of intelligence inherent in tensegrity structures and the self-organizing microscopic multifibrillar network only recently revealed by Jean-Claude Guimberteau’s endoscopic dissections.¹⁴ For his part, Leon Chaitow sought to establish a solid evidence base for manual therapy practices, pruning unnecessary or confusing elements, focusing only on what was functional, effective, safe, and evidence informed.

Now we speak of “a body-wide tensional force transmission system,”¹⁵ and “one large networking organ.”¹⁶ When it comes to dysfunction, we also speak of “densification,”¹⁷ a disorganization of “collagen and matrix deposition,”¹⁸ impairment of motor function resulting from binding among layers of fascia,¹⁹ and “global soft tissue holding patterns,”²⁰ all of which can lead to musculoskeletal restrictions and pain, and negatively impact circulation and drainage. When prolonged, this can reduce proprioception and affect equilibrium, and from there, it can lead to a chronic state of maladaptation, autonomic imbalance, and potentially chronic fatigue.²¹ Yet, all of these reflect Still’s, Rabagliatti’s, and Varma’s original concepts. So, what is the value of this review? What can we gain from it?

Glossary

These terms¹¹ belong to a cluster of philosophies and historical movements often grouped under the umbrella term “esoteric traditions.” They are the subject of a dedicated, interdisciplinary field of study within the History of Ideas. In the past 25 years, the field has developed rapidly (though it was neglected for decades), uncovering the great impact these ideas have had on both culture and science. They have had an intense influence on some branches of the “healing arts,” some of which is still visible.

• Mesmerism: A theory and doctrine based on “animal magnetism” developed by Franz Mesmer (1734–1815) according to which:

“A responsive influence exists between the heavenly bodies, the earth, and animated bodies; a fluid universally diffused, [. . .] continuous, [. . .] incomparably subtle, and naturally susceptible of receiving, propagating, and communicating all motor disturbances, is the means of this influence; this reciprocal action is subject to mechanical laws; properties are displayed, analogous to those of the magnet, particularly in the human body, in which diverse and opposite poles are likewise to be distinguished, and these may be communicated, changed, destroyed, and reinforced.”

Mesmer based this theory on Newtonian fluid dynamics combined with planetary correspondences. He developed treatments based on his theories, and despite criticism, he had hundreds of followers. Mesmerism strongly influenced polarity therapy, homeopathy, and a number of other approaches featuring polarities and fluids.¹²

• Paracelsianism: Philippus Aureolus Theophrastus Bombastus von Hohenheim (1493–1541) was a Swiss doctor, alchemist, and philosopher. He is credited as the father of toxicology, establishing that dosage makes a poison or remedy, and was known for his emphasis on the academic study of chemistry. With strongly vitalistic beliefs, Paracelsus believed that the microcosm of the body and the macrocosm of the universe were connected and followed the ancient theory of correspondences and resemblance to choose medications. He also wrote long treatises on alchemy and philosophy. Paracelsianism was the early modern medical and philosophical movement inspired by his work. One of his most famous quotes is: “The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind.”

• Rosicrucianism: The Rosicrucian idea that swept Europe in the mid-17th century combined alchemy, healing, mathematics, and mechanical arts with a vision of universal wisdom, spiritual illumination, and an initiatory path aiming at the rectification of mankind and nature within a belief that the end of the world and a new age of bliss was arriving. It took form in the Rosicrucian Manifestos, three anonymous texts written in the early 17th century, whose powerful symbology exercised a strong influence on esoteric circles for centuries to come. Members of the fraternity were bound to follow six main rules, which included directives to cure the sick, “and that gratis”; to avoid wearing a distinctive “habit,” but to observe the custom of their country; to spread knowledge; and to meet once a year. The Rosicrucian idea sparked such interest in esoteric circles across Europe that real Rosicrucian brotherhoods quickly emerged and exist to this day. Rosicrucian healing is based in part on the protoscientific practice of alchemy, which involves refining and rectifying body and soul by supporting and helping nature.

• Theosophy: A spiritual society established in New York, later with headquarters in India, by Helena Petrovna Blavatsky (1831–1891) that combined spiritualism, various Western esoteric currents, and what was termed “occult science” in an attempt to scientize beliefs and phenomena in order to legitimize them in the context of the new secular age. Blavatsky’s Theosophic Society (TS) was characterized by syncretism: the combining of diverse theories and beliefs into a common whole, regardless of their historical differences. Enormously influential with a large following and readership, the TS remains an active society with global membership that strongly supports education and retains strong ties with many “traditional” healing practices.

Frames of Reference

As I noted earlier, when we critically examine the conceptual shifts taking place through time, one of the things we observe is that each shift belongs in a unique paradigm, or frame of reference. That paradigm is informed by myriad factors: political, social, cultural, and religious. Within that paradigm are individuals working within certain parameters and pressures: educational (what perspectives were they taught), professional (ethical, ambitious, professional identity), and personal (beliefs, individual culture), while the wider factors are also acting upon them. Together, these shifts form frames of reference, which construct someone’s reality and inform their behavior, practice, and worldview. You can imagine a frame of reference as being equivalent to fascia, in fact (but with reference to our perception of reality), while each of the factors listed above are like forces being applied to it. If one of those factors exercises excessive force, perception also behaves like fascia.

Frames of reference shift as all the factors change and evolve. For example, Leon Chaitow dropped some of the more arcane concepts and vocabulary while seeking to understand the underlying ideas. Lief, on the other hand, accepted the overt vitalistic and ayurvedic terminology used by Varma, because in his context it was still marginally acceptable to do so. In our time, we speak of “somatic psychology”—the very field of psychology grew directly out of the same rich soil that spawned early modern vitalistic practices.

There may come a time, a century or two from now, when future scientific commentators look back in bafflement at current terminology and the trajectory of its evolution. The language we use today rests within a framework that itself is subject to the limitations of our current knowledge. That framework tells us a lot about how we think as a community and as a society. Looking at how the framework has evolved can also provide insight into where we need to either take more care, be aware of how much we do not yet know, or exercise more critical judgment before embarking on debates that, ultimately, have continued for over 300 years.

Once we are aware that we are in fact only one link in a long debate that has been repeated many times before, we can compare contexts and see where we may do things more constructively. We need to be able to have thoughtful discussions without crying “woo,” but only once we have done our homework.

Some debates that continue to rage within the manual therapy communities include the trigger-point question; the argument for evidence-informed versus wholly evidence-based practice; issues regarding techniques that still lack solid evidence; and indeed, the question of fascia itself and whether it is overrated.

In the context of our current frames of reference, all too often views become entrenched in forms of dogma and end up in a binary impasse. Yet, all of these factors are based on how we learn and how we formulate knowledge. By absolving these historical frameworks of the deprecation surrounding them and rescuing them from the wastebasket of history, we can learn a lot about how we have reached the current state of knowledge, and we can also take a far more reflective look at those areas that remain controversial—and our own prejudices.

I am not suggesting for a moment that we can equate earlier perspectives with those supported by solid science, nor am I suggesting that we can resurrect past theoretical frameworks unless we thoroughly understand their history and context—that is what it really means to do the research. I am saying that rather than engaging in binary either/or controversies, we can use examples such as this to reexamine the relative nature of what we think we know and how we learn, and perceive how it has evolved and how the way we talk about it affects both our learning and our practice.

Perhaps the analogy of fascia to frames of reference offers a way forward, but how do we begin unloading it? Herein lies a potential for dialogue and a far more conscious approach to learning, knowing, and practicing. Ultimately, as always, the aim should be to evolve as individuals and as practitioners for the benefit of clients. Therefore, understanding where these practices have been may open up new vistas for where they may one day lead.

Notes

1. Leon Chaitow, Fascial Dysfunction: Manual Therapy Approaches (Edinburgh: Handspring, 2014).

2. Leon Chaitow, Neuromuscular Technique: A Practitioner’s Guide to Soft Tissue Manipulation (Wellingborough: Thorsons, 1984).

3. Ian Coulter, Pamela Snider, and Amy Neil, “Vitalism—A Worldview Revisited: A Critique of Vitalism and Its Implications for Integrative Medicine,” Integrative Medicine 18, no. 3 (June 2019): 60–73.

4. Ian Coulter et al., “Vitalism—A Worldview Revisited”; Dennis Richards, Elizabeth Emmanuel, and Sandra Grace, “Duelling Ontologies: Might Vitalism Offer Balance and Value?” Explore 13, no 12 (March-April 2012): 133–38, https://doi.org/10.1016/j.explore.2016.12.004.

5. Ian Coulter et al., “Vitalism—A Worldview Revisited.”

6. Hedy S. Wald, Jonathan McFarland, and Irina Markovina, “Medical Humanities in Medical Education and Practice,” Medical Teacher 41, no. 5 (August 2018): 492–96, https://doi.org/10.1080/0142159X.2018.1497151; David Pilgrim, “The Aspiration for Holism in the Medical Humanities: Some Historical and Philosophical Sources of Reflection,” Health 20, no. 4 (July 2016): 430–44, https://doi.org/10.1177/1363459315600771; Aileen Patterson et al., “Medical Humanities: A Closer Look at Learning,” Medical Humanities 42, no. 2 (May 2016): 115–20, https://doi.org/10.1136/medhum-2015-010834.

7. Isaiah Berlin, ‘The Divorce Between the Sciences and the Humanities,” in Against the Current: Essays in the History of Ideas (London: Pimlico, 1997): 80–110; Francis Bacon, New Atlantis, 1626.

8. Wouter J. Hanegraaff, Esotericism and the Academy: Rejected Knowledge in Western Culture (Cambridge: Cambridge University Press, 2012).

9. A. Rabagliatti, Initis or Nutrition and Exercises (London: CW Daniel, 1916).

10. Robert Darnton, Mesmerism and the End of the Enlightenment in France (Cambridge: Harvard University Press, 1968), 47–8, 52; Nicholas Goodrick-Clarke, The Western Esoteric Traditions: A Historical Introduction (New York: Oxford University Press, 2008), 174–78.

11. Sasha Chaitow, “Glossary,” in Atalanta Unveiled: Alchemical Initiation in the Emblems of Atalanta Fugiens (Green Forest: Attic Books, 2020); Wouter J. Hanegraaff, ed., Dictionary of Gnosis and Western Esotericism (Leiden: Brill, 2005).

12. Franz Anton Mesmer, Mémoire sur la Découverte du Magnétisme Animal (Geneva: Didot, 1779), 74–6.

13. Leon Chaitow, Neuromuscular Technique: A Practitioner’s Guide to Soft Tissue Manipulation, 14–29; Leon Chaitow, “Pranotherapy: Predecessor of Neuromuscular Technique,” Chaitow’s Chat: Blog & News, January 15, 2012, www.leonchaitow.com/2012/01/15/pranotherapy-predecessor-of-neuromuscular-technique.

14. Jean-Claude Guimberteau and Colin Armstrong, Architecture of Human Living Fascia (Edinburgh: Handspring, 2015).

15. Robert Schleip, Thomas W. Findley, Leon Chow, and Peter Huijing, eds., Fascia: The Tensional Network of the Human Body (Edinburgh: Elsevier, 2012).

16. Robert Schleip, Heike Jäger, and Werner Klingler, “What is ‘Fascia’? A Review of Different Nomenclatures,” Journal of Bodywork and Movement Therapies 16, no. 4 (August 2012): 496–502, https://doi.org/10.1016/j.jbmt.2012.08.001.

17. Luigi Stecco and Carla Stecco, Fascial Manipulation: Practical Part (Padova: Piccin, 2009).

18. Helene M. Langevin et al., “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain,” BMC Musculoskeletal Disorders 12, no. 1 (September 2011): 203, https://doi.org/10.1186/1471-2474-12-203.

19. Robert Schleip, Peter A. Huijing, Peter Hollander, and Thomas W. Findley, eds., Fascial Research II: Basic Science and Implications for Conventional and Complementary Health Care (Munich: Elsevier, 2009).

20. Thomas Myers, Anatomy Trains, 2nd ed. (Edinburgh: Churchill Livingstone, 2009).

21. Leon Chaitow, Fascial Dysfunction: Manual Therapy Approaches (Edinburgh: Handspring, 2014).

  Sasha Chaitow, PhD, is a professional artist, gallerist, and educator who exhibits and teaches internationally. With 20 years in teaching and over a decade in journalism and academic publishing, she is series editor for Elsevier’s Leon Chaitow Library of Bodywork and Movement Therapies. Based between the UK and Greece, she teaches research literacy and writing for the sciences at the University of Patras, Greece.