the fascial distortion model - American Osteopathic Association

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THE FASCIAL DISTORTION MODEL
(FDM)
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A NEW DIAGNOSTIC TOOL
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Presented by Gene Lenard, DO
ACONP 28 OCTOBER 2014
OMED - Seattle, Washington
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But First...
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I have no financial interest in any of the products
discussed or used in this course.
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I am the current President of the American FDM
Association, an AOA affiliate and CME sponsor.
AFDMA is a nonprofit group, currently all volunteers.
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Our primary mission is to train physicians and medical
students in the Fascial Distortion Model. !
AFDMA teaches FDM for AOA 1-A CME credit
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Why Am I Here?
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• Dr. Stephen Typaldos and the model he created and
refined had a significant and positive impact on my
life. I want to pass on the knowledge I received.
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• I enjoy using the FDM more than any other single
program, medical principle, or practice.
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• I have more fun because of the FDM, and I do
something good with my time.
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Stephen Typaldos, DO
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! The Fascial Distortion
Model was created
and developed by
Stephen Typaldos, DO
(UHS-COM 1986) in
1991 until his untimely
death in 2006
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! 4th edition Textbook
published 2002
FDM: Clinical and
Theoretical Application
of the Fascial
Distortion Model
Within the Practice of
Medicine and Surgery
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FDM Introduction: Goals
• Understand the Fascial Distortion Model as an
anatomic perspective
• Know there are six principal types of Fascial
Distortions
• Understand the terminology of the FDM
• Appreciate the “universal sign language of
pain,” an international language
• Recognize that the patient is the expert
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With FDM You Can Expect:
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• To learn and apply new information and techniques that
will help you do a better job for your patients
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• To find ways to put the excitement, fun, and satisfaction
back in your practice
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Why the Fascial Distortion
Model?
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• The FDM provides highly effective diagnostic and
treatment tools as well as improved outcomes.
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• The Fascial Distortion Model significantly improves our
ability to restore and preserve independence.
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The beauty of this model:
• Simplicity.
• The patient is the expert and indicates what
and where is the problem
• The FDM provides the diagnosis.
• The FDM provides a treatment plan
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You and the FDM
• discover that the FDM approach to patient
management will provide your patients with relief of
pain, improved function, and freedom from many
limitations, both acute and chronic.
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• know you will be able to provide immediate
improvement in someone’s condition.
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• succeed with FDM: have the ability to approach
many previously difficult problems with confidence.
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FDM: a new model
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Change may not be easy.
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Remember, confusion is a state of learning.
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To facilitate learning, think in the model.
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This request will be repeated as this is the key to
your success with the Fascial Distortion Model.
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FDM concepts will be repeated.
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Think in the model.
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Remember, once upon a time...
The earth was flat
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Man will never fly
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Someone challenged these beliefs, along came
new evidence, thinking changed, and we have a
new world.
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So, get ready
Empty your brains,
make room for new information!
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FASCIAL DISTORTION MODEL
Fascial - regarding connective tissue
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Distortion - damage, impairment
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Model - a concept, a theoretical construct
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FASCIAL DISTORTION MODEL
(FDM)
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• An anatomical perspective in which virtually
every musculoskeletal injury (and many medical
and neurological conditions as well) is
considered to be comprised of one or more of
six specific pathological alterations in the body’s
connective tissues.
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What else is the FDM?
• The model is a tool kit
- Tools for diagnosis
- Tools for treatment
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• You will find that prior OMM skills will apply, though you
may apply them in different and more selective ways.
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DIAGNOSIS
We only diagnose what we know
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DIAGNOSIS
Long, long ago, for many of us, EKGs and X-rays were
just lines and shadows
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Pattern recognition
Add history: 54 year old male “nothing wrong, my wife
made me come here, she is a worrier.
Diagnosis: wife has anxiety
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Add more history: chest pain to left arm, short of
breath, nausea, sweaty, weak, smoked for 34 years,
claudications, high blood pressure, high cholesterol, 2 siblings with Hx coronary bypass surgery
Diagnosis? something may be wrong with his heart 24
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Pattern recognition
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Add history: 20 Year old female with fever, and cough: Diagnosis pneumonia?
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Add: weight loss and cough for one month
Diagnosis tuberculosis?
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Pattern recognition
Each specialty has it’s own sets of patterns that are
“diagnostic” of certain conditions. !
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If clinical findings do not fit what we “know,” often it’s “all in their head.”
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People continue to die of “anxiety” not their chest pain. Which patterns were recognized?
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Diagnosis Using FDM
–In the manipulative practice of the FDM, each
injury is viewed through the model and the
following are woven together to create a
meaningful diagnosis that has practical
applications:
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»subjective complaints
»body language
»mechanism of injury
»objective findings
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BODY LANGUAGE
• The sign language of pain
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• You have seen this since birth
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• You use it each time you are injured
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• Each patient demonstrates this when asked,
“Where do you hurt?”
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SIGN LANGUAGE
• Humans the world over use the same hand
signals to indicate specific problems.
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Our patients show us specifically where they
hurt; the Fascial Distortion Model tells us why.
• Steve Typaldos DO created a model that
allows us to use the information our expert/
patient provides to us.
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Use Your Expert!
• Our patient is the expert in this sign language
of pain.
• We are the interpreters.
• The sign language is mostly hand signals
that our patient experts use to tell us where
they hurt and also the cause.
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FDM Treatment
• In the FDM approach, treatment is directed to specific
anatomical distortions of the capsule, ligaments, and
surrounding fascia. The treatment physically reverses
these distortions.
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• When the fascial distortions are corrected, the
anatomical injury no longer exists.
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• The patient can resume normal function and is pain free.
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What is Different?
• Orthopedic model: a sprained ankle is rested so
torn ligaments can heal.
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• FDM: the specific anatomical distortions of the
capsule, ligaments, or surrounding fascia are
physically reversed.
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• The anatomical injury no longer exists, and the
patient can walk and is pain free.
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• Typical interventions (RICE, NSAIDS, crutches) are
no longer relevant.
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Six Principal Types of Fascial Distortions
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• Triggerband
• Herniated Triggerpoint
• Continuum Distortion
• Folding Distortion
• Cylinder Distortion
• Tectonic Fixation
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Six Principal Types of
Fascial Distortions
• Triggerband: distorted banded fascial tissue
oriented in a linear array
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• Herniated Triggerpoint: abnormal protrusion
of tissue through a fascial plane
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• Continuum Distortion: alteration of connective
tissue (usually tendon or ligament) and bone
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Six Principal Types of
Fascial Distortions
• Folding Distortion: Three dimensional
alteration of a fascial plane
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• Cylinder Distortion: Overlapping of
cylindrical fascial coils
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• Tectonic Distortion: Alteration in ability of
fascial surfaces to glide
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Triggerband
• Distorted fascial band
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• think of iliotibial band
• pain along linear
pathway
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From: FDM, 4th ed, Typaldos, Stephen, DO
Zip Lock Analogy
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A tear or disruption of
the seal of the storage
bag effectively shortens
the distance between
each end. Were these
ends fixed, there would
be increased tension in
that material
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From: FDM, 4th ed, Typaldos, Stephen, DO
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Linear Deformity
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Triggerbands
• Etiology - fascial bands distorted by separation of
fascial fibers
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• Body language - sweeping motion with fingertips
along painful linear pathway
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• Verbal / symptoms - burning, pulling
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• Treatment - Triggerband Technique:
use thumb to realign the fascial fibers
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Herniated Triggerpoint
• Abnormal protrusion of
tissue through fascial
plane
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• Think of other hernias
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• reduce the hernia and
all may be well
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From: FDM, 4th ed, Typaldos, Stephen, DO
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Herniated Triggerpoint
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Herniated Triggerpoints
• Etiology - protrusion of tissue through fascial planes
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• Body language - pushes thumb, fingers or knuckles
into soft tissue
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• Verbal /Symptoms - aching pain
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• Treatment - Herniated Triggerpoint therapy: push
tissue back through fascial plane
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Continuum Distortion
• Alteration of transition zone between
ligament, tendon, or other fascia and bone
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From: FDM, 4th ed, Typaldos, Stephen, DO
Continuum Distortion
• Etiology - alteration of transition zone between bone
and ligament, tendon, or other fascial tissue
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• Body language - points with one finger to spot of
pain over bone
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• Verbal / Symptoms - may hurt in one or more spots
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• Treatment - Continuum Technique
–apply force with thumb to cause transition zone to
shift
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Continuum Technique
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• Force is applied by
physician’s thumb
directly into injured
transition zone and held
until osseous
components are forced
to shift
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From: FDM, 4th ed, Typaldos, Stephen, DO
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Continuum Distortion
• Alteration of transition zone between
ligament, tendon, or other fascia and bone
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From: FDM, 4th ed, Typaldos, Stephen, DO
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Folding Distortion
• In normal day-to-day activities, our soft tissues are
stretched and compressed repeatedly. Almost always,
they return to their normal configuration.
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• Occasionally, stretching or compressing induces an
injury that is static. The injury may be reversed either
through normal activities or with assistance.
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• Fascia arranged in a plane or sheet is subject to folding
distortions.
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Folding Distortions: 2 Types
• Unfolding distortion: injured by traction (Dog pulls on
leash, injures person’s shoulder)
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• Refolding distortion: injured by compression (person
trips, falls on outstretched arm, injures shoulder)
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Folding Distortions
• Example: the plane of fascia wrapped
around a knee joint is similar to a neoprene
support pulled over the knee; cut it
longitudinally and you have a sheet or plane. • In flexion, both the support and joint capsule
stretch; there is traction anteriorly; unfolding.
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• In flexion, the posterior support and capsule
are in compression, refolding.
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Folding Distortions
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Folding Distortions
• Unfolding -Traction injury: folding distortion in which
folding fascia has unfolded and can’t refold completely.
This tissue was over stretched. Dog pulls leash,
shoulder pain is from over stretch of fascia. Injured in
traction, treat with traction
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• Refolding - Compression injury: folding distortion in
which folding fascia is over-compressed and can’t
unfold completely. Trip and fall on outstretched arm,
shoulder pain due to fascia compressed in the fall.
Injured in compression, treat with compression
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• Recall the road map... unfolds easily; force it back
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together and it will develop “wrinkles”
Folding Distortions
• Etiology - three dimensional alteration of fascial plane
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• Body language - places (cups) hand over affected
joint. One finger across a joint usually indicates
“refolding” distortion
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• Verbal / Symptoms - aches deep in joint or injured
folding fascia
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• Treatment - Folding Techniques
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Unfolding Distortion
• fascial plane has unfolded (pulled too far), contorted
(torsion, asymmetric force), and can’t refold
completely.
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• The fascial plane had a deformity induced while in
traction, then relaxed with the distortion in place.
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• Body language: cups joint with hand
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• Treatment: apply traction and a thrust. The traction
force will “pull out” the deformity. The pain lessens with
traction. The body talks to us. Listen.
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• Injured with traction, treat with traction
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Unfolding Distortion
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Refolding Distortion
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Refolding Distortion
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Refolding Distortion
• fascia is compressed, deformed, and cannot unfold
completely. The fascial plane was distorted under
compression.
• Body language: cups joint with hand and/or one
finger across joint
• Treatment apply compression and thrust. The
compression force will “release” the deformity, allowing
the tissue to return to a normal configuration.
• Injured by compression, treat with compression
Think of a car emergency brake, the foot brake...
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Two Subtypes:
Unfolding and Refolding
• Unfolding:
Injured in traction
Treat with traction
................with traction/thrust
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• Refolding:
Injured in compression
Treat with compression
.......with compression/thrust
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Folding Techniques
• Unfolding: Apply traction to unfold distorted fascia and
allow it to refold normally
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• Refolding: Apply compression to refold distorted fascia
and allow it to unfold normally
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Cylinder Distortion
• Tangling of cylindrical
coils of fascia
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• Think of a “Slinky”
with overlapping coils
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From: FDM, 4th ed, Typaldos, Stephen, DO
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Cylinder Distortion
• Verbal / Symptoms - often bizarre; patients have
difficulty pinpointing source of pain and pain jumps
from one location to another; numbness or
paresthesias, may be noncontiguous areas, pain out of
proportion to our reality . Cannot be reproduced with
palpation (“It’s all in his head,” “malingering”). Non
jointed areas.
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Cylinder Distortion
• Etiology - tangling of cylindrical coils of fascia. Cylinder
distortions can be created by constricting splints and
wraps.
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• Body language - squeezes affected body part, or
sweeping motion with palm over symptomatic area
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• Treatment - Cylinder Technique
–Thumbs, hands, suction cups, combs, or clamps are
used to untangle cylindrical coils
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Tectonic Fixation
• Inability of fascial
surfaces to glide
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• Think of frozen shoulder
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From: FDM, 4th ed, Typaldos, Stephen, DO
Tectonic Fixation
• Etiology: Inability of fascial surfaces to glide. This may
be due to other injuries (distortions) limiting movement,
or physician induced (splint, cast).
• Body language: shoulder-anterior rotation with
abduction, low back-repeatedly twists torso, Hip-hands
on iliac crests
• Verbal / Symptoms: joints are stiff, like “a quart low on
oil”
• Treatment: First, correct all other fascial distortions.
Then, increase synovial fluid circulation (warm packs,
slow tectonic pump, plunger technique).
***This is the only place we use heat.
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Distortion Abbreviations
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• Triggerband TB
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• Herniated Triggerpoint HTP
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• Continuum Distortion CD
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Distortion Abbreviations
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• Folding Distortion FD
– UnFolding UnFD
– ReFolding ReFD
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• Cylinder Distortion CyD
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• Tectonic Fixation TF
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FDM: How Does It Help Us?
• This model allows for strikingly effective
manipulative treatments for diverse afflictions as
pulled muscles, fractures, frozen shoulders, and the
results are:
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• Objective
• Obvious
• Measurable
• Immediate
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How to use FDM:
• THINK
IN THE MODEL
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“Stay in the Model”
! Learning the model is best achieved if you try and
visualize what we are teaching as a complete
system describing the intricate movements of
Fascia, their distortions, and how to treat them.
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“Stay in the Model”
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! If you open your mind to the
model you will find that your
patients pain and their
description of that pain will
guide you towards
successful treatments.
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FIBROMYALGIA
in the
Fascial Distortion Model
• Multiple fascial distortions involving large areas of the body
with excessive fascial adhesion formation
• A assortment of thoracic fascial distortions
• TBs with adhesions make this chronic
• SCHTPs, paravertebral foldings, CDs, Tectonic fixations often
involved. Cylinder distortions may be a prominent and
confounding problem with bizarrre symptoms
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Fibromyalgia
• Pain in may “jump” to noncontigous areas
• Pain deep at times, no change with touch
• Limited motion due to “muscle pain”
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Fibromyalgia and Depression
• This is the chicken and the egg
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Fibromyalgia
and
FDM Treatment
• Identify the fascial distortions involved and correct them
one by one
• First, treat SCHTPs and Triggerbands, usually with adhesions
• Next, tectonic and folding distortions, followed by continuum
distortions if adequate progress has been made
• Finally, the cylinder distortions are treated.
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Fibromyalgia
• Currently, often considered a permanent condition
• The FDM provides tools that allow us to see fibromyalgia as
potentially correctable
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Other neurologic conditions I treat
with the FDM
• Post stroke • Carpal tunnel syndrome
• Reflex sympathetic dystrophy
• Headaches
• Foot drop • Sciatica and pseudo sciatica
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odds and ends
• The distortions exist where your patient/
expert says and indicates. • Heat is only used with tectonic fixations
• No heat 48 hours before/after treatment.
Hot tubs, baths, showers, packs need to be
body temperature
• Bruising may occur; ask about NSAIDs and
anticoagulants
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More odds and ends
• Short thumbnails are a must; file them
• Cylinders should be treated last • Brief Lightheadedness and confusion may
follow a treatment; monitor/hydrate them
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Even more...
• TB- indicated by fingertips in linear path
• CD- one fingertip to a point over bone
• HTP- multiple fingers, knuckles pushed in
soft tissue
• FD- hand cups joint = folding or unfolding
one finger across joint = ReFD
• CyD- palm and/or fingers rub over tissues
• TF- Back: Hands on hips, frozen joint
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Goals for Using the FDM in
Your Practice
• Think in the model with every patient
• Identify the anatomical significance of body
language
• Diagnose using the Fascial Distortion Model
• Treat with FDM techniques
• Communicate using FDM terminology
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Goals for this ACOFP-CA
Introduction to the FDM
• Understand the Fascial Distortion Model as an
anatomic perspective
• Know there are six principal types of Fascial
Distortions
• Understand the terminology of the FDM
• Appreciate the “universal sign language of
pain,” an international language
• Recognize that the patient is the expert
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