School of Physical Education and Sports Science

Home , Endoneurium, Endosteum, Perichondrium, Synovial fluid

ARISTOTELIAN UNIVERSITY OF THESSALONIKI

Bachelor's Thesis:

"MYOFASCIAL NETWORK IN PHYSICAL ACTIVITY AND TRAINING"

Name: Tsourvakas Konstantinos

Supervisor: Papadopoulos Panagiotis PhD

Thessaloniki, June 2018

ABSTRACT

Physical activity can lead people, regardless of age, to a healthier and more quality life. Especially nowadays, that most people follow an intense routine, good physical condition is an essential factor to take care of in order to achieve health and well- being. This project refers to the myofascial system of the human body. It is about a scientific review whose purpose is to highlight the importance of self myofascial release (SMR), to quote the process of SMR through the use of specific tools and methods, and the analysis of its effects to the human body. In the first place, the fascial network of the human body is described, along with the properties, the function and the usefulness of the fascia. Subsequently, the assignment focuses on the significance of self myofascial release for the human body and mostly the way it increases and improves the range of motion. In addition, there is a presentation of SMR's techniques and methods with the application of tools such as foam rollers, roller massagers and tennis balls. The assignment ends up with conclusions and suggestions on further improvement of range of motion.

TABLE OF CONTENTS

Abstract……………………………………………………………………….………2 Table of Contents ………………………...... ………………………………………...3 1. Introduction...………………………………………………………………..……...4 2. The Fascial System………………………………………………..………………..5 2.1 Definition….…………………………………………………..…………………..5 2.2 Structure….……………………………………………………………..…………5 2.3 Function………………………………………………………………..…………22 3. Importance of training fascia …………….....……………………………………..27 3.1 Principles of training fascia...... 27 3.2 Fascia and elastic recoil...... 31 4. Fascia Training…………………………………………………………………….33 4.1 Effect of Yoga in fascia training………………..………………………………..33 4.2 Fascia and yoga training………………………………………………………….34 4.3 Fascia and functional training……………………………………………..……..39 4.4 Fascia and plyo training...... 42 5. The importance of Self Myofascial Release…………………….………………..46 5.1 Definition………………………………………………………………………...46 5.2 Utility……………………………………………………….……………………46 5.3 Benefits………………………………………………………………………….48 6. Tecniques and Methods of Self Myofascial Release……………………………..50 6.1 Foam roller………………………………………………………………………50 6.2 Tennis ball……………………………………………………………………….56 6.3 Roller massager……………………………………………….………………….60 7. Conclusion…………………………………………………..……………………..64 References……………………………………………………..……………………..65

1. INTRODUCTION

Due to new research results in the past few years, interest in the fascia of the human body has increased. Fascia is virtually inseparable from all structures in the body and acts to create continuity amongst tissues to enhance function and support. In the past fascia was difficult to be studied. As a result, ambiguities were aroused in terminology, which have only recently been addressed. The review of the available literature has lead in deep fascia investigation and the handling of issues related to terminology, descriptions and clinical relevance of fascia. The Fascia Research Society states, “Fascia is the most pervasive, but perhaps least understood network of the human body.” It is a fact, that until recently, the body was considered to be composed of, literally, skin and bones, which supported internal systems such as muscles, organs and the fluids that make up over 60% of the body. Nevertheless, there is also something that keeps all the water and fluid in the body from pooling down. Thomas W. Meyers, of Anatomy Trains, poses that “Individual muscles acting on bones across joints’ simply does not adequately explain human stability and movement.” The answer lies in fascia. Fascia has gone from being something insignificant to being the current biological phenomenon that is receiving great attention from body workers, athletes, medical professionals, alternative practitioners and researchers. In fact, fascia could be the answer to a lot of questions about structure, movement, stability, pain and healing.

2. THE FASCIAL SYSTEM

2.1 Definition Fascia is a web of connective tissue formed in bands that wraps around all the internal parts of the body from head to toe. It allows the muscles to move freely alongside other structures and reduces friction. It can be found immediately beneath the skin, around muscles, groups of muscles, bones, nerves, blood vessels, organs and cells. (“Understanding fascia: the bands that bind us”, August 3, (2016), link: https://deeprecovery.com/understanding-fascia/) Fascia is made up of fibrous connective tissue containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull, just like ligaments, aponeuroses, and tendons,. It is consequently flexible and able to resist great unidirectional tension forces until the wavy pattern of fibers has been straightened out by the pulling force. These collagen fibers are produced by fibroblasts located within the fascia. In other words, fascia is body’s connective tissue network, a biological fabric that binds cells all together in their proper placement.

2.2 Structure According to the layer, fascia can be classified as superficial fascia, deep fascia and visceral or parietal fascia. (https://en.wikipedia.org/wiki/Fascia) Superficial fascia Superficial fascia is the lower layer of the skin in nearly all of the regions of the body, which primarily determines body’s shape. It consists mainly of loose areolar, and fatty adipose connective tissue and it is also present on the face, over the upper portion of the sternocleidomastoid, at the nape of the neck, and overlying the breastbone. Apart from the face, superfascial fascia is found at many other locations where it fills otherwise unoccupied space. It surrounds organs and glands, neurovascular bundles, and it serves as a storage medium of fat and as a protective padding to cushion and insulate. HYPERLINK "https://en.wikipedia.org/wiki/Fascia" It is remarkable that after pregnancy and weight loss, the superficial fascia slowly reverts to its original level of tension. (https://en.wikipedia.org/wiki/Fascia)

Visceral fascia Visceral fascia (also called subserous fascia) suspends the organs within their cavities and covers them with layers of connective tissue membranes. Each of the organs is wrapped in a double layer of fascia; these layers are separated by a thin serous membrane. • The outer wall of the organ is known as the parietal layer • The skin of the organ is known as the visceral layer. The organs have specialized names for their visceral fasciae. For example, in the brain, they are known as meninges in the heart they are known as pericardia, in the lungs they are known as pleurae and in the abdomen they are known as peritonea. Visceral fascia is less extensible than superficial fascia. Due to its restraining role of the organs, it needs to maintain its tense. If it is too lax, it contributes to organ protrusion, whereas if it is hypertonic, it restricts proper organ motility.

Deep fascia Deep fascia is a layer of dense fibrous connective tissue which surrounds individual muscles, and also divide muscles’ groups into fascial sections. This fascia has a high density of elastin fibre that determines its extensibility or resilience. Deep fascia was originally considered to be essentially non vascular. However, more recent investigations confirmed a significant amount of thin blood vessels. Deep fascia is also supplied with sensory receptors.HYPERLINK "https://en.wikipedia.org/wiki/Fascia" Examples of deep fascia are fascia lata, fascia cruris, brachial fascia, plantar fascia, thoracolumbar fascia and Buck's fascia.HYPERLINK "https://en.wikipedia.org/wiki/Fascia"HYPERLINK "https://en.wikipedia.org/wiki/Fascia"HYPERLINK "https://en.wikipedia.org/wiki/Fascia" (https://en.wikipedia.org/wiki/Fascia)

Every region of the body has a wide range of different fascial types. The thigh is an example of a body region which contains all four fascial categories: Illiotibial band (Linking), perimysium of the quadriceps femoris muscle (Fascicular), fascia lata (Compression), and subcutaneous tissue (Separating).

I. Linking Fascia The linking category is predominantly dense connective tissue with the presence of collagen type I. This includes fasciae of muscles, fasciae of regions (head & neck, trunk, limbs), aponeuroses, tendinous arches and neurovascular sheaths. This category is subdivided into dynamic and passive divisions. The dynamic division includes major fascial groups more significantly related to movement and joint stability. It is composed of fasciae of muscles (investing layer, fascia of individual muscle), and fasciae of the trunk. The passive division is acted on by other extra muscular tissues to maintain continuity throughout the body or form pouches. The passive division incorporates fasciae of muscles (muscle sheaths), fasciae of the head and neck, fasciae of limbs, aponeuroses, tendinous arches, and retinaculae. The passive linking fasciae can only transmit force when they are stretched and loaded. On the other hand, dynamic fasciae can theoretically contract more autonomously like smooth muscle, thereby affecting tension in the musculoskeletal system, but not significant enough to be the primary mover of limbs.

II. Fascicular Fascia Fascicular fascia forms adaptable pouches which combine vessels as well as fascicles within muscle, tendon, bone and nerves. Fascicular fascia is very important in organization, transport and strength. This category is a mixture of both loose and dense regular multidirectional connective tissues. Fascicular fascia comprises three distinct layers: epimysium which surrounds whole muscles, perimysium which separates fascicles or bundles of muscle fibers within the muscle, and endomysium which covers the individual muscle fibers. This network of collagen fibers is an extensive matrix of pouches that connects and disperses force within muscle, provides intramuscular pathways and mechanical support for large and small nerves, blood vessels and lymphatics. The fascicular fascia of the muscle converges into a dense regular connective tissue link at the myotendinous junction to become fascicular fascia of the tendon. At this junction, fascicular fascia is richly innervated by Golgi tendon organs which are stimulated by muscle contraction. Tension in the tendon results in a reflex decrease of the tense tense in contiguous striated muscle fibers. Generally speaking, fascicular fasciae allows forces to be transferred throughout the muscles. (“Fascia: a morphological description and

7 classification system based on a literature review”, Myroslava Kumka, MD, PhD* and Jason Bonar, BScKin, DC, September 2012, Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/)

III. Compression Fascia Compression fascia is a mixture of dense regular woven and multidirectional parallel ordered connective tissue layers that cover whole limbs. This fascial category plays an important role in mobility and venous return due to its influence on sectional pressure, muscle contraction and force distribution. For example, the crural fascia consists of two or three layers of parallel ordered collagenous fiber bundles, each layer being separated by loose connective tissue. The orientation of the collagen fibers changes from layer to layer within the compression fascia. The presence of loose connective tissue inserted between adjacent layers permits local sliding, allowing the single layers to respond more effectively. Examples of this type of fascia are observed in the limbs as fascia lata, crural fascia, brachial fascia, and antebrachial fascia.

IV. Separating Fascia Separating fascia is generally both loose connective tissue and dense irregular fusocellular connective tissue. Separating fascia divides the body in visible sheets and layers of varying fibers allowing it to take up forces and friction in all directions. While its major function is to allow more efficient sliding of tissues over one another, it may still form adhesions from faulty movement patterns or injury. FICAT’s terms for separating fascia include: parietal fascia, visceral fascia, extraserosal fascia, investing/subcutaneous fascia, formerly known as fascia superficialis. The innervation of separating fascia serves primarily to sense distension and compression of tissues. More detailed histological analyses are necessary to reveal with certainty the fascial innervations of these deep layers. However, concentrations of Pacinian corpuscles (detecting deep pressure) and Ruffini’s corpuscles, which respond slowly to sustained pressure and tangential forces, are thought to be present in much of separating fascia, for example, in subcutaneous tissue. Deep sustained pressure may be necessary for manual practitioners to affect this fascial tissue.

(“Fascia: a morphological description and classification system based on a literature review”, Myroslava Kumka, MD, PhD* and Jason Bonar, BScKin, DC, September 2012, Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/)

Myofascial Lines

The superficial front line • Extensor Digitorum Longus and Brevis • Tibialis Anterior • Patellar Tendon • Quadriceps (including the Rectus Femoris) • Rectus Abdominis • Sternalis • Sternocleidomastoid

Figure 2.1 - The superficial front line

The superficial back line

• Flexor Digitorum Brevis • Gastrocnemius • Hamstrings • Sacrotuberous Ligament • Erector Spinae • Scalp Fascia

Figure 2.2 - The superficial back line

The lateral lines • Peroneus Longus and Brevis • Anterior Ligament of the Fibular Head • It-Band, TFL, Glute Max • Lateral Abdominal • External and Internal intercostals • Splenius Capitis and SCM

Figure 2.3 - The lateral lines

Back functional line • Latissimus Dorsi • Thoracolumbar Fascia • Gluteus Maximus • Vastus Lateralis • Subpatellar Tendon

Figure 2.4 - Back functional line

Front functional line • Lower Pectoralis Major • Lateral Rectus Abdominis and Abdominal Aponeurosis • Adductor Longus

Figure 2.5 - Front functional line

Spiral line Anterior view • Splenius capitus • Rhomboids • Serratus anterior • External oblique • Rectus sheath • Internal oblique • Tensor fascia latae • ITB • Tibialis anterior Posterior View • Peroneus longus • Biceps femoris S/L head • Sacrotuberous ligament • Spinal erectors

Figure 2.7 - Spiral line

Deep front line Lowest Common • Tibialis posterior • Long toe flexors • Posterior inter-muscular septum • Popliteus fascia Lower Posterior • Posterior intermuscular septum • Adductor magnus and minimus • Pelvic floor fascia, levator ani, obturator internus fascia Lower Anterior • Anterior inter-muscular septum • Adductor longus, adductor brevis • Pectineus • Psoas, iliacus Upper Posterior • Anterior longitudinal ligament • Longus colli • Longus capitis Upper Middle • Posterior diaphragm, central tendon • Pericardium • Scalene muscles Upper Anterior • Anterior diaphragm • Infrahyoid muscles • Suprahyoid muscles • Jaw muscles

Figure 2.8 - Deep front line

Deep Front Arm line • Clavipectoral fascia • Pectoralis minor • Coracobrachialis • Brachialis • Biceps brachii • Radial periosteum • Thenar muscles

Figure 2.9 - Deep Front Arm line

Superficial Front Arm Line • Pectoralis major • Latissimus dorsi • Medial inter-muscular septum • Flexor group • Carpal tunnel

Figure 2.10 - Superficial Front Arm Line

Deep Back Arm Line • Rhomboids and levator scapulae • Rotator cuff muscles • Triceps Brachii • Ulnar Periosteum • Ulnar collateral ligaments • Hypothenar muscles

Figure 2.11 - Deep Back Arm Line

Superficial back arm line • Trapezius • Deltoid • Lateral inter-muscular septum • Extensor group

Figure 2.12 - Superficial back arm line

2.3 Function

Fasciae are traditionally considered to be passive structures that transmit mechanical tension generated by muscular activities or external forces throughout the body. One of the most important functions of muscle fasciae is to reduce friction of muscular force. In order to do that, fasciae provide a supportive and movable wrapping for nerves and blood vessels as they pass through and between muscles. Fascial tissues are frequently innervated by sensory nerve endings which include myelinated as well as unmyelinated nerves. Based on this a proprioceptive, nociceptive as well as interceptive function of fascia has been postulated. Fascial tissues - particularly those with tendinous or aponeurotic properties - are also able to store and release kinetic energy and this is utilized in Fascia Training. (https://en.wikipedia.org/wiki/Fascia) The function of each fascial category with a number of examples is summarized in the table below.

Table 1

Fascial categories: function, terms, and histological features

Fascial Function (Examples) Terminologia Histologic category Terminologia Histologica al features Anatomica

Linkin Dynam • – role in Fasciae of Dense regular Collagen g ic movement muscles parallel types: I, and stability (investing ordered XII, XIV • – critical to layer)& fasciae unidirectional Actin- myofascial of individual connective myosin force muscles: tissue proper filaments transmission Pectoral fascia Pacinian • – creates Supraspinatus corpsules, significant fascia Free nerve pretension in Deltoid fascia endings musculature Fasciae of trunk: Thoracolumbar fascia Diaphragmatic fascia Iliopsoas fascia Fasciae of limbs/membroru m Iliotibial tract Axillary fascia

Passive • – maintains Fasciae of Dense regular Collagen continuity, muscles (muscle woven types: I, III, passive force sheath) connective XII, XIV transmission Rectus sheath tissue Elastin • – Head & Neck Multidirection Golgi propriocepti Cervical fascia al parallel tendon ve Carotid sheath ordered organs, communicati Ligamentum connective Pacinian & on nuchae tissue Ruffini’s throughout Ligamentum corpuscles the body flavum Fasciae of

Fascial Function (Examples) Terminologia Histologic category Terminologia Histologica al features Anatomica

limbs/membroru m Intermuscular septae Anterior talofibular ligament Aponeuroses Erector spinae aponeurosis Bicipital aponeurosis Plantar aponeurosis Tendinous arches Muscular & vascular spaces/lacunae Iliopectineal arch Tendinous arch of soleus

Fascicular • – provides Intramuscular & Loose Collagen myofascial extramuscular connective types: I, III, force fasciae. tissue IV, V, XII, transmission Neurovascular Dense regular XIV & sheaths multidirection Golgi propriocepti Endomysium al parallel tendon ve feedback Perimysium ordered organs for Epimysium connective movement Endotendon tissue control Peritendon Dense • – maintains Paratendon irregular protection Perichondrium connective for nerves Endosteum tissue and vessels Periosteum • – allows vascular Endoneurium sheaths to be Perineurium in continuity Epineurium with adventitia

Fascial Function (Examples) Terminologia Histologic category Terminologia Histologica al features Anatomica

Compression • – provides Fasciae of Dense regular Collagen stocking, limbs/membroru woven type I compression m connective Elastin and tension Brachial fascia tissue Ruffini’s compartment Antebrachial Multidirection corpuscles al effects fascia al parallel • – influences Dorsal fascia of ordered venous hand connective return Fascia lata tissue • – enhances Crural fascia propriocepti Dorsal fascia of on, muscular foot efficiency and coordination

Separating • – Parietal Fascia Loose Collagen compartment Parietal pleura connective types: III, alizes organs Fibrous tissue V, VII and body pericardium Dense Extracellul regions to Endothoracic irregular ar matrix: maintain fascia fusocellular reticular structural Parietal connective and elastic functions peritoneum tissue fibers • – promotes Endoabdominal Reticular sliding and fascia fibers reduces Endopelvic fascia provide a friction Visceral fascia cellular during Meninges framework motion Visceral pleura Elastin • – responds Serous Pacinian to stretch pericardium and and Visceral Ruffini’s distention peritoneum corpuscles • – provides Visceral physical abdominal fascia support and Visceral pelvic shock fascia absorption Extraserosal • – limits the spread of fascia infection Sternopericardial ligaments Bronchopericardi al membrane

Fascial Function (Examples) Terminologia Histologic category Terminologia Histologica al features Anatomica

Pulmonary ligaments Extraperitoneal fascia Investing fascia Subcutaneous tissue of abdomen Membranous layer of perineum

J Can Chiropr Assoc. 2012 Sep; 56(3): 179–191. PMC full text: Copyright/License ►Request permission to reuse

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/table/t1- jcca_v56_3_179_kumka/

3. Importance of fascia training

3.1 Principles of fascia training • Principle #1. Enhancing Fascial Elasticity is Essential to Systemic Resilience. Keeping the pliability of the fascia tissues is essential. no matter how you treat it, fascia will eventually lose its elasticity: In your eye's lens, for instance, the net stiffens in a very regular way, requiring you to use reading glasses at about age 50. However, you can delay the process in many ways. Follow these tips to keep the fascial tissues as pliant and flexible as possible over your life span.

TIP #1. Do Whole Body Stretching. If fascial planes aren't stretched or moved regularly, sticky adhesions will form between the fascial surfaces. That tightness you feel upon walking in the morning is the beggining states of this kind of fascial adhesion. Over time, if the adhesions are allowed to grow stronger, the will gradually inhibit your ranger of motion. To avoid this slow deterioration of functional health, engage in whole body stretching every day. Take a few minutes every morning to stretch like a cat from heat to toe. For best results, take up whole body movement forms like hatha yoga or tai chi, which systematically stretch all the fascia planes from many different directions and angles. Fascia stretches more slowly than muscles do. To make sure you stretch both muscles and fascia, hold gentle stretches for at least two to three minutes. Never push, if the stretch to feel too intense, ease off. When it comes to stretching the fascia, less is more. TIP #2. Stray Hydrated. The phenomenon we call "stretch" or lengthening is a function not of the collagen fibers in fascia lengthening, but of the fibers sliding along each other on the glue of large, water-absorbing proteins call glycoaminoglycans GAGs. Take the water out of the GAGs and the result is tissue that is mightily reluctant to stretch. The less fascia is hydrated, the less elastic response it has in it. Drink at least eight 8-ounce glasses of water a day. Caffeinated or sugar-filled beverages don't count.

TIP #3. Favor running, walking, bouncing movements. Connective tissue is much more elastic than previously thought. And the good news is than even when pliability is lost, fascial elasticity can be restored and returned very quickly. Fascial elasticity is a factor only when the motion is cyclic and quickly repeated, as in running walking or bouncing, but not as in bicycling, in which is repetitive cycle is far too slow to advantage of fascia's elastic properties. When you land on the ball of your foot, you decelerate and accelerate in such a way that you not only make use of but actually build elasticity into the tendons and entire fascial system. Measurements of calf lengthening during running have show that much of the length required for dorsiflexion is coming from an elastic stretch of the fascia, while the muscle is contracting. This contradicts our previous understanding that the tendon was no elastic, and that the muscles were lengthening and shortening during these cycle motions prior to the following football. The runners who train for the employ more of this elasticity will be using less muscle power (read: less glucose) during their runs, as they are storing energy in the stretch and the getting it back during the release. Thus, they will be able to run no longer with less fatique. TIP #4. Avoid Jerky Movements and Abrupt Changes of Direction. Imagine jumping rope but landing only on your heels. The stress on all your systems would be enormous, and the would not built elasticity in the fascial system. TIP #5. Go Slowly. Most injuries occur when connective tissue is stretched faster than it can respond. Encouraging greater fascial elasticity is a matter of putting a demand on the tissues to stretch more, but doing this slowly ( as compared with muscle training) is an essential attribute of fascial training. It may take 6-24 months to build fascial elasticity, so proceed with patience, and don't push overexert.

• PRINCIPLE #2. The Fascial System Needs Variation, Not repetition. The fascial system is better trained by a wide variety of vectors - in angle, tempo and load. Isolating muscles along one track (e.g., with an exercise machine) may be useful for those muscles but is less than useful for all the surroundings tissues. Loading the tissue one way all the time means it will be weaker when life-which is rarely repetitive-throws that part of the body a curve ball.

TIP #6. Engage in varied, Whole-Body Movements. The best way to training the fascial system is to engage is long myofascial chains and whole-body movements. Favor complex movements requiring constant adaptation, such as any form of dancing, balancing, tai chi, yoga, and the other types of activities that constantly challenge the body in new ways. If walking, favor uneven surfaces over smooth pavements to train whole body integration, coordination and adroitness. TIP #7. Avoid Repetitive Movement. Machines (or minds) that require you to work in the same line again and again do not build fascial resilience very well. Avoid repetitive movements and avoid always training in the same tempo. Similarly, vary challenge levels. Don't always training at near maximum capacity: Variable loads build different aspects of the fascial. Sticking with near-limit loads will strengthen some ligaments but weaken others. Varying the load is the better way.

• PRINCIPLE #3. Proprioception and kinesthesia Are Primarily Fascial, not Muscular. These are 10 times as many sensory receptors in your fascial tissues as there are in your muscles. So when your say you are feeling your muscles move, this is a bit of a misnomer. You are "listening" to your fascial tissues much more than your muscles.

Tip #8. Follow the pleasure Principle. The best training effect seems to follow the pleasure principle: Feel for the sense of elegance, an ideal resonance with minimum effort and maximum ease. This is one of the most important ways to enhace your proprioceptive abilities and attune yourself to the affects of your fitness activities in the fascial network. Taking attention-your own and your client's-away from the muscles and directing it into the surrounding fascial tissues can help prevent injury and make the skin the surface tissues is another great way to enhace fascial proprioception. Tip #9. Avoid Isolated Muscle Orientation. Exercing a single muscle or muscle group is nearly impossible; every exercise is stimulating multiple nerves, involving multiple muscles and employing fascial tissues all around the site of the effort, as well as "upstream" and "downstream" from it. Similarly, given that the ligaments are often tensed by the muscles, the emphasis on joint receptors-while important- need to be replaced with a more general attention to the whole area, from the skin on down. Tip #10. Take Some R&R. The fascial gets temporarily weaker and the comes back stronger after a heavy workout. Always alternate work-outs with periodic rest to allow for maximum integration and strengthening of the fascial network. Similarly, if you're all tensed up after a long day at the office desk, treat yourself to a 15-20 minute warm Epsom salt bath to relax not just your muscles, but entice tightened fascial tissues to loosen up.

3.2 Fascia and elastic recoil

The elastic recoil of fascial tissues is called “the catapult mechanism” (Kram and Dawson, 1998). In the catapult mechanism the tendons and the fascia of the legs are tensioned like elastic rubber bands. The release of this stored energy is what makes the amazing jumps possible. The possibility of high-resolution examination made it possible to discover that there are similarities in muscle and fascia between human movement and animal movement. Surprisingly, it has been found that the fasciae of humans have a similar kinetic storage capacity to that of kangaroos and gazelles (Sawicki et al., 2009). This is not only made use of when we jump or run but also with simple walking, as a significant part of the energy of the movement comes from the same springiness described above. This new discovery has led to an active revision of long-accepted principles in the field of movement science. In the past, it was assumed that in a muscular joint movement, the skeletal muscles involved shorten and this energy passes through passive tendons, which results in the movement of the joint. This classic form of energy transfer, according to recent measurements, exists in steady movements such as bicycling. In bicucling, the muscle fibres actively change in length, while the tendons and aponeuroses scarcely grow longer. The fascial elements remain quite passive. This is in contrast to oscillatory movement with an elastic spring quality, in which the length of the muscle fibres changes little. Here, the muscle fibres contract in an almost isometric fashion (they stiffen temporarily without any significant change of their length) while the fascial elements function in an elastic way with a movement similar to that of a swinging yoeyo. It is this lengthening and shortening of the fascial elements that mostly ‘produces’ the actual movement (Fukunaga et al., 2002; Kawakami et al., 2002). The elastic movement quality in young people is associated with a typical two- directional lattice arrangement of their fasciae, similar to a woman’s stocking (Staubesand et al., 1997). In contrast, as we grow up and usually lose the springiness in our gait, the fascial architecture takes on a more random and multidirectional fibre arrangement.

Table 1: Muscles and Fascia Properties Source: Article “Training Principles for fascial connective tissues: Scientific Foundation and suggested practical applications” Robert Schleip and Divo Gitta Muller, 2012 Link: http://www.fasciaresearch.de/Schleip_TrainingPrinciplesFascial.pdf

HYPERLINK "https://www.acefitness.org/education-and- resources/lifestyle/blog/5667/5-yoga-moves-for-myofascial-release- stretching"HYPERLINK "https://www.acefitness.org/education-and- resources/lifestyle/blog/5667/5-yoga-moves-for-myofascial-release-stretching"

4. Fascia Training

4.1 Effect of Yoga in Fascia Training The fascia system is responsible for the tensile strength that supports and holds the body. Nevertheless, when injury stress or trauma occurs, the fascia hardens and blocks oxygen and nutrient flow to the injured side. Yoga can traditionally be used to treat musculosceletal disorders in various populations because it is a form of exercise that includes deep breathing, awareness and lengthening of the skeletal muscle. In addition, yoga is implemented for therapeutic purposes including stress and pain management. In order to engage the fascia, this system must be lengthened. Especially when yoga is combined with deep breathing it provides stiff and sedentary bodies and also a healthy fascial system. (“5 Yoga Moves for Myofascial Release Stretching”, Elisabeth Kovar, 25/9/2015, Link: https://www.acefitness.org/education-and-resources/lifestyle/blog/5667/5-yoga- moves-for-myofascial-release-stretching) More specifically, yoga asanas lengthen various myofasical lines with a deep breath and in this way myofascial release stretching is achieved, which is a form of soft tissue therapy that releases pain and increases mobility. Yoga is an indirect form of myofascial release stretching that naturally lengthens the myofascial lines. It is important to mention that myofascial stretching works best when poses are held 90 to 120 seconds.

4.2 Fascia and Yoga Training

4.2.1 Superficial Back Line – Downward Facing Dog

The superficial back line (SBL) runs from the bottom of the toes, around the heels, up the backside of the body and terminates at the frontal ridge of the eyebrows. This pose keeps the body in a standing position and aims to extend the hip and spine and to flex the knee and ankle while moving. Downward-facing dog helps lengthen this line.

How to Perform: Assume an all-fours position, with the hands shoulder-width and the knees hip-distance apart. Curl the toes underneath and lift the hips into the air. Relax the heels, chest, head and jaw. Roll the shoulders away from the ears and press the palms flat into the mat.

Figure 4.2.1 - Downward facing dog

4.2.2 Superficial Front Line – Camel Pose

The superficial front line (SFL) includes both sides of the body and connects the tops of the feet to the skull. Muscles include anterior areas of the shins, quadriceps, rectus abdominus, sternal fascia and the sternocleidomastoideus muscle, as well as the skull’s galea aponeurotica. The pose runs in two sections from toes to pelvis and pelvis to head. The superficial front line in movement tend to flex the trunk and hips, knee extension and dorsiflexion. It also supports the skeletal regions that extend forward from the line of gravity including the ribcage, pelvis and head. Finally, the camel pose supports the lengthening between the quadriceps and the jawline.

How to Perform: Sit tall on the shins, which should be positioned hip-distance apart. Place the hands on the back of the pelvis. Imagine the thighbones moving forward first, and then the pelvis moving forward. Arch the back and lift the ribcage upward. If possible, reach the hands toward the calves or ankles. Roll the shoulders away from the ears and lift the chin upward, allowing the jaw and head to relax.

Figure 4.2.2 - Camel pose

4.2.3 Lateral Line – Extended Side Angle Pose

The lateral line (LL) travels up each side of the body from the medial and lateral midpoints of the foot, around the fibular malleolus, and up the lateral leg and trunk to the skull’s mastoid process. In movement, the lateral line creates lateral flexion and functions as a “brake” to lateral and rotational movements. Side-angle pose is a position that deeply lengthens the side of the body and leg.

How to Perform: Stand with feet 3.5 to 4 feet apart. Turn the right toes forward and kick the left heel out at a 45-degree angle. Lift the arms to shoulder height and bend the right knee to 90 degrees. Reach the right arm to the floor or a block, parallel to the shin. Reach the left arm forward, bringing the biceps above the ear.

Figure 4.2.3 - Extended Side Angle Pose

4.2.4 Superficial Arm Front Line – Seated Gate Pose

The superficial front arm line initiates at the sternum, clavicle and rib cage at the origins of the pectoralis major. It runs through the biceps groove, including the insertion point of the latissimus dorsi and medial biciptal groove. It connects through the medial intermuscular septum, along the humerus and carpel tunnel, and through the insertion of the palmar surface of the fingers.

How to Perform: Sit on the floor and extend both legs into a “V” position. Place the right foot into the left inner thigh. Slide the left arm along the left leg and anchor the hand on the calf or foot. Keep the chest forward and reach the right hand over the right shoulder. Slightly retract the scapulars and lift the chest slightly to feel a stretch from the chest to the palms.

Figure 4.2.4 - Seated gate pose

4.2.5 Spiral Line – Single-leg Revolved Belly Pose

The complex spiral line (SL) contains three cardinal lines. It loops around the trunk in a helix with another loop in the legs, from the hip to the arch and back again. This pose joins on the side of the skull, across the back’s midline to the opposite shoulder, across the anterior torso to the same side of the hip, knee and arch, and returns up the back to the head. The spiral line creates and facilitates spiral rotations and compensates for deeper rotations in the spine and pelvic core. The single-leg revolved belly pose increases the depth of a spinal twist while lengthening the lateral leg.

How to Perform: Lie face up on the ground and place the feet on the floor. Lower the knees to the left and extend the top (right) leg. With the left hand, reach for the knee or foot to hold. Position the right arm on the floor, level with the shoulder. Use a yoga strap to assist and deepen the pose, if desired.

Source: Article “5 Yoga Moves for Myofascial Release Stretching” Elisabeth Kovar, 25/9/2015 Link: https://www.acefitness.org/education-and-resources/lifestyle/blog/5667/5-yoga- moves-for-myofascial-release-stretching

Figure 4.2.5 - Single-leg revolved belly pose

4.3 Fascia and Functional Training

Functional Fascial Movement Training (FFMT) is different from traditional workout machines and time-consuming exercises which isolate a few muscles - working only specific parts of the body. With Functional Fascial Movement Training the whole body works within its natural range of motion. Oliver Schmidtlin, a leading expert on functional training, explains “Classic strength training is pure hardware training, functional training, however, works on the hardware and the software.” In FFMT muscles are considered to be “chains’ strengthened by complex, three- dimensional movements like lunges, squats, lateral moves, jumps and arm hangs - movements that you might encounter in your day. FFMT also works with fascia, the greatest network in our body, in other words the connective tissue. Fascia permeates the entire body as a network of fibers that provides a tensegral force from head to toe. A healthy tensegrity structure provides absorbtion of shock and compression as well as adaption to distribute movement, trauma and shock throughout the body. Fascia wraps and stabilizes muscles and organs and prevents friction between the muscles. Collagen and elastin fibers give fascia its shape and structure. Repetitive motion, overuse and injury cause the fibers to become disorganized and this prevents the muscles from gliding smoothly, causing pain and immobility. FFMT can be intense but also fun and studies have shown that it’s more effective than traditional types of exercise like running and aerobics.

Source: Article “Functional Fascial Movement Training – What Is It And Why You Need It” Nicole Detellis, August 15, 2016 Link: http://fuseyogafitness.com/blog/2016/8/15/f0x3uo9gznwija5mabbxj3qmenmb7i

Figure 4.3.1 - Medicine ball throw to front lunge (https://gr.pinterest.com/pin/280067670554748570/?lp=true)

Figure 4.3.2 - Medicine Ball rotation throw (http://www.stackspt.com/blog/2015/06/18/medicine-ball-training-for-throwers/)

Figure 4.3.3 - Standing medicine ball throw (http://arrigohf.wikispaces.com/COMPONENTS+OF+FITNESS)

4.4 Plyo Training and Fascia Plyometrics are exercises based on the fact that muscles exert maximum force in as short a time as possible, with the goal of increasing both speed and power. They focus on moving from a muscle extension to a contraction in a rapid or “explosive” way. Some examples of plyometrics include squat jumps, lunge jumps, clap push-ups, burpees. (http://pacificwavejiujitsu.com/blog/how-fascial-fitness-can-improve- physical-performance/) Plyometric exercise uses the stretch shortening cycle in order to generate more force in a shorter time frame. A stretch shortening cycle occurs when a muscle is stretched by lengthening (eccentric) and then rapidly shortens (concentric) which produces a powerful contraction. Lengthening the muscle stretches the muscle fibres and connective tissue (fascia and tendons) which preloads them with elastic energy. This elastic energy can be used to contribute to the subsequent concentric action, creating more force, which propels the body up in to the jump. If the turn-around from muscle lengthening to muscle shortening (propelling to take off) is too long, the stored elastic energy ebbs away and the effects are lost. For an exercise to be classified as plyometric this turn-around time (amortisation) must be less than 0.2 seconds.

Source: “PLYOMETRIC TRAINING VS JUMP TRAINING”, September 29, 2015 Link: http://www.bs7gym.co.uk/plyometric-training-vs-jump-training/

Figure 4.4.1 - Plyo push-up with clap (https://www.evolutio.com.au/blog/2014/11/18/7-training-moves-to-complement- your-football-pre-season)

Figure 4.4.2 - Plyo depth step jumps (https://www.verticaljumping.com/amortization_phase.html)

Figure 4.4.3 - Jumping Lunges (https://www.worldwidelifestyles.com/jumping-lunge-techniques/

5. The Importance of Self Myofascial Release

5.1 Definition Self Myofascial Release is a safe and very effective technique (based both on hands and on auxiliary tools) that involves the application of gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion. (https://www.myofascialrelease.com/about/definition.aspx). In other words, SMR is a specialized physical and manual therapy used for the treatment and rehabilitation of soft tissue and fascial aches, pains, tension and restrictions.

5.2 Utility In the past, myofascial release (MFR) was often treated as massage rather than a treatment approach. The meaning and understanding of ‘self myofascial release’ has changed over the last decade. A lot of workshops have been taken place for healthcare professionals. It is traditionally accepted that myofascia is the connective tissue (fascia) between muscles, where muscles are the forces of movement and posture for the body. The application of self myofascial release aims, therefore, to alleviate tension, restrictions and adhesions in the myofascia in order to restore balance and function. SMR focuses specifically on muscles and kinetic chains (muscle chains) because they respond well to firm deep pressure. The method uses a relatively firm force applied by the practitioner and by the use of therapy tools such as foam rollers, cricket balls and massage rollers. Many people, especially sports people, are fond of solid pressure and feel that muscular stretch and deep therapy work benefits them. When people are fit, healthy and physically active, deeper SMR approaches can be appropriate as long as they are not applied to the painful stage. As research has progressed, the knowledge about the fascial system haw increased. A stable, deep pressure into the system has been replaced by a cultivated kinesthetic and skilled touch refined by principles of mechanotransduction, fluid dynamics, piezoelectricity and viscosity. This is about the viscous flow and the piezoelectric phenomenon which means that a low load (gentle pressure) applied slowly will allow

44 a viscoelastic medium (fascia) to elongate. (https://www.myofascialrelease.com/about/definition.aspx) Each self myofascial release treatment session is performed directly on skin without oils, lotions, creams or machinery. It is performed dry so that the practitioner can feel deeper into the tissue and avoid glide over the skin. This enables the therapist to accurately detect fascial restrictions and apply the appropriate amount of sustained pressure to facilitate release of the fascia. These sustained techniques offer body wide change and tissue reorganization as well as offer a platform for emotional release and trauma resolve. An integrated method could teach the practitioners the skill of feeling different layers and structures under their hands and this is the sense of kinesthetic touch. This approach allows practitioners to learn which techniques are appropriate for individuals and how to apply them in a bespoke manner. The awareness of what fascia is has cultivated a change of thinking regarding to what tissues are actually cured by the touch of human body. When the fascial system is restricted, the ground substance becomes thicker (more viscous). This means less lubrication for the soft tissue and myofascial structures meaning they adhered together creating internal scarring and dysfunction affecting all other structures. The fascial is a totally connected system and is the system that touches all others. Injuries, inflammatory responses, and surgical procedures create myofascial restrictions that can produce tensile pressures on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, electromyography, etc.) The application of self myofascial release allows treatments with the use of multitude techniques and movement therapy. It promotes independence through education in proper body mechanics and movement, self treatment instruction, enhancement of strength, improved flexibility, and postural and movement awareness. However, consideration has to be taken in to account that excessive and aggressive deep work either by an unskilled practitioner or by the use of therapy tools by an uneducated person could actually create more restriction, scarring and inflammation and therefore damage tissue. Using strong pressure may affect the deep muscular tissue but can have a damaging affect on the more fragile superficial tissues. (http://www.myofascialrelease.co.uk/what-is-myofascial-release/)

5.3 Benefits of SMR Damaged or tight fascia can cause common problems such as headaches, muscle pain and spasms, back and neck pain, recurring injuries, reduced flexibility, poor posture and others. The most frequent reasons for fascia losing its suppleness include physical traumas such as falls, surgery, and sports injuries, intense physical activity, systemic inflammation (usually resulting from an unhealthy lifestyle), poor posture, lack of stretching and prolonged sitting or standing. (“3 Ways to Use Myofascial Release to Reduce Pain and Improve Performance”, Michael Matthews, Link: https://www.muscleforlife.com/myofascial-release/) SMR contributes to address many systems of the body including the fascia, muscles, nerves, skin and blood vessels. Through the assistance of tools, an individual can self massage and help break up and dissipate knots or restrictions in the fascia and muscle tissue surrounding it. By breaking up these restrictions, the muscle fibers are positioned in better alignment along the natural lines of the muscle fibers, allowing the gliding surface of the fascia to move freely.

A regular performing of SMR has many benefits for both intensive athletes and individuals who exercise often. More specifically, the benefits include: • Muscle relaxation: SMR helps reduce and eliminate stored tension in muscles, which aids in alleviating aches and pains. • Suppression or reduction of trigger point sensitivity and pain: SMR promotes the release of endorphins to help reduce pain. • Reduced soreness and improved tissue recovery: SMR increases circulation, allowing oxygen and other nutrients to reach the muscles and other soft tissues. • Improved joint range of motion, which helps restore optimal length- tension relationships: SMR helps prepare joints for increased range of motion and loads that accompany stretching, strengthening and other dynamic movement exercises. • Reduced adhesions and scar tissue that improves the elasticity of muscles and other soft tissues, to improve movement and reduce pain. • Regulation of the production of compounds called cytokines, which play a role in decreasing inflammation. • Increased activity in the mitochondria of cells, helping promote repair and growth of muscle tissue. • Improved neuromuscular efficiency. • Decreased neuromuscular hypertonicity. • Decreased overall effects of stress on the human movement system. (“9 Benefits of Self Myofascial Release”, Deb Preachuk, 20/4/2016, Link: https://www.puori.com/blog/2016/04/20/9-benefits-of-myofascial-release#)

6. Techniques and Methods of Self Myofascial Release

As it was mentioned above, dysfunctions of the fascia can be indicated by various symptoms such as musculoskeletal pain. As a result, stronger focus has been put on researching therapeutic approaches in this area. Self myofascial release attempts to influence tissue structures by using movement to enhance the function and increase the personal health of individual people. Recent research around fascia tissue has provided new treatment perspectives with the application of special foam rollers, tennis balls and roller massagers.

6.1 Foam Roller

Latissimus dorsi

-The latissimus dorsi originates from the spine, thoracolumbar fascia, and posterior hips, and Muscle Anatomy and Function attaches on the humerus. - The latissimus dorsi is responsible for extension, adduction, and internal rotation of the arm.

• Much like the pecs, the lats can become short and stiff due to overtraining. This lack of extensibility Reasons to Treat can lead to overuse injuries and/or poor mechanics in many lifts, even those not targeting the lats (e.g., squatting, Olympic lifts).

- Lie on one side with the arm closest to the ground outstretched with thumb facing upwards. Place the Set-up foam roller under the arm in the auxiliary region. -Externally rotate your arm to place the lats on stretch.

-Glide the roller up and down the outside portion of Performance your back. -Roll for 30–60 seconds, and then switch sides.

Alternate Modalities - Use a harder roller to increase the pressure.

Figure 6.1 – SMR of latissimus dorsi by moving the foam roller

Figure 6.2 – SMR of latissimus dorsi by mobilizing the arm on the foam roller

Adductors

-The adductors are a group of muscles that originate on the pubis and attach to various points on the femur and tibia. Muscle Anatomy and Function -The adductors promote a variety of movements: hip adduction, medial rotation, and hip flexion. Adductor magnus can also extend the hip.

-It is not uncommon for the adductors to be strained or adhered due to previous injury. Soft-tissue work can help break up adhesions, reduce muscular Reasons to Treat tension, and improve movement quality. -Excessive tension in the adductors can lead to internal rotation of the femur/hip, which increases the risk of knee injury.

-Lie on the stomach on the ground with the roller alongside and parallel to the body. -Flex one hip/knee and place the inner thigh on top Set-up of the roller. -Place the elbows on the ground underneath the shoulders.

-From the starting position, press up and roll back and forth over the inside portion of the thighs. This position will focus on the one-joint adductors. Performance -Roll for 30–60 seconds, and then switch legs. -To work on the two-joint adductors, extend the knee and continue rolling on the inner thigh.

-Use a harder foam roller to increase the pressure. Alternate Modalities -Use a medicine ball to increase the pressure.

Figure 6.3 and 6.4 – SMR of adductors by mobilizing the leg on the foam roller

Gluteus medius

-The posterior gluteus medius originates from the middle/back of the hip and inserts on the top of the Anatomy and Function femur. -The posterior gluteus medius is responsible for hip extension, hip abduction, and hip external rotation.

-The posterior fibers of the gluteus medius can Reasons to Treat become scarred or adhered, leading to an increase in external rotation at the hip.

-Lie on the side on the ground with the roller underneath the back portion of the hip. Set-up -Place the same side elbow and the opposite hand/foot on the ground.

-From the starting position, press up and roll back and forth over the outside portion of the hip. -Try adjusting the body position to really hit the posterolateral hip musculature; it may be needed to move into a face up position and put the foot behind Performance the body to really hit the area appropriately. -Roll for 30–60 seconds, and then switch legs. -Try taking the opposite leg off the floor, or stacking the legs on top of each other, to increase pressure on the hip.

-Use a harder roller to increase the pressure. Alternate Modalities -Use a medicine ball to increase the pressure.

Figure 6.5 – SMR of gluteus medius with rolling over the foam roller

6.2 Tennis ball

Pectoralis major

-The pectoralis major originates on the sternum, clavicle, and costal cartilage and inserts on the humerus. Muscle Anatomy and Function -The pectoralis major is responsible for horizontal adduction and internal rotation. The clavicular fibers flex the extended shoulder, while the sternal fibers extend the flexed shoulder.

-The pectoralis major is typically short and stiff due to overtraining (too much chest training) and chronic poor posture. This lack of extensibility can lead to Reasons to Treat overuse injuries and/or poor mechanics in many lifts, even those not targeting the chest (e.g., squatting, Olympic lifts).

-Stand next to a wall and place a tennis ball on the Set-up wall at chest height. -Push the pecs into the ball to hold it in place.

-With the tennis ball pinned between the pecs and the wall, roll it back and forth. It may help to work in small sections as the tennis ball doesn’t have a large circumference. Performance -Roll for 30–60 seconds, and then switch sides. -To increase the intensity, horizontally abduct and externally rotate the arm to place the pectoralis major on stretch.

Alternate Modalities -Use a harder ball to increase the pressure.

Figure 6.6 – SMR of Pectoralis major by moving the tennis ball over the chest

Posterior shoulder capsule

-The posterior shoulder capsule encloses the back portion of the shoulder joint. Muscle Anatomy and Function -The shoulder capsule provides passive stability to the shoulder joint, and helps lubricate the joint by secreting synovial fluid.

-The posterior capsule is often scarred/adhered in overhead throwing athletes. Reasons to Treat -A tight/stiff posterior capsule can lead to a loss in internal rotation.

-Stand next to a wall and place a tennis ball on the wall at shoulder height. Set-up -Push the posterior portion of the shoulder into the ball to hold it in place.

-With the tennis ball pinned between the shoulder and the wall, roll it back and forward. It may help to work in small sections as the tennis ball doesn’t have a large circumference. Performance -Roll for 30–60 seconds, and then switch sides. -To increase the intensity, pull the arm across the body using the opposite arm. The shoulder can also be extended and flex the elbow to place the posterior capsule on stretch.

Alternate Modalities -Use a harder ball to increase the pressure.

Figure 6.7 – SMR of posterior shoulder capsule by moving the shoulder on the tennis ball

6.3 Roller Massager

Tibialis anterior

-The tibialis anterior originates from the lateral condyle/shaft of the tibia and inserts onto the top of Anatomy and Function the foot. -The tibialis anterior is responsible for producing dorsiflexion and inversion of the foot.

-The tibialis anterior can often become scarred due Reasons to Treat to overuse in running and jumping activities/sports.

-Place one foot up on a low bench. -Place the Stick along the anterior surface of the Set-up lower leg with the palms facing inward (toward your body).

- From the starting position, roll the stick up and Performance down the lower leg. -Roll for 30–60 seconds, then switch legs.

Alternate Modalities -None.

Figure 6.8 – SMR of tibialis anterior by rolling the massager over the tibia

Quadriceps

-The rectus femoris (RF) originates from the front of your hip, the vastus medialis (VM) originates along the medial surface of the femur, the vastus lateralis (VL) originates along the lateral surface of the femur, and the vastus intermedius originates along the anterior surface of the femur. All four Anatomy and Function quadriceps muscles insert on the common quadriceps tendon. The quad tendon then inserts on the patellar ligament and the tibia. -All the quadriceps muscles are responsible for knee extension. Only the RF is involved in hip flexion.

-Excessive tension in the quadriceps can lead to Reasons to Treat knee or hip pain.

-Sit on a low bench or stool with the Stick across the front of the thigh. -The Stick variations work well on the quadriceps Set-up as it can get closer to the patella, which allows the work on the musculo-tendinous junction. This area can become tight or fibrotic due to overuse/overtraining.

-From the starting position, back and forth over the front of the thighs. -To work on the rectus femoris, work on the middle Performance of the leg. For the vastus medialis, move closer to the midline. For the vastus lateralis, move to the outside portion of the leg. -Roll for 30–60 seconds, and then switch legs.

- None. Alternate Modalities

Figure 6.9 – SMR of quadriceps by moving the roller massager over the leg

7. CONCLUSION

Through this review work, it appears that the fascia system is of great importance for the human body. As far as the fascial training is concerned, the elastic recoil (as its property) as well as the energy transport (dynamic-kinetic) are two elements that constitute the core of the fascial function. Regarding to the release, hydration is more closely related to the fascia according to specified researches. In the whole spectrum of the fascia, from training to its release, there is a continuous development. Many researches are carried out and as a result, more data are increasingly emerged which are even more detailed and valid than previous investigations. The connective tissue as a set of data with a scientific background has been adopted by various other forms of movement and exercise. Some of them are dance, martial arts, and various training systems. It is quite clear that fascial lines are common characteristic in many sports, with or without the necessary scientific research on fascia. It will be really optimistic and reasonable, if an exchange of information and data, between researchers and those who are involved in the movement as a means of exercising the human body, will continue and vice versa.

REFERENCES

Articles:

• “Fascia: a morphological description and classification system based on a literature review”, Myroslava Kumka, MD, PhD* and Jason Bonar, BScKin, DC, September 2012, Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/ • “3 Ways to Use Myofascial Release to Reduce Pain and Improve Performance”, Michael Matthews, Link: https://www.muscleforlife.com/myofascial-release/ • “9 Benefits of Self Myofascial Release”, Deb Preachuk, 20/4/2016, Link:https://www.puori.com/blog/2016/04/20/9-benefits-of-myofascial- release# • “5 Yoga Moves for Myofascial Release Stretching”, Elisabeth Kovar, 25/9/2015, Link: https://www.acefitness.org/education-and- resources/lifestyle/blog/5667/5-yoga-moves-for-myofascial-release-stretching) • “Training Principles for fascial connective tissues: Scientific Foundation and suggested practical applications”, Robert Schleip and Divo Gitta Muller, 2012 Link: http://www.fasciaresearch.de/Schleip_TrainingPrinciplesFascial.pdf

Διαδικτυακοί Τόποι: • http://yogarethimno.blogspot.gr/2015/06/blog-post_17.html • http://www.bestrong.org.gr/el/health/fitness/historyoffitness/

• https://www.myofascialrelease.com/about/fascia-definition.aspx • http://paultimpas.gr/%CE%B4%CE%B9%CE%B1%CF%84%CE%B1%CF% 83%CE%B7-%CE%B3%CE%B9%CE%B1- %CE%BC%CF%85%CE%BF%CF%80%CE%B5%CF%81%CE%B9%CF% 84%CE%BF%CE%BD%CE%B9%CE%B1%CE%BA%CE%B7- %CE%B1%CF%80%CE%B5%CE%BB%CE%B5%CF%85%CE%B8%CE% B5/ • https://en.wikipedia.org/wiki/Fascia • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/table/t1- jcca_v56_3_179_kumka/ • http://www.bodyworkmovementtherapies.com/article/S1360-8592(16)30091- 2/fulltext