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Introduction to Fascial Distortion Model(FDM)Byron E. Perkins, DO

9/19/2016American College of Osteopathic Family PhysiciansOMED 2016Renew your Purpose, Renew your Passion:An Introduction to the Fascial Distortion ModelByron Perkins, DO, Medical Director, Cornerstone ClinicFDM Instructor, Past-President, American FDMAssociation (AFDMA)Anaheim, CASeptember 20, 2016 2016 All Rights ReservedFascial Distortion Model Anatomical perspective in which mostmusculoskeletal injuries and certain medicalconditions are envisioned as consisting of one ormore of six principal fascial distortion types each of which have signature clinicalpresentations.1

9/19/2016FounderSteve Typaldos, DO Founded and developed by StephenTypaldos, DO (UHS-COM 1986) in1991 until his untimely death in 2006 Published in AAO Journal 1994 and1995 4th edition Textbook published 2002FDM: Clinical and TheoreticalApplication of the Fascial DistortionModel Within the Practice ofMedicine and Surgery 2013 AFDMAIntroduction to the FascialDistortion Model Based on simple principles of personalexperience and observation Patients intuitively know what needs tohappen to feel better Patients communicate this throughconsistent verbal and body language This system of knowing and communicatingis inherent in the Fascia, and is universal.2

9/19/2016Fascial Distortion Model Anatomical perspective in which mostmusculoskeletal injuries and certain medicalconditions are envisioned as consisting of one ormore of six principal fascial distortion types each of which have signature clinicalpresentations.Fascial Distortion Model The Fascial Distortion Model is a patientcentered, symptom-based modality, useful todiagnose and treat painful musculoskeletaland other medical conditions. In this model, the patient becomes the“expert”, skilfully guiding the trainedphysician to the FDM diagnosis andtreatment.3

9/19/2016Fascial Distortion Model In the manipulative practice of the FDM,each injury is envisioned through the model,and the subjective complaints, bodylanguage, mechanism of injury, andobjective findings are woven together tocreate a meaningful diagnosis that haspractical applicationsFascial Distortion Model In the FDM approach, treatment is directedto the specific anatomical distortions of thecapsule, ligaments, and surrounding fascia,physically reversing them. When the fascial distortions are corrected,the anatomical injury no longer exists, thepatient can resume normal function and ispain free.4

9/19/2016Fascial Distortion Model This model allows for strikingly effectivemanipulative treatments for diverse, andoften difficult to treat conditions such aspulled muscles, sprains, fractures, frozenshoulders, and other soft tissue injuries. It is effective in the treatment of othermusculoskeletal and neurologic conditionswith heretofore limited treatment options.Results of Treatment in theFascial Distortion Model oducible5

9/19/2016Six Principal Types ofFascial Distortions TriggerbandHerniated TriggerpointContinuum DistortionFolding DistortionCylinder DistortionTectonic FixationFDM Approach to Diagnosis History and Mechanism of InjuryBody Language and Verbal AssociationsPhysical Exam-Before and AfterEstablish Treatment Goals-How will the Ptknow it is better, what will the patient beable to do without pain that they cannot dowithout pain before the treatment6

9/19/2016Definition of Body Language:“Kinesics” Body Language, or Kinesics, is the study of nonverbalcommunication Body Language is both a learned and instinctual process Some is hard wired (instinctual) and therefore the same(universal) in all humans The rest is variable (learned) depending on how andwhere a person was raised (cultural)How to Read Body Language, Sharon Livingston, PhD; Glenn Livingston, PhDPsy Tech Inc. 2004Body Language in the FDM Body Language in the FDM is postulated to beinstinctual and intuitive The majority of people exhibit body languageclues without being aware they are doing so Much of the behavior is either autonomic (hardwired and reflexive), or so highly conditioned thatit occurs without thinking. FDM Body Language is consistent & reliableacross cultures , and as such, is Universal7

9/19/2016Universal Body Language The concept of a Universal Body Languagefor pain is not new Universal sign of Myocardial Infarction Universal sign of Choking Universal signs of Stroke The study of Body Language and FacialExpression of emotion is well establishedPrimary Objectives for TodaysPresentation Gain basic understanding of the model as an anatomicperspective Develop working knowledge of the Six principal typesof Fascial Distortions Introduce nomenclature and terminology of the FDM Appreciate historical and international significance ofthe FDM Spark an interest to Renew your Passion and Renewyour Purpose8

9/19/2016Ultimate Goal Provide you with an amazingly powerful tool that canchange the way we practice medicine. Spark your interest to the point that you will want tobecome a part of the spread of the FDM throughoutthe USA and world.Videos Watch for body language Listen to description of pain Ask yourself which fascial distortions arepresent Think about what FDM techniques willlikely be most successful Carefully observe techniques used Duplicate techniques in practice session9

9/19/2016FDM Techniques In this program, you will be introduced tonumerous fascial distortion modeltechniques. However, please keep in mindtechniques that you are already familiarwith and contemplate the anatomical effectsof those modalities through the fascialdistortion model.Summary:What is the FDM? An anatomic model for envisioning, diagnosing andtreating mechanical soft tissue injuries, based on 6specific fascial distortions, each with their own signatureverbal and body language. The model allows for a better anatomic understanding of,and therefore predictability in, diagnosing and treatingpreviously difficult to treat (and often inadequatelytreated) soft tissue injuries. The model has practical applications in diagnosing andtreating other painful medical conditions.10

9/19/2016Questions?Six Principal Types of FascialDistortions Triggerband: Distorted banded fascial tissue (TB) Herniated Triggerpoint: abnormal protrusion of tissuethrough fascial plane (HTP) Continuum Distortion: Alteration of transition zonebetween ligament, tendon, other connective tissue andbone (CD) Folding Distortion: Three dimensional alteration offascial plane (FD) Cylinder Distortion: Overlapping of cylindrical fascialcoils (CyD) Tectonic Fixation: alteration in ability of fascialsurfaces to glide (TF)11

9/19/2016Triggerband Etiology - distorted fascial bands (twistedfascial fibers) Body language - sweeping motion withfingers along painful linear pathway Symptoms - burning, pulling, tight Tx - Triggerband Technique– use thumb to untwist the twisted fibers and ironout the wrinkled tissueTriggerband Technique Corrects distortedfascial bands byphysical force fromphysician’s thumb12

9/19/2016Herniated Triggerpoint Abnormal protrusionof tissue throughfascial planeHerniated Triggerpoint Etiology - protrusion of tissue through fascialplane Body language - pushes thumb, fingers, orknuckle into protruding tissue Symptoms - ache between neck & shoulder(SCHTP), aching pain in buttock (bull’s eye),flank aching/renal colic (flank HTP) Tx - Herniated Triggerpoint Therapy– push tissue back through fascial plane13

9/19/2016Herniated Triggerpoint Therapy Technique used tocorrect herniatedtriggerpoint in whichphysician’s thumbpushes protrudingtissue through fascialplaneSCHTP Supra-clavicular herniated triggerpoint Number One cause of loss of:– 1. Shoulder abduction– 2. Shoulder internal rotation– 3. Cervical rotation14

9/19/2016Continuum Distortion Alteration of transition zone betweenligament, tendon, or other fascia and boneContinuum Distortion Etiology - alteration of transition zonebetween bone and ligament or tendon Body language - points to spot of pain withone finger Symptoms - hurts in one or more spots Tx - Continuum Technique– apply force with thumb to force transition zoneto shift15

9/19/2016Continuum Technique Force is applied byphysician’s thumbdirectly into injuredtransition zone andheld until osseouscomponents are forcedto shiftFolding Distortion Three-dimensionalalteration of fascialplane16

9/19/2016Road Map Analogy FDM: Clinical andTheoretical Applicationof the Fascial DistortionModel Within thePractice of Medicineand Surgery4th edition Textbook 2002Folding Distortion17

9/19/2016Folding Distortion Etiology - three dimensional alteration offascial plane Body language - places hand over affectedjoint, or pushes fingers into intermuscularseptum or interosseous membrane Symptoms - aches deep in joint or injuredfolding fascia Tx - Folding TechniqueTwo Subtypes:Unfolding and Refolding Distortions Unfolding - Subtype of folding distortion inwhich folding fascia has unfolded contorted,and can’t refold completely Refolding - Subtype of folding distortion inwhich folding fascia is over-compressed andcan’t unfold completely18

9/19/2016Two Subtypes:Unfolding and Refolding Distortions Unfolding: pain worsened with compressionand lessened with traction– Tx: Modified traction with traction/thrust Inversion therapy for stubborn cases Refolding: pain worsened with traction andlessened with compression– Tx: Modified compression with compression/thrustFolding Technique Modified traction approach which isdesigned to unfold distorted folding fasciaand allow it to refold normally, or Modified compression approach whichrefolds distorted folding fascia and allows itto unfold normally19

9/19/2016Cylinder Distortion Tangling ofcylindrical coils offasciaCyD Slinky Toy Analogy20

9/19/2016Superficial FasciaCylinder Distortion Etiology - tangling of cylindrical coils of fascia Body language - repetitively squeezes affected bodypart, sweeping motion with palm over symptomaticarea Symptoms - often bizarre; patients have difficultypinpointing source of pain and pain jumps from onelocation to another; numbness or paresthesias Tx - Cylinder Technique– Thumbs, hands or suction cups are used to untanglecylindrical coils21

9/19/2016Double Thumb Cylinder Techinque FDM: Clinical andTheoretical Applicationof the Fascial DistortionModel Within thePractice of Medicine andSurgery4th edition Textbook 2002Tectonic Fixation Inability of fascialsurfaces to glide22

9/19/2016Tectonic Fixation Etiology - inability of fascial surface toglide Body language - stiff joint movement Symptoms – stiffness, “feels like it needs topop” Tx - Tectonic Technique– pump fluid through joint and force fixatedsurface to slideFacet Tectonic Fixations Most High Velocity-Low Amplitude(HVLA) treatments anatomically correctfacet tectonic fixations Thrusting chiropractic spinal manipulationalso treats facet tectonic fixations23

9/19/2016Slow Tectonic Pump of Shoulder Useful in treatment of so-called adhesivecapsulitis frozen shoulder These shoulders have thick synovial fluidthat can be pumped through the joint toimprove gliding motion Slow tectonic pump must be done slowlyQuestions?24

9/19/2016Side Effects of FDM Treatments Pain/discomfort during treatmentErythema of the skinBruisingHemorragic petechaeRebound tendernessSide Effects of FDM Treatment25

9/19/2016Side Effects of FDM TreatmentSide Effects of FDM Treatment26

9/19/2016Side Effects of FDM TreatmentRelative Contraindications* Infectious arthritisOpen woundsOsteomyelitisPhlebitisPoor doctor/patient rapportPregnancy (treatment ofabdomen and pelvis)Previous strokesSkin WoundsVascular diseases AneurysmsArteriosclerosisBleeding disordersCancer (with boneyMetastasis)CellulitisCollagen Vascular DiseaseEdemaHematomasInfections*Each physician should use his or her best judgment before employing these (or anyother) treatment modalities27