The Role of Fascia in Pilates 4 Parkinson’s Disease

by Cecilia Pulido

 

For the last nearly 20 years Pilates teachers have been inspired by the work of Thomas W. Myers, and others in the Fascia education realm, to make a shift from a traditional isolated muscle theory training approach, to a longitudinal anatomy training paradigm [13].  Fascia extends, pervades and wraps every component of anatomy, from large muscles to cells.  It is an interstitial substance that unifies the body in such a way that no thing is isolated from another within the human body.  It is an incredibly strong, tensional network permeating every surface and space and unifies it into a global network.  It is wholly unique in that as the structural architecture of the human body, it is mobile, fractal, irregular and adaptable [13].  Fascia comprises in large part, every system in the body and is a continuous multi-dimensional web of tissue extending to every inner surface of the body.

 

Due to its tensegrity, elasticity, ability to store energy, highly kinetic nature, and metamorphic-like behavior, fascia can facilitate or restrict movement in all forms within the body, from cells, to muscle spindles, organs, bones and more.  Fascia over time can reshape the musculoskeletal system, as well as influence the same directional movement in all adjacent structures to it.  We see this most prevalently in the case of Scoliosis and spinal asymmetries which are the result of, or result in fascial strains and adhesions [14]).  Wolf’s law regarding soft tissue, and Davis’s law regarding osseous structures demonstrate this phenomenon.  

 

With a general understanding of fascial tissue behavior, we examine the more common debilitating musculoskeletal occurrences due to the progression of Parkinson’s disease.  For example, stooped posture, cervical dystonia, misalignments leading to acceleration patterns of the head and pelvis during gait, forward flexion of the trunk, and other musculoskeletal disturbances in people with PD.  All of the above create misalignments of the musculoskeletal system, interfere with center of mass and center of gravity, and corrupt proximal stability.  Moreover, the above incongruent musculoskeletal length tension relationships will influence or will result in fascial deformities, which can eventually lead to ambulatory activity decline, create and or exacerbate motor symptoms, and overall diminish quality of life.

 

In a research study by Vucolova (2016), the hypothesis was introduced that “...the disruption of tensegrity equilibrium of mechanical forces and geometrical form can lead to changes of mechanical behaviour, known as cardinal motor symptoms: rigidity, bradykinesia and postural impairments.”  Vucolova proposed abnormal posture to be a driving force in the progression of motor symptoms in people with PD, and concluded after a year long study that by restoring tensegrity equilibrium and posture, motor functions improved [24].  

 

Parkinson’s disease may start in the brain but symptoms affect the whole body and movement in particular.  The exercise method must take a physically therapeutic approach in addressing posture imbalances, connective tissue, and muscle atrophy as well.  While other training modalities strive to keep a person with PD “moving’, in most cases the benefits of exercise programs like dance, boxing, Tai Chi, and Yoga to name a few, are overshadowed or curtailed by the pain and movement dysfunction that the person is experiencing (Timothy Agnew Clinic) Poor posture directly affects balance and thus postural dysfunctions are important to address initially upon exercise training. Further, diminished quality of movement and associated pain generally are the result of disturbances in fascial integrity.  

 

Since fascia is highly nociceptive (nerve receptors sense pain) and proprioceptive (nerve receptors that sense pressure), PD patients experience higher degrees of soft tissue hyperacuity (timothy agnews).  Fascia also has the ability to contract and relax.  It would thus seem prudent to take into consideration myofascial meridians when applying manual and physical therapies to people with Parkinson’s disease, and focus on movements which increase range of motion (ROM), while working to alleviate stress on the joints.  Pilates exercises encompass and elaborate this type of rehabilitative work.

 

Pilates principles of movement correlate with fascia-focused movement, and help to develop proprioceptive refinement and kinesthetic acuity [13].  Additionally, well trained Pilates teachers work to develop movement programs that take into account biotensegrity of the whole structure (the human body), as part of the underlying goal to enhance motor control and improve functional movement [13] in their clients.