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4 projects entered 3 positive feedback from outsourcers 2 positive feedback from colleagues
Translation Volume: 4 days Completed: Feb 2009 Languages: English to Spanish
7472 words proofreading of food industry texts
Food & Drink
positive Aberdeen Traductores: Very accurate translator.
Translation Volume: 0 days Completed: Feb 2009 Languages: English to Spanish
1293 words translation on Clinical Trials
Translation Volume: 2 pages Completed: Jan 2009 Languages: English to Spanish
Two pages translation of Body Psicotherapy Glossary
positive Bibiana Badenes: She has been very accurate , I do speak fluent English and has helped with the specific words and meaning
Translation Volume: 0 days Completed: May 2007 Languages: English to Spanish
Six pages translation of Research in Nursing Book
Medical: Health Care
positive Cristina Sánchez: No comment.
Teresa Miret: Me llamo Teresa Miret y tuve el placer de colaborar con Gemma en la traducción del libro Investigación en enfermería, como parte práctica del Postgrado en Traducción Médica que realizamos en la Universidad Jaume I de Castellón. Confío plenamente e Sol Hurtado: Yes, I confirm that I worked together with Gemma in this project and she proved to be a diligent and hard worker translator
English to Spanish: Fascinados por la fascia General field: Medical Detailed field: Medical (general)
Source text - English How do you explain the current surge of interest in fascia all over the world?
Well, fascia has been treated as the „cinderella tissue of orthopedic medicine“ during the last three decades. It has mostly been discarded as a mere passive packing organ for the underlying muscles; and medical students all over the world were instructed to start their anatomical dissections by carefully cleaning the fascia away in order to reveal „the more interesting structures“ below. That has definitely changed during the last few years. Scientists and practitioners are realizing now that fascia plays more substantial roles in musculoskeletal dynamics. New measurement tools like high resolution ultrasound as well novel histological examinations have contributed to that shift. Today we know that fascia is highly innervated, both with proprioceptive as well as nociceptive nerve endings; and that the bodywide fascial network can be considered as a sensory organ, as our most important organ for the sense of proprioception and for what movement therapists call embodiment.
A very powerful landmark for the new interest - or you could say renaissance in fascia research - has been the first Fascia Research Congress held at Harvard Medical School in 2007. I had the luck to belong to the initiators of that congress and we managed to get a substantial US government funding support for that congress, as we had the leading scientists from the different fields related to fascia at our hand, which were eager to exchange their new insights, and we could show that there are many new laboratory as well as clinical findings to support the fostering of a new research field. That congress received an unusually positive press coverage in the highly respected journal ‘Science’, and since then there has been an avalanche of scientific studies, further congresses, etc.
The situation can be compared with the sudden interest in glia cells in the field of neurology. For many decades scientists considered neuronal cells as the main actors in signal transmission, and considered glia cells to serve secondary background functions in support of the neuronal cells. However, about a decade ago scientists realized that glia cell are main players in neural dynamics, and since then there has been a lot of excitement in this field of research, with new conferences and journals only devoted to glia cells and their contribution to many fields of neural dynamics such as learning, memory, Parkinson’s disease, etc. The situation in the field of orthopaedics is very similar in respect to fascia: there is now a lot of excitement in this field and a lot of collaborative activities happening among clinicians and researchers all over the world. I see it a bit like the early years of the gold diggers rush. If you are a scientist, and you include fascia into your research studies, you have something like a 50% chance – which is exceptionally high compared with other fields - that you discover something new and meaningful. For example a recent sports medicine study from Denmark examined the tissue effects of exercise induced muscle pain, or what is called delayed onset soreness. In extension to their original study plan they decided to add an examination of the fascia into that study … and bingo, they then discovered to their surprise that the epimysium, i.e. the fascial envelope on the outside of the large muscles, plays a major role in the related muscle pain.
And that is just one of many examples.
Robert, I remember meeting you first in 1994. At that time you were an instructor of the Rolfing method of myofascial manipulation. However at some point later you seem to have shifted you prime attention into research. And today you are one of the leading fascia researchers internationally. Can you tell us, what motivated you to become a scientists, and how did that shift happen?
Yes I have been a Rolfing practitioner for now over 30 years, and have been an instructor of that method of fascial manipulation for many years. And I continue to be impressed by the profound changes in terms of posture as well as in movement orchestration and also in the autonomic nervous system balance, which can be evoked by that method. However, as an instructor I wanted to understand more the scientific basis behind this work and found out that only very few of the underlying assumptions had any scientific evidence based research basis behind it. However I found some of the clinically based concepts from Ida Rolf (original founder of the Rolfing method) as well as from A.T.Still, the founder of osteopathy, as very intriguing. When diving into the scientific literature on fascia, I found two independent studies which indicated a potential active contractility of fascial tissues; i.e. that fascial sheets may contain smooth muscle like cells, which enable these tissues to contract and relax independently from the regular muscle tonus regulation. That was very intriguing! After contacting several scientists and laboratories worldwide, I finally set out to cut my teaching and practice down to half, and to devote the rest of my life to a doctoral dissertation, in my case in the field of human biology, for something like 4-5 years.
To make a long story short: this was tremendously successful, as we found contractile cells, called myofibroblasts, in all human fasciae and we could also show in organ baths experiments, that fascia can indeed actively contract in a smooth muscle like manner, although much slower than skeletal muscles. This finding was honored with the Vladimir Janda Award of Musculoskeletal Medicine in 2006, and since then the momentum has been increasing. Today I am directing the Fascia Research Laboratory at Ulm university, in Germany, where we have the most advanced in vitro system for mechanographic examinations of fascial tissues. And besides our own staff, we have usually one or two international clinicians or researchers visiting us for a few months, to work with us and learn more about fascia themselves.
What are the main areas of your research now?
One of them is the examination of the links between sympathetic activity in the autonomic nervous system and fascial contractility. When I started out with my laboratory examinations, I strongly believed that there must be a close connection between the two. However, none of the sympathetic nervous system transmitters, adrenaline, noradrenaline or acetylcholine elicited any contractile effects our organ bath examinations. However, last year some important papers were published in the field of psychoneuroimmunology, that revealed that the sympathetic nervous system transmits its influence on the immunal function of the lymph nodes via a cytokine known as transforming growth factor, TGF-beta-1. If you block that particular cytokine, the sympathetic nervous system can no longer activate theT3 cells of the immune system, as it usually does under stressful situations. Now that same cytokine, TGF-beta-1, also has been known as the most potent stimulator for myofibroblast contractility and resultant tissue contractures. However, so far this has only been shown in cell cultures. So we are now doing these examinations with whole fascial tissue pieces in our organ baths, and the results so far have been encouraging. If verified, this would mean that there could indeed be a strong link between fascial tissue stiffness and long term sympathetic activation of the autonomic nervous system.
Another fascinating finding from cell culture studies is that myofibroblasts tend to orchestrate their cellular contractions, particularly when the tissue is at rest, into a common rhythm. This rhythm has been shown to be very slow, with an average period length of 100 seconds. Interestingly this may be related to the socalled ‘long tide rhythm’ (or breath of life) reported in the teachings of biodynamic craniosacral osteopathy …. or it could also be a mere coincidence. At this stage we don’t know. However, we are now examining our recordings for such superimposed rhythms, which is quite exciting as we have never done that before. Hopefully in a few months I can tell you more, whether fascial tissues as a whole, not just myofibroblasts in an artificial cell culture dish, tend to show such slow oscillatory rhythms.
Are there any other areas of research that you are aware of and which may be of interest for physiotherapists?
Yes, let me give you just two examples. First, at our histological examinations of different fascial tissues at Ulm University we recently became aware of an unusually high density of myofibroblasts within the perimysum, i.e. within the fascial layer that separates a bundle of muscle fibers from another bundle. I find this particularly interesting, since tonic muscles – which tend to stiffen in most of us – tend to have a thicker perimysium compared with phasic muscles, which constitute the ‘tender meat’ in nutritional meat science and which have a much thinner perimysium. If reconfirmed by future evaluations, this could support the concept, that the increased myofascial stiffness – or the high resting tone - of some tonic muscles like the upper trapezius or levator scapulae may be due to a myofibroblasts induced fibrosis of the intramuscular perimysial tissues.
The second example concerns low back pain. While the lumbar discs may in fact be pain generators in a minority of cases of acute low back pain, the question as to the origin of the pain creation is still unresolved for the remaining 80% of cases. However, recently it was shown that the lumbar fascia contains a very high density of free nerve endings which are substance P positive; i.e. which are potential nociceptors. It has also been shown, that when there is an inflammation in another tissue innervated by the same spinal segement, the dorsal horn neurons in the spinal horn react to the slightest stimulation of the nerve endings in the lumbar fascia with a nociceptive response. In addition, it has been shown that the posterior layer of the lumbar fascia tends to be thicker and shows less shearing motion during forward bending than in healthy controls. There are also surgical reports which demonstrate a high occurrence of tissue tearing and hernias within the lumbar fascia of people who are getting surgery for acute low back pain. This suggests that micro tearing, inflammation and sensitization of the posterior layer of the lumbar fascia could be a frequent source of low back pain. This has of course wide implications not only for rehabilitation but also for preventative medicine and also for the sports and exercise oriented practitioners which are aiming at injury prevention.
Being a Rolfing myself, I would be curious to hear how you are combining your clinical work as a Rolfer with your life as a researcher.
I have compressed my clinical practice as a Rolfing practitioner into two long days per week. so that I can then devote the rest of the week to the research work. I find this a mutually inspiring combination between clinical experience and laboratory work. As a Rolfing practitioner I know how hard and immobile fascia can get, and also how the tissue can become softer and more mobile with skilful myofascial manipulation. This is a daily experience that most of the laboratory researchers are lacking. On the other side there are also many aspects and new insights from the research world that have tremendously inspired and actually altered my clinical work as a Rolfer.
Can you tell us about your visit to Spain this December?
Of course. First there will be a replay event of the recent Fascia Research Congress, held at Amsterdam’s Free University. Here we will show and summarize the best presentations during that congress, as we have them recorded in excellent visual and auditory quality, and will summarize the clinical implications of these new insights for physiotherapists as well as other manual practitioners and movement therapists. Then you Bibiana are organizing a 2-day workshop on ‘Fascia as a sensory organ’ with particular focus on myofascial hands-on work around the thorax, with special attention to idiopathic scoliosis. This is something that I absolutely love doing, as it gives me a great chance to show how new scientific insights can be translated into clinical applications, and into a refinement of working techniques. I will cover each of the four fascial mechanoreceptors – Paccini, Golgi-, Ruffini- and free nerve endings – and show specific working styles for each of these receptors. And we will then apply that to practical applications for working with my favourite type of clients: people with idiopathic scoliosis. For many of them the muscular body does not give them a high stability, and the tensional patterns within the bodywide fascial network are fundamentally influential. However, in waking up their fascial mechanoreceptors and increasing their related proprioception can help them dramatically in achieving a better dynamic trunk stability and alignment in everyday life. I am sure, that many of the participants will then add something like ‘myofascial scoliosis treatments’ to their speciality menu as a practitioner; as it is a very rewarding field.
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