Author Archives: mskrehab

About mskrehab

Hello, After recently returning to the UK after working overseas I have jumped on the bandwagon for blogging. Despite a huge number of rehabilitative blogs available, I feel I could still spam your news feed with how to better yourself as a human… After graduating in Sports Therapy & Rehabilitation, I moved to Melbourne, Aus for two years practicing in a musculoskeletal rehab clinic. Currently located in a unique London exercise and therapy clinic. Feel free to share, discuss and even disagree with whatever I am discussing here!

Foam Rolling your ITB won’t fix you…

One current craze in the health and fitness world is the use of a foam roller. Foam rollers are proven to hydrate tissue and improve flexibility without any detriment to power or skill. Most fitness enthusiasts know what a foam roller is and often use it during movement prep and muscle activation exercises. Some know the benefits of using one, however not many know that smashing your lio-tibial band (ITB) until your grimacing is actually a pointless task.


Over the past couple of years, many clients and friends have asked about foam rolling the ITB. My response usually involves asking them what they want to achieve by foam rolling which usually sounds something like “Pete at the office said it will loosen my ITB and stop my knee hurting”. Now, I have no problem with Pete and his suggestion, in fact it’s a great idea to help hydrate your myofascial tissue; but it won’t fix your knee and it won’t ‘loosen’ your ITB. 


In the game of chinese-whispers, foam rolling your ITB is probably the one which has gained most momentum over recent times. A gentle application of slow pressure onto quads, hamstrings and the ITB is recommended prior to and after exercises. For me and my clients, this gentle application is enough – there is no need to buy ‘The Beast’ foam roller (infact anything which claims to ‘deactivate trigger points’ should be questioned) I wouldn’t want to jab that into my quad to be honest. It’s going to be painful! From a sellers perspective, foam rollers are great. Cheap to make and easy to sell; hence the evolution of foam rolling becoming a do or die activity. It’s not long before hardware tools become marketed as ITB fixers!


Lets take three common pathologies that diagnose the ITB as the perpetrator:

Runners knee, ITB friction syndrome and lateral clicking hip syndrome


For these injuries, there’s a common treatment protocol in place from physical therapists – most will prescribe some soft tissue release work through the ITB, some heat and stretches and a little bit of a reduction in activity to allow for recovery. Then we see how we feel in 7-14 days. Most people will then have some great symptomatic relief and will be able to head out for a run again. However it is merely a band-aid solution treating only one part of the chain. The cause of your pain will be either above or below your ITB, lets discuss why:


The ITB is a fascial bridge connecting the hip and the knee, distributing stresses and movements. Establishing the anatomical connections that the ITB has is encouraged to assist in diagnosis, but often overlooked. The ITB is part of the tractus ilius tibias (TIT) which is a fascial band running from the top of the hip, laterally around the knee, and into the plantar fascia of the foot.


Deltoid of Farabeuf

A generic textbook definition of the ITB will describe the proximal attachment to the TFL and it’s distal insertion below the knee into fibula head. A functional description, allowing us to understand movement of the lower limb will mention the deltoid of farabeuf. If we look fascially at the ITB, the structure completely changes. DoF expands the current anatomical definition with more insertions and a greater influence upon gluteal muscles. The DoF suggests superficial fibres of the gluteus maximus and medius attach into the TFL and consequently into the proximal portion of the ITB. Now we can see that the function of the two gluteal muscles have a large influence on our ITB’s position and mechanical stress. This direct effect on ITB function is vital in rehabilitation and conditioning.



Below the ITB

Movement of the foot can affect the insertion of the ITB into the fibular head. Why? Well any movement from the distal end of the fibula creates movement at the proximal head (where the ITB inserts). Plantar and dorsi flexion of the ankle joint creates movement at the distal end of the fibula. Imagine we have limited dorsi flexion of the ankle joint (a very common problem) resulting in the distal head of the fibula ‘stuck’ posteriorly. Up the chain, our proximal distal head is pulled posteriorly placing the ITB in traction. All of our hard work foam rolling the painful ITB is not increasing the range of movement at our ‘stuck’ ankle joint.


Start your assessment and movement patterns above and below the ITB. Analysing your TIT (from your plantar fascia and tracking this up to the iliac crest of the glute medius) is essential. The ITB is only a symptomatic problem in the TIT. Look above and below the ITB, it’s a mechanical transfer device producing symptomatic pain.




“Brain of the upper lower limb”

A quick point to make is the structural difference of the ITB doesn’t make it a black sheep! It’s fascial, collagenous make-up helps position the rest of the quadriceps and hamstrings ensuring muscular balances are maintained. We also have 6 ‘quad’riceps but we’ll discuss that later on.


Remember, like many other muscles in the body it has a lot more attachments than we give it credit for!



1)   Look above and below the ITB when presenting with pain on the lateral leg

2)   Ensure a good range of dorsi-flexion at the ankle

3)   Poor gluteal function can lead to symptomatic ITB pain.






To Run, or to Lift… Should Endurance Athletes Exploit Strength Training Programmes?

By Josh Betteridge


With marathon season upon us, there is an inevitable increase in pedestrian traffic around us for the next few months. For all of you out there training for an event, aside from putting miles in the tank have you considered what else you can be doing? There is growing evidence suggesting more time spent in the conditioning suite can help prevent injury and to reach your running goals. I had my first run of the year a couple of days ago, running harder than I thought I would and without feeling too sore the following day. Was this a surprise to me? Nope! The training programme I have been following has allowed my body to become a stronger runner without a treadmill in sight. Today we are going to look at how cross-training your physiological systems have a profound effect on your ability to be citius, altius and fortius.


How should I be running?
Every so often, a runner asks whether they should train cross-fit, or implement a hypertrophic training programme, or even attempt to snatch their bodyweight. Before we get carried away with the new ‘lifting’ culture, the most important thing a runner should do is run. The most demanding part of your training should be running with a slight focus on strength training.


During my run I noticed a variety of gait cycles around me, some were likely to be a natural variation without the susceptibility to cause pathological problems and others probably a muscular imbalance creating a diversion of mechanical stress in certain structures.  In 2011, Patrick Makau broke the marathon world record with a time of 2.03:38. A textbook definition of his running style would indicate over-pronation of the foot, limited dorsiflexion of the ankle joint, valgus knee stress and weak gluteal muscles. This is most therapists’ favourite cocktail of pathological movement patterns to correct, using an array of rehabilitation techniques. But why would we bother correcting a world record holder’s running style? Why would we bother correcting anyone’s movement if they are pain-free and hitting their targets? The main point I am getting at here is there will be a huge variety of different running techniques from person to person, textbook definitions of how our body should move are non-applicable! If we are presenting with pain, then yes we need to assess and treat the body to disperse stresses equally. If we suspect loading patterns could be premeditating an injury, again, yes we should assess and treat. If you’re reaching your targets, there is no need to strip down the foundations of movement. If it isn’t broken, don’t fix it.


How does strength training improve my running?
The unfortunate association with strength training asks why we would train anaerobically when we are fully aware the aerobic energy system is utilized when running over a long period of time. Well, lets look at some common goals all runners want to achieve:


1) Increase Speed
Your goal as a runner is to increase the body’s ability to use oxygen efficiently. If we can train our body to use less oxygen at certain speed, the more we’ll have readily available if we want to run harder or for longer. Aagaard and Andersen (2011) concluded there was an enhancement in endurance capacity for short and long distance runners when combining strength and endurance training.  There was a particular increase in endurance performance, maximal muscle strength and muscle morphology. This is one of many studies to suggest a combination of strength and endurance training is beneficial. Taipale et al (2010), also suggested maximal or explosive strength training improves neuromuscular performance and VO2 max when training with endurance. 

It’s imperative to gain a higher percentage of muscle fibre contraction if you wish to increase your running speed. Neuromuscular activation and adaptations will occur in sync with the amount of stress you apply through specific myo-fascial tissue. When we jog, our muscle tissue does not require a large contraction of fibre to produce the movement because it doesn’t take a lot of muscle activation to move the body. The brain understands this and will complete the movement with as little energy expenditure as possible. It can pick and choose what to switch on and off depending on how strong connections are between brain and certain muscles. When we strength train however, we need a larger contraction to move. Our brain realizes it needs a higher proportion of muscle fibres and motor neurons to recruit when squatting, compared to running, to ensure you complete the movement. After consistent strength training, we now have an increased motor unit recruitment and synchronization, as well as increased force development in the muscle tissue. This is due to a simultaneous firing of more motor neurons and more muscle fibres applying an overload principle (Bawa, 2002). Picture a tug of war with only half of the people pulling – if we get the other guys to begin the pull as well, all of a sudden the strength is improved. Transferring this into your running – you’ll have a larger contraction of your muscles from strength training, simple!

2) I don’t want to get sore
There is a rational fear of strength training for many runners due to the association with muscle soreness and fatigue. Unfortunately, much of the literature surrounding strength training correctly discusses the need for recovery times and the expectation to feel DOMS up to 48 hours post-workout. Remember, we aren’t body builders, we are not expecting you to be slamming weights around and grunting. This stigma also enhances the belief that stretching and a big focus on recovery will boost their running more than strength training. Gee et al’s (2011) study proposed high-intensity strength training increases muscle soreness and decreased strength-based performance 24 hours post-exercise, however it did not reduce performance of aerobic, endurance-based activity. It is key to understand you will feel sore post-strength training, particularly in the early stages as your body adapts. In the long-term however, these adaptations are increasing neural activation and motor recruitment of your myo-fascial system allowing you to produce stronger contraction. Of course we still need to recover with stretching and rest days but they will only take you so far using them as a means of improving running.

Much of the available research is still debating the best type of strength training and when to apply it into our programme. My advice to you out there is to slowly integrate some steady strength training twice a week around your running. The gradual process of combining strength and endurance allows your body to adapt without the concern of injury or negatively affecting your running.


3) I want to prevent injury
Strength training with correct form will ultimately rid you of those niggling injuries and even chronic pain. It is so important to be strong to boost injury prevention (read thetigerbalmwarrior’s blog for more). Our bodies are full of myo-fascial imbalances determining which areas mechanical stress transfer through during movement. We are born with a blue-print of how to move, next time you see a toddler bending down to pick up something, I can guarantee you won’t be able to squat as deep! Over-time our repetitive movements and postures limit our movement ranges – altering our biomechanics. Undesirably, with repetitive running movements where stress is heavily increased, our body struggles to cope with the demand and suddenly that pain we didn’t have has developed into a tendinopathy, bursitis, muscle tear, etc. For those reading who have been clocked up a few mileage in their time will have heard of runners knee, ITBFS, plantar fasciitis, weak gluteals, medial tibial stress syndrome – the list goes on. I digress; the easiest way to eliminate these imbalances is to increase your neuromuscular activation of weak muscles (sound familiar?) to disperse the load equally through the body. How do we increase our neuromuscular and motor unit recruitment of muscle? Strength training. With more muscles recruiting, the stress is more equally distributed, just like our tug of war.

4) I don’t want to get bigger
Once again, the bodybuilding fear factor hit us and we are lead to believe we will gain heaps of muscle mass. Females in particular fear they will end up with big thighs and arms if they conduct a strength programme. This is untrue! Aagaard et al (2011) proved strength training to improve maximal force production without an increase of muscle mass and body weight.  Remember our strength-training programme will be minimalist compared to the endurance training. You will not be demanding a hypertrophic level of adaptation for your muscle. In fact, if we look at the biological processes we appreciate the opposite occurs; we can lose weight. Increased body fat slows down our metabolism due to the hormones produced, whilst more muscle and leaner tissue actually improves it. If you’re a runner who is struggling to shift a few pounds with running, the increase in heart rate with strength training compared to endurance training produces a harder output, thus more energy needed. You will have more fat (non-contractile) used as a fuel source whilst maintaining muscle (contractile) – If you’re lighter, you’re going to be faster!

Understanding our muscles breakdown during exercise and then rebuild post-workout is an important factor. During exercise, our body is working in a catabolic state which is the breakdown of tissue and afterwards an anabolic state which rebuilds our tissues. We don’t particular want muscular hypertrophy as a runner, just an increased neuromuscular adaptation to gain more power from our gait cycle. An increase in muscle mass can be detrimental as we are only fighting gravity and our own body weight when running. When we cross-train endurance and strength, we are contradicting the catabolic and anabolic processes in the body. What this means for the body is we are gaining leaner muscle tissue, converting muscles fibres to type I (more on this shortly) and reducing body fat. Crucially, we are preventing the high anabolic process of muscular hypertrophy. 

5) What type of strength training do I do?
The type of strength training will assist the converting of slow twitch muscle fibres (Type I) to fast twitch muscles fibres (Type IIa/IIb). Type II fibres produce speed and power, whereas type I are for endurance based activities. Increasing the proportion of type II allows you to sustain power and speed for a longer duration during exercise. The only way to convert these fibres is by training them in their adaptation zone, which is strength. There is plenty of research needed on fibre type, a recent course I attended suggested there are between five and seven variations of muscle fibre with varying roles. Unfortunately there are differing thoughts on how many of our fibres we can actually convert and the length of time it takes for this to happen. However, if you have rarely trained for strength consistently, you will find an immediate change in your power output as pretty much all of the research out there suggests! The adaptation process allows the fast-fatiguing, powerful type II fibres to become more fatigue-resistant and increase in concentration allowing you to rely on IIa and IIb opposed to purely the slow-twitch type I.


So, the type of strength training does not matter initially in my eyes – all have been proven to increase the proportion of faster-twitch fibres, increase neuromuscular hypertrophy and create a leaner body composition.


6) Can I get it wrong?
Using basic strength training principles it is simple to prevent yourself from getting it wrong. However there are common mistakes we make leading to pain or preventing us from improving our running. It’s essential to make sure we don’t over-train certain muscle groups. For example, most runners will have dominance through the quads and lower back where there will be a strong neuromuscular connection, plenty of sporadic collagen synthesis and plenty of fascial connections (refer to the last blog!). Because of this, the predictability of developing weak gluteal muscles, hamstrings and lower abdominals are quite likely.


Strength training should be varied! All exercise should be varied in fact (I’m sure cross-fitters have got something to say here). What’s important is to create activation of these weak areas – your glutes have probably never really functioned efficiently when running, your elongated hamstrings aren’t supporting mechanical stress and your achilles aren’t producing as much kinetic energy as they could be. We need to create a base-level of neuromuscular activation utilizing all three fibre types, producing a balanced muscular system to become energy efficient and a hell of a better runner! Once we have a base-level of strength, lets start chucking in some multi-planer, multi-dimensional power lifting exercises into the equation and you’ll soon find the myo-fascial connections between your toes all the way up to your spine will be a well-oiled machine.


Start off slow and integrate a few basic strength exercises into your programme, I have purposefully not included specific exercises – that’s a blog for another occasion. Pretty much all of the research available concludes any form of strength training will assist your running programme as long as there is a minimalist approach and correct movement patterns for your body are addressed!


A) Slowly integrate
B) You can only strength train so much before your running is compromise.
C) Build up towards multi-planer, varied, whole-body movement patterns.
D) Neuromuscular and motor unit recruitment is essential to address myo-fascial imbalances
E) You will not get bigger!!!
F) Utilizing three types of muscle fibre is better than one type.
G) Keep your energy systems guessing – variance is what keeps you strong!

(George Ashwell performing a KB clean, pout and jerk)

1) Aagaard, P. Andersen, JL. (2010) Effects of Strength Training on Endurance Capacity in Top-Level Endurance Athletes. Scandinavian Journal of Medicine & Science in Sports 2, 39-47.

2) Bawa, P.  (2002)  Neural control of motor output: Can training change it?  Exercise and Sport Science Reviews 2, 59-63.

3) Okada, T. Huxel, KC. Nesser, TW. (2011) Relationship Between Core Stability, Functional Movement and Performance. Journal of Strength and Conditioning Research 1, 252-61

4) Sato, K. Mokha, M (2009) Does Core Strength Training Influence Running Kinetics, Lower-Extremity Stability and 5000-M Performance in Runners? Journal of Strength and Conditioning Research 1, 133-40

5) Taipale, RS. Mikkola, J. Nummela, A. Vesterinen, V. Capostagno, B. Walker, S. Gitonga, D. Kraemer, WJ. Hakkinen, K.  (2010) Strength training in endurance runners.  International Journal of Sports Medicine 7, 468-76

6) Yamamoto, LM. Lopez, RM. Klau, JF. Casa, DJ. Kraemer, WJ. Maresh, CM. (2008) The Effects of Resistance Training on Endurance Distance Running Performance Among Highly Trained Runners: a systematic review. Journal of Strength and Conditiioning Research 6, 2036-44

Fascia, Keeping it Healthy (Pt 2)

By Josh Betteridge

Welcome back,


Hopefully we’ve absorbed a little bit about fascial structure and the importance of it for everyday function. Today we are going to discuss how we make our fascia healthy again and how to maintain its function.

There are many factors influencing fascial structure. Before we dive into that, lets recap some key points from part one:


1) Our fascial system is like a network of rivers, which transport mechanical stress throughout the body.
2) It’s essential for our river (ECM) to stay fresh and flowing
3) Fascia is innovated with lots of sensory detectors
4) A weak link in fascia can produce pain elsewhere due to large connections between muscles
5) Structural shape is guaranteed by a 3D tensional model, not compression or stacking.

Is my fascia ‘bad’?
There are many contributing factors that result in a structural change of fascia. Using our river analogy we can understand this in a much easier way, instead of talking to you about the role of glycosaminoglycans (If you want to impress someone, do a bit of research about GAGs).

If our river dries out, stops flowing, or the riverbank becomes weak; the transportation system is disrupted as much as the M25 in rush-hour. There is no FLOW!

The essentials to keep fascia flowing are:



Simple. The end…

A) Unfortunately, it’s not as simple as drinking water and thinking everything’s going to work itself out. The majority of us do not consume enough water daily for fascial rehydration. It can even take up to eight weeks for your hypothalamus to secrete antidiuretic hormone (ADH) efficiently once water intake has been increased. A general rule – drink water (and only water) until your urine is clear. Even if we are drinking enough water and produce sufficient ADH, our pathways are blocked. We’ll cover this later on.


B) Furthermore, increased viscosity of the ECM not only occurs from lack of hydration but through ‘bad’ movements, emotional stress and poor diet. ‘Bad’ movements range from sedentary positions (refer to our sitting down article for a recap) to over-exertion in the gym – we need to find the balance of ‘correct’, varied movements.

Lets review a bit of human biology. Successful repair of a muscle is a balance between collagen synthesis and progressive exercise. We have an abundance of cells called fibroblasts which blast collagen into areas of the body where we think we need it and usually they’re right. Fibroblasts sporadically lay collagen down in certain areas and we must exercise appropriately to realign the collagen (riverbank).


If we DO NOT help align the collagen, our rivers become stagnant and blocked. Imagine sticks building up in a river, slowly creating a damn. This is similar to a build up in the ECM through excess collagen.


I made note of the word ‘think’ because even when we are sedentary and seated for long periods of time, our bodies are in myofascial contraction – producing excess collagen, most notable in areas of shortening such as hip flexors and pec major.


On the other hand, if we exercise too much with lots of repetitive movements and high-load, cellular fibroblasts are going to be spraying collagen around like no tomorrow!


Remember your myofascial system will reinforce your daily patterns with increased collagen synthesis.


The photo on the right is our dehydrated, viscous, excess-collagenous, stagnant myofascial system we see in office workers right through to high-level athletes!


How to Hydrate your Myofascia


Drink plenty of pure filtered water, anything else containing water such as juices, coffee and fizzy drinks will not hydrate you! Alcohol inhibits the release of ADH meaning all water goes straight through the pipes and out the other end, so when a client questioned me believing they are ‘hydrated because of the clear urine after five beers’ I felt obliged to tell them otherwise….

As your body takes in water, it distributes it around the body with certain structures prioritising absorption over others. Take our river network and apply it into a 3D structure like a sponge. If our sponge and rivers are dried out it becomes very turgid and brittle with minimal ability to absorb forces without fraying or breaking. However, if we hydrate our network of rivers within our sponge, the pliability of our sponge increases. It is able to withstand torsion, squeezing and force! (NB: A compression model would not work in this way).

Dr Guy Voyer sums up pain in relation to myofascial restrictions: “Without water there is friction between structures. Where there’s friction; there’s fire”



Without movement, excess collagen will not be aligned and the pure water will not be distributed evenly through your fascial network. Fascial is a hydrodynamic tissue. Hydrodynamics is the study of liquids in motion and it’s the motion that is key to spread of hydration through tissue. Movement actually squeezes water out of our tissues (refer back to the sponge) and is then able to reabsorb fresher water (slowly removing stagnant water and replacing it with a more nutrient-dense form). Through movement, our stagnant rivers with dams are eliminated providing we have enough fluid in our system and we move correctly.


If our myofascia moves in only particular ways, such as isolated gym-based movement, we drive fluid out of some structures and into others, dehydrating certain parts of the myofascial chain. This predisposes us to higher levels of pain and injury.


Ideally, we want to produce full body movements using full myofascia links progressing to bouncing, springing and multiplanar movements such as:

Yoga, Kettlebells, Plyometrics and Olympic Lifting.

(NB. Stagnancy in myofascia leads to further chronic issues such as increased toxin levels, we’ll cover this at a later date)


I’m sure we’ve all had a sports massage at some point feeling pretty sore before, during and even after in some cases. There has been a huge increase in fascial release techniques which have greater benefits than generic sports massages. Before eating an orange, you’ll notice you roll it around in your hand and suddenly it’s easier to peel. When you’re rolling it around you’re breaking down small fascicles in the orange and allowing fluid to move around as well as increasing heat and pliability. Fascial release produces the same effect on the human body and our rivers of myofascia. Good fascial release should feel refreshing, deep and not too painful. You can even conduct this on your own using a foam roller and golf ball.

(NB: There are recent discussion’s suggesting fascial ‘release’ is not an applicable term due to high shear forces needed to ‘release’ fascia. Until more research is proven it’s a debate for another time)




The majority of us reading this will have some areas of discomfort and pain somewhere in the body, the good thing to know is its possible to create an entirely rehydrated fascial system over a few months with consistent movement and treatment if needed.


Drink well, move functionally and release! All three of these contribute hugely to reducing the viscosity of your ECM, providing a healthy environment for mechanical stress, and aligning strong, uniformed collagen.


Thomas Myers sums up the importance of our ECM:
“The ECM has evolved to distribute the stresses of movement and gravity while at the same time maintaining the shape of the different components of the body. It also provides the physico-chemical environments of the cells imbedded in it, forming a framework to which they adhere and on which they can move.”

So we’ve just been told that gravity, movement and chemical secretions influences ECM function. There’s no escaping those three things. Ever.









Buckminster-Fuller, R (1982) Synergetics: Explorations in the Geometry of Thinking (Macmillan)

Laycock, JF (2010) Perspectives on Vasopressin. Imperial College

Maffulli, N. Renstrom, P. Leadbetter, WB. (2005) Tendon Injuries. Springer

Myers, TW (2009) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone.

Schleip, R. (2012) Fascia: The Tensional Network of the Human Body. Elsevier.

Fascia – A Brief Introduction..

By Josh Betteridge


I’m sure everyone is thinking “Great, another article on how cool and amazing fascia is.” It’s so cool it’s uncool, the hipster of therapy and rehab.

The great debate today ranges from whether fascia has any relevance to our movement, to can we even produce enough force to make any changes to our fascial structure and even whether fascial restrictions influences pregnancy complications. Today we’re going to investigate a little further into the role fascia plays on our body…

What is Fascia?
Everything. Our whole body is one fascial system which surrounds our muscles like a big envelope. It surrounds your vital organs, assists your vertebrae with padding and has a thin cling film like layer around your bones.

Remember, three key points:

A) All of our structures are made from the same material
B) When we label and analyse structures (tendons, ligaments, etc) as individual, we disregard the connections between them.
C) Fascia is our biomechanical regulation system and not a series of parts like a machine.

To put this simply, we must analyse and rehabilitate the body as a functional being! The lack of quality research in the past using cadavers and dissection methods failed to recognise the importance fascia has on human movement resulting in those boring textbook definitions of muscle, nerve innervation, fibre type, next muscle, nerve innervation, fibre type, zzzzz… Unfortunately, this translates to a lot of professional practice, assessing injury to an isolated area. With fascia extending from our head to toe, we should be assessing the human body from head to toe regardless of where the injury site is.

Research over the years
In the 70’s, Harry Farfan proposed the idea that fascia was needed to transfer forces from muscle to muscle however it was questioned at the time. As Serge Gracovetsky discussed, it’s easy to say fascia transmits force between muscles, it’s harder to explain how (we’ll leave that for another day). Bartelink’s theory, despite the evidence proving otherwise, suggests muscles in the lower back are responsible for lifting. It came under scrutiny when his relationship between muscle strength and abdominal pressure to lift heavy loads was calculated to create a force so strong in an individual, an explosion would occur! After more research, It was from here the fascia in our lower back was understood to assist heavily in movements!

Thomas Myers has consistently argued fascia’s role in human function has a large influence on musculoskeletal aches and pains. If we were to view an individual’s skeletal system, we would be able to notice wider hips on females. If we viewed their muscular system, we’d probably be able to see whether the individual went to the gym or not. If we viewed their fascial system however, facial expression, organ location, posture, previous trauma are only a few of the many discrepancies we would be able to conclude. You would essentially be a recognisable 3D figure!

Following on from this, Robert Schleip’s research suggests the number of sensory nerve endings in fascia is up to 6 times(!) more than that of muscle proving it to be the most influential proprioceptive system in our body.

Today we have a better understanding of fascia and it’s is remarkable ability to process sensory and proprioceptive information!

A bit more boring science…
Sorry, one final important boring bit. The assumption our body is a stack of compressed bones (like brickwork in a building) must be disregarded to appreciate body movement. You’ve probably noticed skeletons in your classrooms/clinics are supported by wire. Unfortunately it’s pretty tricky to replicate a skeleton with a 3D fascial tensegrity model surrounding it. Picture the human body as a balloon, not a building. As the layers expand, stress is distributed evenly to support the growing structure. Where there is imbalance and weakness, the structure will fail (balloon bursts), a compression-based model will not expose this.

Structure of Fascia
What makes fascia quite fascia-nating (wahaaayyy!), is the collagen which makes it strong and the extra-cellular matrix (ECM) which creates the fluid-like consistency. Picture a fresh-water river with strong banks, our collagen is the river bank and the fresh-water is our ECM, providing a healthy environment for movement of life.

If our collagen isn’t aligned well and our fresh, flowing river becomes slow and stagnant = INJURY

Our fresh-water river can become stagnant, viscous and dry or it can maintain it’s flowing quality. If the former, how are we able to transmit forces appropriately through the body? Simply, we don’t. If our muscles cannot transmit forces between fascial connections to other parts of the body – injury occurs!

Healthy Fascia?
We’re probably all wondering this is all well and good but how do you maintain a healthy fascial system. Before we get onto that we need to tie all these points together:
A) Fascia connects everything to everything!
B) We have fascial connections from our head down to our toes.
C) Fascia assist heavily in transferring load when moving the body.
D) The ECM must be fluid and flowing to transfer load!
E) Tensegrity not compression!

Hopefully we have a little understanding about fascia’s role in human movement. Part two will discuss how we maintain a healthy fascial system!


(To see a network of fascial rivers, follow this link:

1. Schleip, R. et al. (2012) Fascia: The Tensional Network of the Human Body. Elsevier

2. Myers, TW. (2009) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Churchill Livingstone.

3. Gracovetsky, S. (2008) Is the lumbo-dorsal fascia necessary? Journal of Bodywork and Movement Therapies 12, 194-197.

4. Farfan, H. (1975) Muscular mechanism of the lumbar spine and the position of power and efficiency. Orthopedic Clinics of North America 6, 135–144.

Is sitting the new smoking?

By Josh Betteridge

Are you sitting comfortably? Great, we’ll get started. Most of us reading this will be either relaxing on the sofa, tucked into their work station or on the daily public transport commute. Lets dive a little further into why this can be causing you unsuspecting problems…
I’m sure we’ve all picked up on something in the media recently suggesting how sitting down for long periods of time increases your chances of disease and muscular pain? Fear not, there are a few key ways to assist you in preventing and curing such issues.
To begin, let’s rewind back to our ancestors 50,000 years ago who would run, walk and jump around all day keeping their musculoskeletal systems active and switched on. They would climb trees to hunt food and sprint after prey day after day using their body through full range of movements. Our bodies were designed for this sole reason! Compare this against the 21st century human who sit, inactive for long periods of the day whether it be at work, in the car or on the sofa.
Sitting is an activity which does not involve much energy expenditure (obviously). Thus, our bodies increase glucose levels in the blood and decrease the good cholesterols. This occurs because our body believes we are in a storage phase due to the low-level activity which ultimately makes us resistant to insulin. There are numerous studies being concluded with these findings and more empirical evidence is being produced too!
As soon as we sit down…
1. Our calorie burning reduces to 1 per minute
2. Enzymes which break down fat decrease by 90%
3. Electrical stimulation in our legs (essential for muscular contraction) switches off.
At this point most of us are now having a bit of a panic and get out for a run only to return 10 minutes later with potentially what feels like a torn calf or sciatica or a groin pull and so on….. and most importantly, a reason to discontinue exercise.
The reason why we feel this pain is due to the muscular imbalances which have derived from a poor postural foundation due to long periods of sitting. Once we decide to chuck the skins on and jog around Hyde park, our bodies are not balanced well enough to deal with the stresses which are placed on the muscular system. We are quite literally running before we can walk.
Jump up for a moment and stand up straight. Take your hand and feel one of your hip flexors (the muscles at the front which cross the hip joint). Don’t be shy to get stuck in a little bit – I’m sure you feel that ropey and tight muscular band? The tight muscle you are feeling is pulling your hips forward and creating this muscular imbalance.
This can be applied to many areas of the body. For example, if you press into where your pectorals insert in the front of the shoulder you’ll also feel plenty of tension.
With our hips constantly flexed and our arms always outstretched forward in a seated position, our brain recognises this as your ‘normal’ position. As our brain is a clever piece of equipment it remembers what we do day after day. So, to help us be really really good at sitting down, it tries to put our body in a nice seated posture producing very tight, overactive hip flexors and shoulder internal rotators.
What this means for the body when we exert ourselves is some muscles are working too hard and others are not working enough. 
All we need to do is restore balance and alter the load correctly through the musculoskeletal system! This simply results in pain-free exercise.
Get those hips and arms moving! We see many people with chronic pain due to long periods of sitting. With a few pro-active lifestyle changes you can prevent such problems:
1) Tissue Release
Targeting restricted myo-fascia reduces pain and increases range of movement to assist in reaffirming muscular balances and symmetry through your body.
2) Corrective Exercise
Once you have restored range of movement to a joint it’s imperative to build your body back up in a balanced, strong fashion to keep you fit and healthy for life even if you’re desk-bound!
3) Move!
Don’t email Claire downstairs about lunch. Get up from your seat, use the stairs and start activating those muscles more regularly. Get a few jumping jacks on the go or march on the spot. Activation of joints and muscles prevent them from becoming dominant, stiff and glued together.
4) Get off the sofa!
Those who sit for more than 3 hours a day watching TV are 64% more likely to die from heart disease. We sit down enough at work, don’t add to the problem away from the office.
5) Dynamic Stretching
Put your body into positions it’s not been for a long time. How many of you could squat down and get your ass to grass without falling over?
So, are you sitting comfortably?




After recently returning to the UK after two years working overseas I have jumped on the bandwagon for blogging. Despite a huge number of rehabilitative blogs available, I feel I could still spam your news feed with how to better yourself as a human…

After graduating in Sports Therapy & Rehabilitation, I moved to Melbourne, Aus for two years practicing in a musculoskeletal rehab clinic. Currently located in a unique London exercise and therapy clinic.

Feel free to share, discuss and even disagree with whatever I am discussing here!