fdm-textbook_section2.pdf

S ECTION T WO

M EDICAL C ONCEPTS

Chapter 9

O RTHOPEDICS

Orthopedic treatments can be thought of as forms of fascial distortion techniques.

Examples: Reduction of a dislocation is a generalized folding technique, the surgical

repair of a ruptured quadriceps tendon includes pulling and untwisting the fibers

(triggerband technique), and carpal tunnel release surgery involves an incision of the

retinaculum (fracturing adhesions and cutting apart tangled cylinder coils).

When orthopedic injuries are consciously envisioned as fascial distortions, specific

modifications in orthopedic procedures can be made. For instance, in the reduction of a

dislocation, if the goal is to unfold the fascia, then the added finesse of doing so allows

for an easier reduction and minimizes pharmaceutical support. In the case of a quadriceps

rupture, if the residual distorted tendon fibers are intra-surgically straightened, post-

operative stiffness is reduced. Similarly, if carpal tunnel surgery were focused on

selectively untangling cylinder distortions and ironing out distorted fascial fibers, the

surgery itself would be less intrusive than it currently is and much more effective.

The success of any specific orthopedic intervention is, at least in part, contingent upon the

type of fascial distortion present. For instance, injecting a steroid into the gleno-humeral

joint of a frozen shoulder is only likely to be effective for a tectonic fixation. In the FDM,

the positive outcome from the drug itself is thought to be derived from the increased

volume and improved synovial fluid circulation which occurs as the added liquid is

physically pumped into the joint. Then over the next several hours or days, the now re-

circulating fluid slowly seeps between the fixated surfaces and changes the magnetic field,

which allows for capsular sliding. In the future, more specific drugs or solutions could be

developed which would be even more successful. 1 And perhaps the best treatment to

come will be drawing synovial fluid from another joint and injecting and pumping it back

and forth through the fixated joint.

In addition to volume enhancement, steroid injections (and oral steroid prescriptions) have

the physiological effect of chemically shifting the entire continuum of musculoskeletal

tissues so that osseous components are pulled from the bone into the attaching fascial

structures. The practicality of this approach can be seen in treating a specific condition

such as tendonitis. In the FDM, the underlying anatomical injuries associated with the

symptoms clinically diagnosed as tendonitis are triggerbands and continuum distortions.

1 Current viscosupplementation injectables include Hylan G-F 20 and Sodium Hyaluronate

In the case of triggerband tendonitis, the sensation of pain is due not only to the

mechanical shortening of the fibers, but also to the sensory changes secondary to altered

fluid transmission in the osseous-depleted portions of the fiber that are distal to the twist

( roadblock effect ). The subjective benefit of steroid treatment is that the shifting of

osseous components into the fascia floods and replenishes the ligamental fibers and

thereby eliminates one of the pain-generating mechanisms of the anatomical injury. In the

case of continuum tendonitis, the flood of osseous components through the transition zone

forces the entire zone into the osseous configuration. Having all of the areas of the zone

in one configuration balances the mechanical tension forces and thereby eliminates the

difference in sensory tension that is subjectively appreciated as pain.

However, as the physiological effects from the steroid diminish over time, the flow of

osseous components into the fascia from the bone slows and then reverses. In the

triggerband this means that areas distal to the twist once again experience deficiencies in

osseous components. In the case of tendonitis from a continuum distortion, the transition

zone slowly shifts back into the neutral state. The problem is that if the portion of the zone

stuck in the osseous configuration remains stuck, the continuum distortion seems to

reoccur. In either of these two scenarios, patients are likely to express the renewal of their

symptoms by saying “the shot wore off.”

Other desired effects and side effects of steroid therapy involve this same shifting process

of the continuum. The apparent increased muscular strength is derived from osseous

components stiffening myofascia and providing a firmer background for muscular

contractions. The ligaments, like the tendons, become less flexible and more brittle,

making them susceptible to tears between the fibers (i.e., forming triggerbands). The bone

itself becomes osteoporotic which increases the risk of unidirectional forces causing

compression and stress fractures.

Although steroids are the most common chemical therapy for manipulating the

musculoskeletal continuum, other non-drug approaches also exist. Examples of structural

continuum technique include surgery for lengthening long bones and orthodontic braces.

For many injuries, physicians prescribe non-steroidal anti-inflammatory drugs (NSAID’s)

to reduce inflammation (although they do so to a much lesser extent than steroids).

NSAID’s subjectively reduce pain by diminishing the overall amount of fascial fluid

seeping from distorted fascial tissues, such as mal-folded joint capsules. Therefore, they

give the most relief to patients with folding distortions, since of all the distortions these

disrupt the fascial fluid network the most.

To a lesser extent, triggerbands and continuum distortions also disrupt fascial fluid flow,

so NSAID’s have a minor value in treating these injuries. Herniated triggerpoints are

rarely associated with inflammation, so NSAID’s are generally not effective in reducing

the discomfort of these injuries. Cylinder distortions can at times cause inflammation by

blocking fascial fluid transport (particularly cylinder foot sprains), and therefore NSAID’s

are a possible adjunct therapy. Finally, since tectonic fixations do not cause inflammation,

NSAID’s have no direct effect on them.

Clinically, extensive folding distortions of extremities are appreciated by circumferential

joint swelling. For instance, in folding ankle sprains, bi-malleolar traumatic inflammation

is expected. The FDM explanation for swelling on both sides of the joint has to do with

the folding injury to the capsule or other peri-capsular folding tissues that stretch within,

along or around the joint. When a folding distortion occurs in these structures, fascial

fluid transportation is physically blocked in virtually every direction. Thus fluid flowing

through the capsule or similar structures is blockaded and pushed out of the fascia and into

either the joint space causing an effusion, or into the extracellular fluid resulting in

swelling. In either case, the accumulation of fluid around the mal-folded tissue then exerts

an additional pressure against the capsule or peri-capsular ligaments which further

restricts fascial fluid flow and which again results in increased spilling. In time this

vicious cycle fills either the entire joint or the surrounding soft tissues with fluid.

Aspiration to remove excess fluid without correction of the folding distortion is beneficial

but not curative.

F RACTURES

In the FDM, bone fractures are perceived to be extensions of fascial distortions into the

osseous matrix. Spiral fractures, for instance, follow the pathway of a single fascial

triggerband into the bone as it becomes a bony triggerband . Chip and avulsion fractures

result when the challenged transition zone is unable to shift quickly enough into its proper

protective configuration (osseous if the force is unidirectional and ligamentous if it is

multidirectional). And finally, comminuted fractures occur when a fascial or ligamental

triggerband is driven into a continuum distortion and the bony matrix is splintered — this

is analogous to a block of ice being shattered by an ice pick.

Manual treatment of fractures should include fascial distortion techniques. For instance,

patients with greenstick fractures point to a spot of pain with one finger (body language

indicative of a continuum distortion). Therefore, the FDM treatment is continuum

technique — firm pressure from the physician’s thumb directed onto the point of

maximum discomfort and held until release (i.e., shifting of stuck transition zone). The

expected subjective result of a successful treatment is complete elimination of pain and

immediate restoration of lost motion. (Note that a small residual soreness may still be

present for several days.) Since in this type of fracture (as in almost all fractures) the

continuum distortion is of the everted subtype, there is virtually no chance for recurrence

of symptoms. Secondary interventions such as application of ice, casting, or splinting are

generally not necessary but are options that the orthopedist may wish to consider on an

individual basis.

Stable fractures of the ankle also respond well to fascial distortion techniques. Again,

focus of treatment is directed by body language, which typically includes:

1. Sweeping fingers along linear pathway (triggerbands of medial or lateral ankle

pathway)

2. Pointing to spot(s) of pain along lateral or medial ankle (continuum distortions)

3. Gently wrapping fingers around proximal dorsal foot or ankle (folding distortion

of articular capsule of ankle)

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