Earlier this year, I spoke at length about fascia, pain, schisms, debates within our field, and much more with Robert Schleip, PhD, director of the Fascia Research Group at Ulm University and research director at the European Rolfing Association. In this second excerpt from our conversation (which has been lightly edited for clarity), Schleip talks about social media discussions around fascia and pain; the pitfalls of certainty in an uncertain world; and networking, humility, and sharing as ways forward.

Til Luchau: We’ve seen a lot of recent debate about the mechanisms that might explain the effects we see in manual therapy, and your work with fascia has in many ways been central to those discussions. In the first part of our conversation (see “Talking to Fascia— Changing the Brain, 20 Years Later: A Conversation with Robert Schleip” in Massage & Bodywork July/August 2020, page 80), you told me a story about how your research interests started with neurological explanations for the effects we see in bodywork. But maybe because of your visibility and identity as a fascial researcher, you sometimes end up being asked to defend or make the case for manual therapy’s tissue effects, generally by people arguing that the effects we see are more neurological than tissue-based. I’m just wondering if you see any irony in that?

Robert Schleip: Ah, you’re referring to the recent debate with the neurocentrists on Facebook and in social media.

TL: Sure, there’s an example. On Facebook recently, I posted the question, “When does the tissue matter?” You gave a very precise answer. You said, “Maybe in the case of Dupuytren’s contracture,” and gave a couple of other specific examples. Then, the post exploded with over 200 responses, with people debating back and forth.¹

RS: I think your question was great, Til, but it was interesting that most people said either that tissue never mattered or that it always mattered. And there was almost no constructive debate or discussion happening between the two groups. You warned me about that last time we met face to face—that in the United States there is almost a split around fascia and pain. In my impression, it is similar to the schism you have between Democrats and Republicans—if you belong to one group, you don’t have productive conversations with the other one.

So I started to ignore it, thinking, “These people are only using social media. The important scientific debates happen on different forums.” But that was the first time I think you managed to pull me into that kind of social media debate, and I was amazed how people were not so open to say, “It could be a multidimensional soft-tissue pain.” Most people said either “It’s only the nervous system” or “Tissue always matters.” There is a commonality that I suggested to the Rolfers 20 years ago: Maybe it is the nervous system that is included. And maybe we should be able to question our simple monocausal explanations and say, “Maybe it could be different. Maybe it could be more complex.”

TL: You were quite masterful in your ability to shift the debate from “Which of these two is it?” to underlying questions about certainty. You invited a point of view that says, “Well, could be. Maybe, maybe not. But what if we acknowledge that we actually don’t know?” The longing for certainty itself may be part of what is polarizing us.

RS: Yes. And many things in life are multicausal. You start with one thing, it triggers the next thing and the next thing, which then, as a consequence of the first one, becomes itself something that stabilizes the whole system. Often, it doesn’t matter how it started, which is often the case in self-regulating dynamic systems such as the human body.

I think we should be open to look at different factors. For example, the people in the neurocentric group also strongly believe, like me, that nociception and proprioception are very often in a mutually inhibiting relationship. So if the brain is in a protection mode, it drives the proprioceptive acuity for a related body region down, and vice versa. Now, if (as Helen Langevin and other colleagues have shown) chronic lower back pain goes along with an increased adhesion (or you could call it gluing together) between adjacent layers of the lumbar dorsal fascia (whether that’s a cause or an effect is another question), then it is quite likely that this increased adhesiveness is itself a factor that inhibits proprioception, because most of the proprioceptive nerve endings are in layers where you have relative shearing motion.

The Golgi receptors and the muscle spindles are embedded in a fascial tissue, whether you call it tendon, muscular septum, epimysium, perimysium, or endomysium. But if, for example, your lumbar dorsal fasciae glue together, you won’t have any movement there—no matter how much your brain is interested in picking it up. And then you could have a multicausal relationship. Your brain is in a protection mode that drives down your daily movement, and due to the lack of daily movement, your fascia glues together, and your proprioception goes down due to the gluing of the fascia. As research by Mense and colleagues has demonstrated, a decrease in regional proprioception will augment nociceptive sensitivity within the same region.

But then, maybe because of a new girlfriend or a new sport you try, it is possible that you may move out of the previous protection mode in your brain. But I suspect that even then your proprioception will be inhibited because of the fascial adhesion. Then, you will still be not able to replace the previous pain perception with a useful functional proprioception from your lower back. Based on this, I think we should work hand in hand with the people who work with the brain and the people who ask, “How is the local tissue behaving and feeding into that?”

A big interest now is to move beyond the field of passive manual therapies, where the client lies on the table and is asked to stay still while a bodyworker leans on their tissue without any active movement participation from the client. In many cases, it is more valuable to inspire our patients to move their bodies in a fascia-friendly manner in activities of daily living or during specific movement rituals, such as sport or dance or yoga, outside of our treatment rooms.

TL: Can you say what you mean by a fascia-friendly manner?

RS: For example, to move your hip joint in more than 90 degrees during an average day. When you stand and walk, you have approximately zero degrees in the hip joint i.e., neither flexed nor extended. Then, when you sit on the couch or in the car, you have 90 degrees of flexion and that’s all. You never go into full external rotation as in cross-legged sitting position on the floor or into full flexion like in a prayer position. Advise your clients to sit on the floor once in a while, or to swing a free leg while talking on the phone when standing, or pretend to kick somebody in a friendly manner, or to go into different meditation poses. I think that these activities are more fascia friendly. We know from animal experiments that chronic lack of movement tends to change the fascial architecture and make it stiffer and more fibrotic.

TL: Robert, what would you say are some ways your work has commonly been misunderstood?

RS: I don’t like the question so much. Maybe because I’m often surrounded by people who have something like this as a life script: “I have been deeply misunderstood.” It’s the story of the overlooked hero, and some people die with that life script. I have had very lucky experiences, in the last 10 years or so, in which I realized: If you become a better networker, people support you. That principle has become a driving aspect in my life.

If you wanted to choose the pathway of an unsung hero, saying, “I told you for 20 years, and nobody listened to me—I’m one of the biggest overlooked heroes in the history of bodywork,” that is (of course) something you can go to the grave with. That pathway is still a valid option for some. Our small fascia research group at Ulm University recently formulated the following slogan for ourselves: If you want to understand fascia as a networking organ, it works best if you work on your own personality—like on your information sharing or your communication style with your colleagues—such that you become a very good networker yourself.

In science, competition is often the name of the game. You don’t share your insights until the right moment because other people could steal them, and protection of intellectual properties is very important. In some ways, our group and many other fascia-inspired researchers are partly doing the opposite in the past five or 10 years. We tend to display all our valuables, all our jewels, and people can steal them—which will definitely happen—but the disadvantages are outweighed (at least 10 times) by the joy and exaltation of receiving so much support and inspiration from like-minded colleagues who feel motivated to give you something back in return.

If you want to understand fascia, if you want to become a good therapist or good scientist, then you don’t say, “I have the answer, and everybody else is an ignorant asshole.” You say, “I have a tiny contribution to make. What do you think? What can I learn from you?” People appreciate that. Therefore, I would reformulate your initial question for myself the other way: “Where have I misunderstood things in the past, and where am I learning to be a better networker in the present?”

TL: That’s fantastic. Thanks for the reframe.

RS: You’re doing that very well too, Til, in how you communicate within the bodywork field! Also, you’re doing this podcast with me. That’s a very nice learning thing for all involved, which I will copy from you in the future.

As a therapist, it is sometimes not so easy to stay humble because clients often favor full-of-themselves evangelical therapists who say, “My method works simply, and it always works. I know with complete certainty what’s wrong with you, and I’m sure I can fix it in three sessions.” If you say instead, “Honestly, I don’t know how your pain is created. I don’t know how my therapy works. It has been helpful in 78 percent of cases in similar situations so far, but I don’t know why I couldn’t help in the rest of them,” then these types of clients may not respect and admire you as much.

TL: Well, I’d say the same forces are true as an educator. The market encourages us to make big claims, and people respond to certainty and to dramatic claims. People don’t get as excited when the answer is, “Well, it’s actually pretty complicated. And we’re still learning.” But that’s the honest answer, and it actually opens up even more possibilities.

RS: Yeah. But maybe 10 years later it looks almost the opposite. My experience is that the majority of your long-term colleagues tend to respect you much more if you are humble in your claims, keep an open mind, and have had a curious attitude all along.

Note

1. Til Luchau, “When does the TISSUE matter, in manual therapy/massage/bodywork/SI etc? (& brain tissue doesn’t count:-),” Facebook post, January 2, 2020, www.facebook.com/til.luchau.profile/posts/10157832891968252.

Til Luchau is the author of the Advanced Myofascial Techniques books and training series, a Certified Advanced Rolfer, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the United States and abroad. He and Whitney Lowe host the Thinking Practitioner Podcast. Luchau invites questions or comments via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.