I am extremely excited to have Dr. Andreo Spina coming to Portland in March to present his Lower Extremity Functional Anatomic Palpation & Treatment Course. For registration information CLICK HERE (NOTE: Early Bird Discount ends January 1!). This is a course you wont want to miss and it isn’t often that Dr. Spina comes up to the Northwest.
I truly believe this is one of the best con ed courses out there for chiropractors, physical therapists, and massage therapists. You can read my review of the course HERE.
Despite Dr. Spina’s crazy schedule of traveling, teaching, studying, and, lets not forget, being a clinician, I was fortunate enough to snag a bit of his time so that we could do a short interview for the site discussing some of his thoughts on soft tissue treatment.
1) Thanks for taking the time out of your busy clinical and teaching schedule to do this interview, Dr. Spina. Can you please give the readers a short overview of your background??
I studied Kinesiology at McMaster University in Hamilton, Ontario, Canada. I later graduated with summa cum laude and clinic honors from the Canadian Memorial Chiropractic College as a Doctor of Chiropractic and subsequently completed the two-year post-graduate fellowship in sports sciences. During my time studying Chiropractic, I became the first pre-graduate student to tutor in the cadaver laboratory in the department of Human Anatomy, a position that continued throughout my post-graduate fellowship program.
Stemming from my passion of studying and teaching anatomy, in 2006 I created Functional Anatomic Palpation Systems (F.A.P.)™ which is a systematic approach to soft tissue assessment and palpation. Following the success of F.A.P. seminars, I later created a follow up system of soft tissue release and rehabilitation called Functional Range Release (F.R.)® technique which is now being utilized by manual practitioners around the world including the medical staffs of various professional sports organizations. I then combined the scientific knowledge gained during my studies with my 29 years of martial arts training in various disciplines to create the third installment of my curriculum, Functional Range Conditioning (FRC)™, which is a system of mobility conditioning and joint strengthening.
Aside from my work teaching seminars, I also own a sports centre in Toronto, Ontario where I practice and train clients. I am a published researcher, and I have authored chapters in various sports medicine textbooks.
2) You approach to soft tissue therapy is extremely comprehensive and, after having attending one of your courses before, it is obvious that you have spent a lot of time reading research in order to develop your thought processes and theories about what may be taking place when we apply contact to another person’s body. The fascial system is a big part of your approach and the concept of the fascial system and how the body is connected has gained a lot of popularity in recent years. Can you please explain your approach and this concept you refer to as “Bioflow Anatomy”?
To say that the Functional Range Release system has a sole focus on fascia is not entirely accurate actually, although it might have been in the not so distant past. Further examination of literature has led/forced me to be more inclusive of other tissues, which together constitute the most abundant type of tissue in the human body, namely Connective Tissue (CT). Examples of other tissues inclusive in CT other than fascia include bone, cartilage, tendons, ligaments, blood vessels, lymphatic tissues…and even 80% of nerve structure. When contemplating the effects of manual therapy ‘inputs,’ or even training inputs for that matter, we must be inclusive of all of these tissue types as each of them will equally adapt to applied inputs. To say that with a particular soft tissue technique application I am affecting one tissue vs. another is as inaccurate as claiming that any particular exercise targets a single tissue, which is in fact impossible. This line of thought stems from literature examining the effects of load inputs on cellular/subcellular processes…a topic that we dive into deeply in the FR Release curriculum.
There has indeed been an increased focus on the ‘body is connected’ concept mostly stemming from a renewed interest in fascia. This has led to the concept of myofascial slings/trains for example which speaks to the idea that tissues of the body blend into one another rather than existing/acting as independent structures. This concept has progressed our view of live anatomy immensely at a gross tissue level. However in my opinion it also contradicts its own premise. Namely, that all tissues are connected. If all tissues are indeed connected, then to distinguish specific lines in the body is to fall into the original trap of structure individualization.
I believe that the next ‘evolution’ of how we think about the anatomic continuum must occur not at the gross tissue level, but at the microscopic level, as this is where its true nature is observed. The fact of the matter is that all of the tissues listed above under the broader label of connective tissue represent a continuum whose boarders are difficult to delineate even with the help of a microscope. In other words, it is difficult, and unrealistic to distinctly separate these tissue forms as they simply represent changes in composition of identical elements – namely cells, fibers, and ground substance.
If I were to show you a magnified tissue slide of a tendon ‘inserting’ into a bone and asked you to draw a line distinguishing where the change occurs you would not be able to do so. You would simply be able to say that on one side of the slide the composition of cells, fibers, and ground substance looks more “tendon-like,” while on the other side it looks more “bone-like.” Thus the distinction between the two exists as a gradual progression/change in composition. In this light, ALL body tissues are not only connected…they are actually all different expressions of the same substances.
We get into much more detail in the FR curriculum regarding this topic as I feel that we must consider the affects of our assessments, treatments, and even training applications at a histological level, vs. the gross tissue level, which is the norm.
Getting back to your original question regarding BioFlow anatomy, it can be generally defined as a term used to describe, and conceptualize the extent of continuity found in human tissue at the microscopic level. Part of the FR curriculum is dedicated to creating a detailed understanding of how tissue exists in the living body. Specifically how tissues seemingly ‘flows’ from one form to another. This concept vastly alters not only ones perception of anatomy, but also their understanding of tissue assessment, treatment, rehabilitation, and training.
3) Your courses all start with a very comprehensive palpation class. I feel this is not only important but also incredibly helpful. A lot of therapists or clinicians say, “I don’t need to start with the palpation course. I already know how to palpation”. Can you please tell us why you feel the need to start there and why specific palpation is so important? I feel like your course does one of the best jobs in teaching this than any I have ever taken.?
It’s a common occurrence that some practitioners enter the seminars with the belief that the palpation portion will serve simply as a review, as it is there belief that their palpation skills are adequate. I enjoy seeing the ‘ah-ha’ moments when they realize that they are palpating many of the structures that they have been ‘treating’ for years…for the very first time. In fact, I had many, many of these moments during the creation of the palpation system that is taught at FR seminars – Functional Anatomic Palpation Systems.
In my opinion palpation forms the backbone of manual therapy practice…or at least it should. Although many of us are taught to rely on orthopedic testing, such tests can only provide general information regarding the location of an injury. The reason is that orthopedic tests are developed (and for that matter are only useful for) is for the localization and diagnosis of what I refer to as ‘macro’ tissue injury, which can be defined as damage on a gross tissue level. Examples of this type of injury include osseous fractures, overt muscle or ligament tears, neural tissue damage, etc. As manual therapists however, the majority of the cases that we deal with are ‘micro’ tissue injuries such as feelings of ‘tightness,’ poorly defined aches/pains, movement errors, etc. For such conditions, ‘macro’ tissue diagnostic procedures help very little in generating a useful manual medical diagnosis, and even less in guiding the creation of a subsequent manual therapeutic treatment plan.
As an example, tests confirming a diagnosis of “Sub-acromial impingement” only serve to inform us of the area of pain; namely the sub-acromial space. However this diagnosis can represent pathology in several different structures and can comprise of several different histological processes – Supraspinatus Insertional tendonopathy, Biceps tendonitis/opathy/osis/tenosynovitis, Internal impingement (Posterior superior Glenohumeral joint impingement), sub-acromial bursitis, etc., are all possible under this ‘umbrella’ diagnosis. While this diagnosis may be suitable for a medical doctor, for a manual therapist it is of very little use, as it does not allow us to select the appropriate treatment intervention(s). Say for example this diagnosis represents a bursitis and the therapist decides to try Graston for example. Being an inflammatory condition, this would lead to a worsening of symptoms. Or say the diagnosis represents a tendonosis of the Supraspinatus muscle and the therapist decides to apply ultrasound & ice. In this case the literature dictates that the selected treatments will have little to no effect.
The reality of manual practice is that aside from a good clinical history, which is by far the most important aspect of assessment, it is the palpatory findings that are ultimately used to both define pathologic tissue, and subsequently to guide decision making when selecting a treatment approach. This is a concept that I learned very early in my career by shadowing various manual medical practitioners. Following any and all diagnostic procedures, it always came down to the therapist actually palpating the area….and subsequently, during the application of manual care, it is ones ability to palpate that guides our decisions moment by moment.
In light of this, I always found it odd that so little effort was dedicated to perfecting the art of palpation, and as I began to teach practitioners of several disciplines all around the world I soon learned that this problem was not solely found in my profession, nor was it localized to North America.
With any skill, be it in sport, art, etc., the perfection of the skill cannot simply be obtained via brief introduction…it requires training. No martial artist has ever had confidence in using a technique in competition simply by observing it on a few occasions. They require hours and hours of mindful, repetitive practice before they can demonstrate proficiency. Contrary to how it is taught, I believe palpation requires the same dedicated practice. Thus, in Functional Range Release curriculum, a large percentage of time is dedicated to learning a systematic approach to the palpation of soft tissue structures.
This includes not only instruction regarding the localization of structure (which by it self is insufficient) but also in the interpretation of palpatory findings. When I confront a group of practitioners with the simple question of “what are we palpating for,” I am always surprised by the large variety of conflicting answers. I am even more surprised to hear that almost all of the offered answers represent on scientific ‘analogies.’ Some common examples include:
- “Knots” – which obviously do not occur in any literal sense.
- “Scar” tissue/“adhesions” – which simply represents disorganization of connective tissue amounting to fibers being laid down in the wrong direction…fibers which are nanometers in size and are thus un-palpable.
- “Rope-y-ness” – which is inevitable as all muscles are encased and are thus shaped like ropes.
- “Tightness” – This can refer to ‘mechanical’ tightness caused by an area of aberrant fibrosis…OR it can refer to ‘neruologically-induced” tightness/spasm. Thus it does not defined the pathology enough to decide on clinical interventions.
- “Range of motion” – which is generally not a good clinicical outcome measure as per the literature. Further, soft tissue application is not intended to induce permanent improvements to range of motion as that is generally known to require progressive stretching/strengthening procedures over a period of time.
- “Pain” – which can normally be found in various areas of everyone’s body during palpation.
- “Bumps” – which likely represent the small pockets of adipose tissue which sit in the sub-dermal fibrous scaffolding known as the fascia Superficialis.
- …and the most common, “I don’t know…but I know it when I feel it,” which can be loosely translated as “I don’t really know.”
If a practitioner cannot define what they are feeling for in any realistic, scientific manner, then what is the outcome measures guiding their treatment? By this I don’t mean the outcome measure used to define success in the eyes of patients such as pain or range of motion. I mean what is the tactile finding that, on a moment-by-moment basis, guidance the practitioners treatment? How does one know when soft tissue ‘release’ procedures are appropriate vs. passive modalities? How does one know the needed amplitude and direction of force to apply? How does one know when the treatment is over? These and many other questions require that the practitioner is able to palpably distinguish between normal and abnormal anatomic structure, and further that they have a working definition/understanding of what they are looking for.
Of course at this point I expect many readers to be thinking that they did indeed have instruction in palpation during their education…to them I encourage them to find a certified FR practitioner and ask them to describe the level of palpation specificity that was taught to them at the certification seminar….its far more powerful to hear it from them then from the person teaching the courses.
4) There are many systems of soft tissue release or fascial release out there. One question that always comes up is, “How is your course different than the others?” Can you please address that for the readers??
I think the best way to answer that question is to describe both why, and how I developed the FR Release system. When I was a student studying manual therapy, I made it a point to both exposed myself to, and understand the premise of as many approaches as I could. By doing so I soon realized the following:
- The development of most soft tissue treatment systems have historically been done in a trial and error fashion. Supporting scientific evidence was then sought out retrospectively to justify the various approaches. If none was to be found, it seldom led to any significant changes. Further, it would be commonly claimed that there is no literature available to guide manual care in an evidence-based manner.
- Many ‘new’ systems simply represented a re-packaging of older systems approach.
- None of the currently available systems gave any focus to either assessment, or rehabilitative procedures.
- Most systems, when given enough time, began to lag behind in terms of current scientific knowledge.
The development of the FR system came out of a desire to create an approach to soft tissue injury management OUT OF the most current scientific literature. As I read more and more I soon realized that there is indeed ample scientific knowledge available that can be used to develop a ‘best-approach’ to the management of soft tissue injury and/or dysfunction. The key was that I had to dive more deeply into topics seldom studied in the context of manual therapy such as cellular/sub-cellular biology, tissue morphogenesis, and cellular biophysics. In this literature one can learn of tissue responses to load application at the cellular level. Because the application of manual care at the base level is concerned with controlled load application (be it via externally applied load such as soft tissue ‘release’ procedures, or internal loading via rehabilitative procedures) a logical, evidence-guided approach can be made for both soft tissue treatment application and rehabilitative procedures utilizing this knowledge, which forms the basis for the FR Release system. I believe this to be a major way that the system sets itself apart from others. We not only take a logical, evidence-guided approach, but we insist that each participant be thoroughly exposed to these concepts. To do so we provide several mandatory online lectures, to be studied prior to the seminar that walk participants through the through process and supporting evidence for its creation and utilization. These lectures cover topics ranging from how to interpret palpatory findings, to BioFlow Anatomy (described earlier), to progressive tissue adaptation mechanisms.
Further, as is noted above, much of the seminar is dedicated to learning our specific system of soft tissue palpation and assessment. We are not concerned with simply teaching treatment “protocols.” Rather we teach a complete system of assessment, treatment, and rehabilitation, thus preparing participants to apply FR to any and all potential musculoskeletal diagnosis’. We are less concerned with changing what one thinks than we are with how one thinks.
5) You mentioned in your bio that various professional sports organizations medical teams have begun using the FR Release system. Can you tell us more about that?
Sure. Thus far we have certified the staffs of the Arizona Diamondbacks (MLB), and Houston Rockets (NBA). We also currently have seminars lined up with the staffs from the Chicago Cubs, Seattle Mariners, San Diego Padres, and the Philadelphia Phillies MLB teams. We are also working with the NCAA staff of Texas A&M University.
Our feedback thus far has been outstanding with regards to the effectiveness of the system on their players for injury treatment, rehabilitation, and prevention.
6) What would one expect if they choose to attend a certification seminar?
The FR curriculum is divided into 3 sections – Upper Limb, Lower Limb, & Spine. Each section consists of a 3-day practical seminar along with a significant preparatory online lecture component (9 lectures in total).
Each seminar begins with training in the Functional Anatomic Palpation Systems (FAP) for the body region. FAP is a systematic approach to soft tissue palpation and assessment looking to improve the practitioner’s ability to both locate tissue, as well as interpret their palpatory findings for assessment purposes.
Following that we teach the FR Release component, which includes manual treatment/release procedures as well as an original rehabilitative approach including the PAILs & RAILs systems (Progressive & Regressive Angular Isometric Loading).
Once successfully completed, participants receive certification for the particular body region (FR is a registered trademarked system). This automatically includes them in our websites find a provider function, and allows them access to our social media groups, as well as our members only online site where we are constantly providing new ideas, techniques, concepts, cases, etc, related to the FR system. This allows us to omit the need for “recertification’s.”
7) You also teach a mobility conditioning seminar called Functional Range Conditioning, or FRC. Perhaps you can give us a brief overview of that system?
FRC is a system of mobility training based in scientific principals and research. Mobility, defined as flexibility plus strength, refers to the amount of USABLE motion that one possesses across a particular articulation (joint). The more mobile a person is, the more they are able to maximize their movement potential safely, efficiently, and effectively. FRC Seminars teach participants, ranging from manual therapists, to personal trainers and strength and conditioning specialists, how to improve mobility in both their clients, as well as themselves. In the process, the system also builds articular strength and neurological control, which translates into injury prevention. More importantly, workshops explain the scientific basis behind this new and invaluable system. Participants come away not with a simple list of exercises, but a greater understanding of the musculoskeletal system, and the tools needed to implement FRC methodology in the training/ rehabilitation programs of patients, clients, or themselves.
8) Thank you for your time today, Dr. Spina. Can you please tell the readers where they can find more information about your courses as you have several coming to the United States in the upcoming months and through 2014, including one that we will be hosting in Portland.
For more information regarding seminars including dates and locations you can visit FunctionalAnatomySeminars.com. I am also one who shares lots of information on social media including a frequently updated blog – FunctionalAnatomyBLOG.com, Twitter feed – @DrAndreoSpina, and Facebook page – FunctionalAnatomySeminars.