Thursday, June 14, 2012

TCM meridians and fascia: what do they have to do with the internal arts?

This is a first for this blog, and I hope it’s not the last. Today I’m featuring a guest blogger, Trevor Aungthan. He is both a gifted student of multiple martial systems (internal and external) as well as a qualified and experienced physiotherapist who has worked with Cirque du Soleil and is the creator of an exciting new exercise program called "Circus Conditioning". In this article Trevor gives a fascinating and highly informative analysis of the meridians of traditional Chinese medicine, fascia and the internal arts. Enjoy!

If you've ever seen an acupuncturist, you may have heard what Traditional Chinese Medicine (TCM) practitioners call 'meridians' - these are the pathways that Qi (or Chi) flow through in our bodies. There are 14 meridians and along each meridian are Qi (or acupuncture) points where Qi can be manipulated to restore balance, via acupuncture needles or acupoint pressure. Much research has been done and is currently ongoing on the correlation between TCM meridians and our own fascial pathways. The fascial pathways are interconnected lines of fascia, or connective tissue, that run in various trains throughout our body (see Anatomy Trains for more details). Tai Chi quan and other Internal Martial Arts (IMA) are believed to help cultivate our Qi as a dynamic, flowing form of Qi gong.

So what is the link between these systems: the meridians and the fascial network and how does it relate to IMA practice?

Have a look at the following picture of the Superficial Back Line (SBL) - which is an interconnected fascial chain - from Anatomy Trains (Myers, 2nd Ed. 2009) juxtaposed with the bladder meridian.



Pretty close right?

Similarly, the other six Anatomy Trains correlate very closely with the other meridians i.e. Superficial Front Line = Stomach meridian and the Lateral Line = Gall Bladder.

One of the pioneers in research into TCM meridians and fascia is Helene Langevin, a Professor in Neurology from the University of Vermont. Langevin and her team found that most of the Qi points occur where fascia planes or networks converge. They showed that acupuncture points mostly lie along the fascia planes between muscles or between a muscle and tendon or bone. When an acupuncture needle pierces the skin, it penetrates through the dermis and subcutaneous tissue, then through deeper interstitial connective tissue. Langevin hypothesized that a Qi blockage can be viewed as an alteration in the composition of the fascia and that needling or acupressure may bring about cellular change in the fascia (Langevin & Yandow, 2002).

    Sun Xi Kun performing Bagua Single palm change from his book "Genuine Transmission of Bagua Quan"
For internal martial arts practitioners (Tai Chi, Bagua, Xingyi, Yiquan, etc) like us, what does this mean for our own practice? How can we manipulate our meridians and thereby the fascial system through movement?

We, probably more than anyone else, already use our fascial systems whenever we practice jibengong (foundational exercise) or via forms practice without many of us realizing it. At the base level, everytime we were told to fang song (relax) what was our laoshi or sifu really trying to tell us?

I know, personally, it was a difficult concept for me to comprehend - movement without muscular activation - or movement without a reliance on overt muscular activation.

If the muscles were not to work, how was I moving my body through space? How were my arms 'parting the horses mane' without my deltoids, pectoralis major and latissimus dorsi co-activating the movement required?

One word –
Fascia


Guimberteau

It was my fascial network all along that was driving the movement. Fascia has long been neglected as just the 'white packing stuff' around our muscles - anatomy labs around the world have been in competition as to who can clear out the fascia best so that the muscles are left pristine for examination and study. Looking at the video above by Dr Guimberteau which shows video of fascia in-vivo, in live fascial tissue, we can see the chaotic, fractal design of our fascial networks. In the last few years, there has been a paradigm shift in how we look at fascia and what it means for movement, health and dysfunction.

The traditional model of the human spine was based upon the post-and-beam model of a skyscraper (Schultz, 1983) and the soft tissues (muscles, fascia, tendons, etc) were always regarded as just curtain walls or stabilizing guy wires. If we assume our bodies as non-living organisms, this may hold weight but as biological structures we are mobile, flexible-hinged, low energy consuming, omni-directional structures that can function in a gravity-free environment (Levin, 1995). Skyscrapers are immobile, rigidly hinged, high energy consuming, vertically oriented structures that depend on gravity to hold them together. Similarly, the lever model we have previously used to explain muscles and joints in the body is flawed. See below.

A load of 200 kg, (not unusual for a trained weight lifter), located 40 cm from the fulcrum requires a muscle reaction force of 8 x 200 = 1600 kg. The erector spinae group can generate a force of about 200 to 400 kg, a force of only one quarter to one half of that necessary. Even a weight of 25 kg would put an average man at risk of tearing his back muscles. Muscle power alone cannot lift moderately heavy loads close to the body or light loads extending out from the body, such as a fish on the end of a rod. The calculated forces of these actions would rip muscles, break bones and severely deplete energy stores (Levin, 1995). The model nowadays agreed upon which most closely resembles our bodies' is based upon the tensegrity model, a type of truss system, which is omni-directional so that the tension elements always function in tension no matter the direction of applied force (Fuller, 1975).

A balloon is a great example of tensegrity; the skin of the balloon is the 'tension member' pulling in, the air is the 'compression member' pushing out; replace a series of rubber bands in lieu of the skin and dowels for the air in the balloon and you have a classic tensegrity structure (Myers, 2012). If we substitute bones for the dowels and our fascial and myofascial membranes for the rubber bands/skin, that is the fascial integrity of our body.

If we take a look at the drawing of 'spiral Qi lines' by Chen Xin taken from his book, Illustrated Explanations of Chen Family Taijiquan, what seem like random circular drawings around the body were possibly an early attempt to explain the concept of fascial integrity with what was familiar to Chen at the time - spiral Qi.

Another way to look at his drawings are a rather accurate 'force-map' for the major fascial connections in the body. A small excerpt from his book reveals his deep knowledge;
Coiling power (Chan Jin) is all over the body. Putting it most simply, there is coiling inward (Li Chan) and coiling outward (Wai Chan), which both appear once (one) moves. There is one (kind of coiling) when left hand is in front and right hand is behind; (or when) right hand is in front and left hand is behind....once Qi of the hand moves to the back of the foot, then big toe simultaneously closes with the hand and only at this moment (one can) step firmly...
It's amazing to think 100 years ago, Chen was already alluding to things we now know about integrated movement (connectivity of the big toe to the rest of the body) and kinetic awareness (left-right hand interplay). These things play a big part in the new sub-science of Fascial Fitness, or in other words, how to train our fascia to be resilient and elastic as to perform optimally and prevent injuries (Müller and Schleip, 2011).

So how do we as IMA practitioners, or more importantly, as human beings attain this Fascial Fitness? Müller and Schleip (2011) outline six guidelines to efficiently train our fascia.

(1) Preparatory counter-movement, or pre-stretch

Before performing any movement, there should be a slight pre-tensioning in the opposite direction. This is like drawing a bow to shoot an arrow, the pulling back action of the bow string is akin to the pre-tension on the fascia before movement i.e jumping, leaping. An example from the IMA is beng quan from xingyiquan: the loading into the rear foot pre-tensions the fascia in the lower leg which helps explode forward into the punch.


Hebei xingyi master, Dong Ziyi, performing beng quan

(2) The Ninja principle

Just as this sounds, this involves performing dynamic movements such as jumping, leaping and hopping as lightly, silently and smoothly as possible. Each movement should flow into the next and any extraneous and jerky movements should be avoided. The video of Swedish high-jumper Stefan Holm below is a perfect example, jumping around 1.70M (!) seemingly effortlessly. To IMA practitioners this should need no explanation - we should endeavour to do this each and every time we practice!


Stefan Holm

(3) Dynamic stretching

Two types: fast and slow. Contemporary research now suggests that fast, dynamic stretching is actually beneficial to the elastic architecture of the connective tissue when performed correctly (Decoster et al, 2005). Muscles and tissue should always be warm when performed and jerky and abrupt movements should be avoided. When combined with a preparatory countermovement, this type of stretching is found to be even more effective (Fukashiro et al, 2006). Rhythmical controlled bouncing at end range, when warm, is effective at this.

With slow dynamic stretching, the aim is to focus on engaging the longest possible myofascial chains (Myers, 2009) rather than isolated muscle groups. These should be multidirectional movements with slight changes in angle and direction i.e. sideways or spiral-type movements to have maximum effect on large areas of the myofascial web. An example of this might be performing a downward dog stretch with a right-to-left side emphasis, focusing on lengthening each posterior myofascial chain (i.e hamstring and calf) separately.

(4) Proprioceptive refinement

Current research indicates that the superfical fascial layers of the body are in fact more densely populated with mechanoreceptors than tissues situated more internally (Stecco et al, 2008). This goes away from the traditional thought that joints were the source of most of our proprioceptive capabilities - it is now believed that joints only provide joint feedback when at end of range movements and not during physiological motions (Lu et al, 1985).


Wu style taijiquan

To best stimulate fascia in this way, 'fascial refinement' training is recommended i.e. super-slow movements that may not be perceptible to an observer and also very quick macro-movements of the body. This concept will be familiar with IMA practitioners that do zhan zhuang training (standing post) or who perform their tai chi or other forms/partner work at super slow speeds as well as fast-form training.

(5) Hydration and renewal

The video at the beginning by Dr JC Guimberteau illustrates how important water and hydration is to our fascia. Our fascia is predominantly made up of both moving and bound water molecules that move in/out of fascial tissue like a sponge in the more stressed areas when stretching (Schleip & Klingler 2007). More fluid re-fills these areas when the stretch is released, coming from the surrounding tissue as well as the lymphatic and vascular networks - pain or dysfunction in areas is due to poor rehydration at neglected areas. With these types of specific exercises and through various therapies (myofascial, foam roller, etc) the aim is to refresh these neglected areas.
Interval training is also recommended over long, intense periods of exercise to allow adequate rehydration of the fascia.

(6) Sustainability

Fascial changes, unlike muscular adaptation, can take a long time and researchers advise 6 to 24 months before any significant changes may take place. This time-frame will not deter any serious IMA or yoga practitioner. Training needs to be persistent, regular and in small doses for collagen re-adaptation to occur.

By adapting some or all of the properties of Fascial Fitness into our existing training regime will certainly help towards us moving and feeling better. The evidence seems to acknowledge that TCM practices were very advanced considering they were developed approximately 2000 years ago. Many of today's top athletes have already incorporated these principles into their training and anecdotal evidence is promising. It's also interesting to note that the experts advise 6 to 24 months for these fascial changes to take effect, rather close to certain timelines to gaining some basic skills in the IMA. I’ll finish with a video of Yiquan master Wang Binkui which I believe portrays rather nicely the elasticity, fluidity and resilience we all strive for.


Wang Binkui Yiquan

Copyright © 2012 Trevor Aungthan

Further study

Chen X: Illustrated Explanations of Chen Family Taijiquan. Translated from Chinese by Jarek Szymanski; © J.Szymanski 1999-2002.
Decoster LC, Cleland J, Altieri C, Russell P (2005) “The effects of hamstring stretching on range of motion: a systematic literature review,” J Orthop Sports Phys Ther 35(6): 377-87.

Fukashiro S, Hay DC, Nagano A (2006) “Biomechanical behavior of muscle-tendon complex during dynamic human movements,” J Appl Biomech 22(2): 131-47.

Fuller RB: Synergetics. New York, McMillan Publishing Co, 1975, pp 372-420.
Guimberteau, JC: Strolling under the Skin DVD.

Langevin HM and JA Yandow: Relationship of acupuncture points to connective tissue planes. The Anatomical Record (New Anat.) 269:257–265, 2002.

Levin SM: Spine: State of the Art Reviews. Volume 9/Number 2, May 1995 ©Hanley and Belfus, Philadelphia. Editor, Thomas Dorman, MD.
Lu Y, Chen C, Kallakuri S, Patwardhan A, Cavanaugh JM (2005) “Neural response of cervical facet joint capsule to stretch: a study of whiplash pain mechanism,” Stapp Car Crash J 49: 49-65.

Müller DG and Schleip R (2011): Fascial Fitness: Fascia oriented training for bodywork and movement therapies. FF Yearbook.

Schleip R, Klingler W (2007) “Fascial strain hardening correlates with matrix hydration changes,” in: Findley TW, Schleip R (eds.) Fascia Research: Basic science and implications to conventional and complementary health care. Elsevier GmbH, Munich, p.51.

Schultz AB: Biomechanics of the spine. In Low back pain and industrial and social disablement. American Back Pain Association. Nelson L ed, Redesign, London, 1983.
Stecco C, Porzionato A, Lancerotto L, Stecco A, Macchi V, Day JA, De Caro R (2008) “Histological study of the deep fasciae of the limbs,” J Bodyw Mov Ther 12(3): 225-230.