Webinar Dr. Jan Wilke: Tackle the cause, not the symptom: understanding myofascial chains in sports and therapy: On demand webinar

Webinar Dr. Jan Wilke: Tackle the Cause, Not the Symptom: Understanding Myofascial Chains in Sports and Therapy

Webinar content

The webinar covers: fascia as a local structure, its layers and gliding; the four mechanisms of fascial stiffness regulation; muscle injury as connective tissue injury; delayed onset muscle soreness as a fascial phenomenon; collagen loading and gelatin supplementation; myofascial continuity in cadaveric material; the arm chains and the posterior, lateral and anterior chains; the basics of epimuscular force transmission and anisotropy; non-local exercise effects and in vivo ultrasound evidence; anatomical differences between upper and lower body and between anterior and posterior; hyaluronan, thixotropy and warm-up; immobilisation, tissue remodelling and cross-linking; and fascia as a non-local origin of plantar fasciitis, Achilles tendinopathy, adductor complaints and low back pain — followed by an extensive Q&A session.

Why local treatment often falls short

Dr Jan Wilke (Goethe University Frankfurt, head of the "Fascia in Motion" research group) started out treating athletes and general patients, and kept running into the same problem: local treatment did not deliver the result he was after. In this webinar he explains why. Fascia is not passive packaging that separates muscles; it is an active tissue that connects muscles and transmits force over considerable distance. That changes how you analyse a movement restriction or a recurrent complaint.

What muscle injury actually is

Pooled imaging studies show that only around ten per cent of so-called muscle injuries are isolated muscular lesions. In roughly ninety per cent the damage lies in the extramuscular fascia or at the myotendinous junction. You will learn what that means for your tissue hypothesis, your prognosis and your loading progression — including the concrete parameters for collagen synthesis: loading blocks of ten to twenty minutes, a recovery interval of at least six hours and intermittent loading. Delayed onset muscle soreness likewise correlates more strongly with an increase in fascial thickness than with classical muscular parameters.

Myofascial chains — what is demonstrated and what is not

This webinar examines the chain concepts critically. Not every chain described in the literature holds up: only a limited number have actually been demonstrated, among them the long posterior chain from the sole of the foot to the back and two diagonal chains. You will see cadaveric work, tensile testing and ultrasound evidence of tissue displacement in the thigh during passive ankle motion. You will also learn where force transmission is strongest — posteriorly and in the lower limb — and where the boundary lies between structural and neural explanations.

Directly applicable in practice

You will learn a sequential ankle mobility examination that differentiates in four steps whether the restriction sits in the gastrocnemius, the hamstrings or the lumbar fascia, compared left to right. The webinar also covers the non-local associations that should guide your examination: hamstring tightness in plantar fasciitis, a thickened plantar aponeurosis in Achilles tendinopathy, the link between adductor and abdominal complaints in footballers, and the hamstring and latissimus findings in low back pain. Ninety per cent of time-loss hamstring injuries are preceded by a non-time-loss complaint, about a third of which are non-local.

Who is this webinar for?

This continuing professional development webinar is designed for physiotherapists, sports physiotherapists and manual therapists who want to update their knowledge base on connective tissue, force transmission and non-local complaints, and to sharpen their clinical reasoning. The webinar is accredited through Kwaliteitshuis Fysiotherapie (KHF) and counts towards the specialist registers for Sports Physiotherapy and Manual Therapy. For Belgian participants accreditation runs through Pro-Q-Kine.

Scientific faculty: Dr Jan Wilke

Dr Jan Wilke is based at Goethe University Frankfurt, where he leads the "Fascia in Motion" research group. He has published systematic reviews and meta-analyses on myofascial chains, force transmission and connective tissue injury, and combines his research with work as a strength and conditioning coach in tennis, baseball, American football and soccer. Together with Robert Schleip he has published a book on fascia in movement and therapy.

Upon completion of this course, the participant is able to:

1. Myofascial continuity and clinical significance

Appraise the histological, cadaveric and imaging evidence for myofascial continuity and epimuscular force transmission in terms of its strength and its scope, and, for a given case, explicitly distinguish which conclusions rest on demonstrated anatomical continuity, which on demonstrated mechanical force transmission and which on clinical assumption — and determine on that basis which links of the chain to include in the physiotherapeutic examination.

2. Fascial stiffness and choice of intervention

Justify a choice of loading, mobilisation and stretching interventions in terms of the four mechanisms of fascial stiffness regulation covered — passive force transmission during muscle contraction, direct muscular insertions, myofibroblast contractility under autonomic control, and changes in hydration — taking the markedly different time courses of these mechanisms into account in dosing and progression, and stating which claims rest on mechanistic and acute mobility research rather than on clinical effectiveness research.

3. Connective tissue involvement in muscle injury

Revise the tissue hypothesis, the prognosis and the loading progression in a case presenting as a so-called muscle injury, on the basis of the finding that the lesion is in the majority of cases located in the extramuscular fascia or at the myotendinous junction, while explicitly justifying which of the recovery and dosing parameters presented — loading duration, recovery interval and intermittent loading — are treated as directive and which as uncertain.

4. Interpretation of the sequential ankle mobility examination

Interpret the findings of the sequential ankle mobility examination from the video demonstration and the case data, and differentiate the contribution of the gastrocnemius, the hamstrings and the lumbar fascia to the movement restriction, recognising measurement error, compensatory strategies and the limited tissue specificity of the test, weighing competing explanations against one another, and selecting a substantiated next step in the examination.

5. Non-local factors in clinical reasoning

Design an examination and treatment strategy for a complex case of recurrent or persistent musculoskeletal complaints in which possible non-local contributions are weighed against local explanations, specify in advance the evaluation criteria by which that strategy can be adjusted or rejected, and explain the distinction between association, causation and residual uncertainty to the patient in accessible terms.