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Myofascial
Induction™
of related interest
Myofascial Induction™
An anatomical approach to the treatment
of fascial dysfunction Volume 1:
The Upper Body
Andrzej Pilat
Forewords by Jan Dommerholt, Robert
Schleip and Andry Vleeming
ISBN 978 1 91342 633 0
eISBN 978 1 91342 634 7

The Myofascial System in

Form and Movement
Lauri Nemetz
Foreword by David Lesondak
ISBN 978 1 91208 579 8
eISBN 978 1 91208 580 4

Mobilizing the Myofascial System

A clinical guide to assessment and
treatment of myofascial dysfunctions
Doreen Killens
Forewords by Diane Lee, Thomas W.
Myers and BetsyAnn Baron
ISBN 978 1 90914 190 2
eISBN 978 1 90914 191 9
Myofascial
Induction ™
An anatomical approach to the
treatment of fascial dysfunction
Volume 2 The Lower Body

Andrzej Pilat
Forewords
Jan Dommerholt
Robert Schleip
Andry Vleeming

Edinburgh
First published in Great Britain in 2023 by Handspring Publishing,
an imprint of Jessica Kingsley Publishers
An imprint of Hodder & Stoughton Ltd
An Hachette UK Company

Copyright © Andrzej Pilat 2023

Foreword copyright © Jan Dommerholt 2023

Foreword copyright © Robert Schleip 2023
Foreword copyright © Andry Vleeming 2023

Please see the Permissions and Sources list at the end of the book for copyright acknowledgements.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means without the prior written permission of the publisher, nor be otherwise
circulated in any form of binding or cover other than that in which it is published and without a similar
condition being imposed on the subsequent purchaser.

Disclaimer: Neither the Publisher nor the Author assumes any responsibility for any loss or injury and/or
damage to persons or property arising out of or relating to any use of the material contained in this book. It is
the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient,
to determine the best treatment and method of application for the patient.

A CIP catalogue record for this title is available from the British Library and the Library of Congress

ISBN 978 1 91342 635 4

eISBN 978 1 91342 636 1

Printed and bound in China by Leo Paper Products Ltd

Jessica Kingsley Publishers’ policy is to use papers that are natural, renewable and recyclable products and
made from wood grown in sustainable forests. The logging and manufacturing processes are expected to
conform to the environmental regulations of the country of origin.

Handspring Publishing
Carmelite House
50 Victoria Embankment
London EC4Y 0DZ

www.handspringpublishing.com
 CONTENTS

Dedication viii
About the author ix
Foreword by Jan Dommerholt x
Foreword by Robert Schleip xi
Foreword by Andry Vleeming xiii
Preface xiv
Online videos xvi
Acknowledgments xvii

CHAPTER 1 Connecting and moving forward: Fascia as a multifunctional system 1

Introduction 1
The fascial system and communication between body systems 2
References 21

CHAPTER 2 Thoracolumbar fascia: The heart of the matter 25

General considerations related to the fascial system of the lower quadrant 25
How load is transferred between the spine, pelvis, arms, and legs 26
Thoracolumbar fascia: The heart of the matter 28
Conclusion 44
References 46

CHAPTER 3 Lower quadrant assessment 49

Introduction 49
The characteristics of the lower quadrant 49
The assessment process 51
Conclusion 90
References 91

CHAPTER 4 Pelvic girdle dysfunctions: Lower back and sacroiliac structures; Abdominal area 95
Lower back and sacroiliac structures 95
Introduction: The lower back 95
Anatomical considerations related to the lower back 96
Neurological considerations related to the lower back 97
The pelvic girdle and low back pain 98
The cell–ECM–brain model 105
Introduction: Sacroiliac structures 106
Structure and function of the sacroiliac joint 108
Conclusion 124
Abdominal area 126
Introduction 126
Anatomical considerations related to the abdominal fascial system 128
CONTENTS continued

Biomechanical considerations related to the abdominal fascial system 135

Blood supply to the abdominal fascial system 136
Innervation of the abdominal fascial system 137
Conclusion 139
References 140
MIT procedures for common pelvic girdle dysfunctions: Lower back and
sacroiliac structures; Abdominal area 145

CHAPTER 5 Pelvic girdle dysfunctions: Gluteal structures; Inguinal and pubic structures; Pelvic floor (external) 173
Gluteal structures 173
Introduction 173
Anatomical considerations related to the gluteal structures 173
Biomechanics and the gluteal area 177
Deep gluteal syndrome 179
Conclusion 186
Inguinal and pubic structures 187
Introduction 187
Anatomical considerations related to the inguinal and pubic structures 187
Symphysis pubis dysfunction and groin pain 191
Conclusion 194
Pelvic floor (external) 196
Introduction 196
The pelvic floor, posture, and gravity 197
The pelvic floor system and its supporting structures 198
Endopelvic fascia as a part of the dynamics of the pelvic floor system 205
Pelvic floor dysfunction 211
Conclusion 220
References 221
MIT procedures for common pelvic girdle dysfunctions: Gluteal structures;
Inguinal and pubic structures; Pelvic floor (external) 227

CHAPTER 6 Lower extremity dysfunctions related to the fascial system 247

Introduction 247
Anatomical considerations related to the fascia of the lower limb 247
Thigh structures: Fascia lata 262
Knee structures 273
Lower leg structures: Crural fascia 280
Foot structures 286
Conclusion 299
References 302
MIT procedures for common lower extremity dysfunctions 307
CHAPTER 7 Fascia and therapeutic movement in translational practice: From the laboratory to the clinic 355
Introduction 355
Human existence as a biological behavior 355
The therapeutic process 358
Conclusion 366
References 368

Permissions and sources 369

Subject index 370
Author index 376
 DEDICATION

In May 2016 I had the opportunity to show a sample chapter of this book to Dr. Leon
Chaitow. On reviewing it carefully, he exclaimed: “I want this book!” He also generously
agreed to my request to write the book’s foreword. I promised he would be the first to read
the book. Sadly, his sudden passing did not allow me to fulfill my promise.

I am honored to dedicate the book to this great person, clinician, researcher, writer,
lecturer, educator, editor, and visionary.

Andrzej Pilat

viii
 ABOUT THE AUTHOR

Andrzej Pilat

Andrzej Pilat is a physical therapist. Born in Poland, has become intensely interested in fascia in the search
throughout his professional life he has practiced across for answers to the (always) global response of the body
continents. This has given him the opportunity to be in- to disease and healing.
volved in a variety of aspects of physical therapy: health
Andrzej’s experience as a photographer has allowed
care (a bustling hospital environment; the mystery of an
him to immerse himself in the intimacies of the unem-
operating room; the adrenaline of intensive care units;
balmed cadaver, capturing in pictures the beauty of the
and the intimacy of a private practice); teaching (in a
inner body architecture. The pages of this book reflect
university setting, tutoring graduate and undergraduate
these experiences by taking the reader on a fascinating
students); research (decoding the human body’s enigma
journey through the puzzle of the fascia, from a micro-
by dissecting unembalmed cadavers); management (he
biological, anatomical, biomechanical, neuroscientific,
has been chair of domestic professional associations
and even psychological and philosophical approach.
and international organizations); publishing (he was
an editor for the Venezuelan Manual Therapy journal); Today Andrzej leads the Myofascial Therapy School,
and information dissemination (he is the author of sev- Tupimek, in El Escorial (Madrid), Spain, where he gives
eral papers and books). These experiences have led him
to a better understanding of people’s culture, customs,
instruction in Myofascial Induction Therapy (MIT) ,
in collaboration with certified teachers both in Spain
™
and attitudes towards diseases, thus awakening his in- and worldwide. Andrzej lectures in specialized work-
terest in therapeutic approaches and treatments that shops and teaches for different master’s programs in lo-
will adapt as effectively as possible to the individual, as cal universities and abroad. He has participated in nu-
opposed to the disease. In his quest, Andrzej has experi- merous international congresses about fascia, manual
enced a fruitful array of different approaches to physical therapy, and physical therapy in general. In recent years,
therapy, with a wide range of exercises, modalities, ap- his participation in webinars has resulted in a growing
plications (devices), manual applications, and concepts
– learned from well-known masters, such as Maitland,
™
international following. Myofascial Induction : An an-
atomical approach to the treatment of fascial dysfunction
Mulligan, McKenzie, Upledger, Barnes, Greenman, and is the result of five years of intense research through a
others. The study of different concepts of manual ther- vast amount of scientific evidence about the fascia’s in-
apy has occupied the last 35 years of his career and he creasing importance to people’s health and illnesses.

ix
 FOREWORD by JAN DOMMERHOLT

I do not recall when and where I first met Andrzej Pilat, have to rise above it to the next level.” That observation
but I suspect it was at either a myofascial pain congress, is applicable to Pilat at many levels. Myofascial Induc-
a fascia congress, or a physiotherapy course or confer- tion™: An anatomical approach to the treatment of fas-
ence somewhere in the world. Often Andrzej’s travels cial dysfunction is the ultimate proof of the innovative
coincided with mine, and every time I attended his lec- pathway which A ­ ndrzej has carved out, often against
tures several thoughts and associations came to mind. the contemporary viewpoints of other scientists, social
It was clear to me that this man is an innovator in the media influencers, and established traditions.
field of physiotherapy and beyond – someone who fol- At the time I was preparing this foreword, Colleen
lows in the footsteps of other innovators from many Kigin, PT, PhD, FAPTA was presenting the 52nd Mary
different fields, dispelling the many erroneous belief McMillan Lecture as part of the centennial celebration
systems so common in our discipline. I have a feeling of the American Physical Therapy Association. By pure
that already, during his time as a physiotherapy student, coincidence the title of her lecture was “Innovation: It’s
young Andrzej would have been questioning his tutors in our DNA.” Although I am personally not convinced
and challenged their teachings and convictions about that “the [physical therapy] profession is rich with in-
physiotherapy treatment methods. In a time when the novators,” Dr Kigin hit the nail on the head when she
terms evidence-based and evidence-­informed physi- summarized, that physical therapy innovators have the
otherapy had not been invented, Andrzej was proba- ability to connect the dots, accompanied by intense
bly way ahead of many of his professors in his critical questioning, observing, networking, and experiment-
thinking skills and vision for the profession. ing. I have read several older chapters about myofas-
During our lifetime, physiotherapy has evolved cial induction written by Pilat in other textbooks, but
from a tradition-based therapy to an evidence-in- this book goes far beyond anything I have read before
formed approach. Charles Kettering is quoted as say- or seen during Pilat’s lectures. It was such a pleasure
ing: “If you have always done it that way, it is probably and enrichment to learn about tensegrity, the embryo-
wrong” – words that could easily have been uttered by logical development of the extracellular matrix, fascial
­Andrzej Pilat. During a myofascial pain conference in anatomy, pain sciences, allostasis, interoception, and
­Bangalore, India several years ago, Andrzej and I had additionally, myofascial induction – all in one book!
numerous opportunities to reflect, share ideas, admire The many outstanding illustrations, including line
each other’s creative presentation styles, share a beer drawings, exquisite anatomy photographs, and dia-
or two, and ponder about the future of physiotherapy. grams complement the text together with links to sup-
His attention to detail, his phenomenal dissection vid- porting videos online showing Andrzej at work. While
eos, animations, and photographs were most impres- at times, Pilat becomes rather philosophical, he never
sive, not to mention his good nature and willingness to loses track of educating clinicians and scientists across
share his perspective with anyone willing to listen. At- a wide spectrum in the current knowledge of fascia.
tendees of the congress recognized his brilliant mind, I admire and congratulate Andrzej Pilat for this phe-
creativity, and tenacity, and our chats were frequently nomenal book. It is such an honor to introduce you, the
interrupted by requests to take selfies with Andrzej! reader, to this outstanding publication.
In a time where many physiotherapists have adopted
a mindset that because “pain is in the brain” and “the Jan Dommerholt PT, DPT
issues are not in the tissues,” so “hands-on therapies Bethesda Physiocare, Inc.
are a thing of the past,” Andrzej continued to defy such
Myopain Seminars
developments and instead explored new developments
beyond what most of us could ever have imagined. Al- Lecturer, Department of Physical Therapy and
bert Einstein reportedly stated that: “You can’t solve Rehabilitation Science, University of Maryland
a problem on the same level that it was created. You Bethesda, MD, USA, September 2021

x
 FOREWORD by ROBERT SCHLEIP

Fascia is a connecting (t)issue. While Western conven- On the other hand, I must confess that for therapeu-
tional medicine underestimated it for centuries as a tic treatment of myself or my family members, I con-
mere packaging organ, recent advances in assessment tinue to appreciate the healing attention of therapists
methods – such as shear wave ultrasound elastogra- who work with a more holistic and intuitive approach.
phy or harmonic generation microscopy – have trig- In my experience, their quality of touch, loving pres-
gered an avalanche of new discoveries and insights ence, and wonderful enthusiasm are priceless compo-
into the collagenous tissue network that keeps many nents of a healing relationship. These qualities are less
researchers and clinicians around the world on their often found – at least not with the same depth – among
toes. Although many aspects remain to be explored, my respected scientific colleagues. Or to put this ob-
recent publications have shown that this network not servation the other way around: When listening to the
only influences muscular force transmission in a sig- personal explanations of the best therapists in our field
nificant manner but also constitutes our richest sen- about the healing mechanisms involved in their work,
sory organ. one must often be prepared to hear interpretations that
any of my undergraduate Life Science students would
One of the fascinating aspects of the fascial network
easily recognize as premature logical conclusions.
is its connective nature, which makes it difficult for pre-
cision-minded thinkers to describe its clear boundaries If you have already guessed how this situation relates
and distinctions in a satisfactory manner. While this to the author of this book and the brilliant book he has
fact is frustrating to some, it has also piqued the inter- written, you have my collegial applause. Yes, the au-
est of esoteric healing practitioners who wish to project thor, Andrzej Pilat, is indeed a very rare exception to
far-reaching hypothetical abilities, such as telepathic the common disparity described here. I consider him
intuition or cosmic resonance transmission, into this one of the best manual therapists I know, and I do not
elusive tissue network. Indeed, among the many differ- say that lightly. When I see Andrzej at work, I feel as if
ent scientific and therapeutic congresses I have attend- I am watching a master artist, like Michelangelo as a
ed, I have never seen such a diverse and interdiscipli- painter or like a Butoh dancer in slow motion. But the
nary audience as at fascia-oriented congresses, ranging most impressive aspect for me is his connection with
from biomechanical engineers, plastic surgeons, meat the client: Both seem to be united in a joyful and al-
scientists, matrix biologists, and orthopaedic research- most hypnotic process of discovery.
ers to osteopaths, yoga teachers, meditation instruc-
Nevertheless, when Andrzej describes his work in
tors, martial arts gurus, and Reiki practitioners.
terms of suggested fascia changes, I feel like asking all
What does this aspect have to do with the excellent my students to join me in listening to him with eager
book you are holding in your hands right now? Let me attention. The way he weaves together various findings
explain after completing the next two paragraphs. and issues of the latest international research is truly
outstanding. The author of this brilliant book has not
Having been a holistic therapy practitioner and mis-
only been a passionate manual therapist for many dec-
sionary myself for several decades, my personal path
ades but has also been actively involved in academic
has led me more and more to the humble, question-
fascia research, including the first Fascia Research
ing approach of those scientists who are interested in
Congress (Harvard Medical School Conference Center,
unraveling the mysteries of the human body in many
Boston, 2007), all subsequent such events, and in seve­
small and careful steps. When it comes to drawing
ral similar congresses which he hosted himself and
conclusions about cause-and-effect relationships in the
used to interact personally with the leading scientists
fascia-oriented field I personally tend to side with those
in our field.
researchers who work with a curious “we don’t know”
attitude. This approach can be frustrating as it is of- Those of you who have had the pleasure of attending
ten less exciting and less charismatic than allowing our one of the international Fascia Research Congresses
wishful thinking to generate broad assumptions and know that Andrzej Pilat’s presentations tend to be ab-
easy explanations about the implications of a perceived solute highlights. After his presentation, he is usually
fascial phenomenon. surrounded by a crowd of enthusiastic attendees who

xi
 FOREWORD by ROBERT SCHLEIP continued

want to collaborate with him in one way or another, currently known about the many functions of this tis-
or to find out how they can get their hands on the fan- sue. Finally, this masterpiece in print introduces you
tastic photos and videos of fascia anatomy that he has to a fascia-oriented manual treatment method that you
shown. For many years, his constant response to the will surely want to experience yourself after reading
latter request has been: “Give me a little more time to the first few chapters. I congratulate the author for this
finish my book, which will contain all of this and much fantastic achievement. Myofascial Induction™: An ana-
more.” tomical approach to the treatment of fascial dysfunction
is a milestone contribution to the literature on fascia.
Here it is, dear friends and companions in the field
of fascia research: the long-awaited – and I think truly
historic – contribution of Andrzej Pilat to our com- Robert Schleip Dr biol.hum., Dipl.Psych.
mon field of fascination. Many of the fascial images, Visiting Professor, IUCS Barcelona, Spain
based on fresh tissue dissections, are the best presented
Director, Fascia Research Group,
outside of professional conferences. One cannot help
but admire the beauty of the complex architecture Ulm University, Germany
of the wonderful connecting tissue called fascia. The Research Director, European Rolfing Association
book also provides an up-to-date overview of what is Munich, Germany, September 2021

xii
 FOREWORD by ANDRY VLEEMING

The complexity of fascia and its functions has been well description of fascial topographical anatomy, its layers
documented, and it is evident that some of its secrets and architecture. The book then explores embryologi-
are yet to be unfolded. As this information expands, cal development, histological characteristics, neurody-
it is convenient to have a go-to source to help us bring namics, and the role of force transmission relating to
this knowledge together and explore tools useful in ap- the fascia.
plying this information in the clinical setting.
The later part of the book invites the reader to explore
Developed over years of dedication and enthusiasm the clinical applications of Myofascial Induction Ther-
this book delivers exactly that. It is systematically or- apy. This section is neatly categorized into treatment
ganized to take the reader through the relevant clinical regions – craniofacial, craniocervical, the thorax, ­upper
research and literature. It does so in a way that enables and lower extremities – with each region providing
us to gain a greater understanding of this three-dimen- ­detailed information regarding clinical assessment and
sional sensory organ. Let me explain why… dysfunction. The relevant manual techniques are ­clearly
described in a format that is easy to follow. Evidently
Because it is a continuous matrix fascia is not easy
much thought has been given to the layout of this book,
to map. It reaches out to all corners of the body and to
employing wonderful photography and well-designed
every cell. It provides the framework that helps support
diagrams, enabling us to get a deeper understanding of
and envelop muscles, organs, blood vessels and neurons,
the fascial system. If you wish to expand your knowl-
enabling the body to function as a whole. Its various
edge of the anatomical approach to the treatment of fas-
mechanical properties are intriguing and complex. Ad-
cial dysfunction Myofascial Induction™: An anatomical
dressing this complexity, this book does a wonderful job
approach to the treatment of fascial dysfunction will be a
of bringing us up close and personal to the topograph-
very welcome addition to your collection.
ical anatomy. It also helps us explore, through illustra-
tion, the anatomical continuity of the fascia and how it My warmest congratulations to you, Andrzej Pilat.
relates to other body systems. This is achieved through
the use of wonderful photographs and diagrams that
help the reader visualize what lies beneath the skin. Professor Andry Vleeming PhD
To start you off in this exploration, the opening chap- Chairman, Interdisciplinary World Congress
ters provide the reader with an overview of what is cur- on Low Back and Pelvic Girdle Pain
rently known in the field. This includes an in-depth Antwerp, Belgium, September 2021

xiii
 PREFACE

The truth of science is always provisional, but still The uniqueness in the configuration of each individ-
­scientific research is the best method to obtain reliable ual’s fascial system is part of this process. In order to
information. achieve the desired movement our brain manages its
complex neural network, selecting for activation those
In 2003 I published my first book on fascia and Myofas-
motor units that enable optimal performance for the
cial Induction Therapy: Terapias miofasciales: Induc-
task in hand. It is obvious that in this process, the mus-
ción miofascial. This was based on the limited scientific
cles (muscle tissue) are the main engines of movement.
information then available and at that time images of
However, it should be remembered that none of the
fascial anatomy were very scarce. I had to undertake a
muscle fibers acts in isolation. They are fascial struc-
detailed search for evidence to corroborate the criteria
tures that transmit dynamic adjustments according to
presented in that book. Today, 18 years later, the pic-
demands.
ture is very different. The problem now is how to make
the best selection from the mass of high-quality scien- Following this reasoning, the question is: What is the
tific information on fascia that is available today. This significance of fascia for body movement and what is
detailed and richly illustrated book distils that infor- its relevance in the therapeutic processes?
mation, and puts it into the context of my own exten-
In this context, the book deals with fascia and kine-
sive study of human tissue, creating a unique textbook
sis, the latter defined in the Merriam-Webster diction-
and manual on the fascia and on how to manage its
ary as “a movement that lacks directional orientation
dysfunctions.
and depends upon the intensity of stimulation.” A
Over the past 15 years I have undertaken many dis- human being can choose his movement at will. This
sections of unembalmed cadavers and this work has attribute is guided by the brain. The brain uses past ex-
allowed me to open up new perspectives in the field of periences to anticipate movements. The brain does not
fascia research. Through these anatomical explorations see the future, but makes intelligent predictions about
I discovered the harmony, omnipresence, architectural what will happen in the immediate future. It is a learn-
complexity, diversity, and continuity of this amazing ing process that involves the senses (exteroception). In
fascial system. No less fascinating (although c­ omplicated this way we perceive the world. In parallel, the same
and laborious) was the photographic effort necessary to senses are influenced by body condition (interoceptive
capture this infinite, diversified, and colorful network. messages) based on experience, which is personal. The
Through macrophotography I discovered the hidden plasticity of the nervous system allows body movement
beauty that is the continuum of the endless fascial web. As to accommodate to diverse circumstances (for exam-
a result of this detailed research, the extensive ­approach ple, facing dangerous situations) based on experience
to fascial anatomy presented in the book (with the sup- and current information. The nervous system and the
port of numerous full-color photographs and v­ ideos) fascial system share the principles of plasticity, and ad-
encompasses not only the topography of the fascial tis- just movement in an anticipatory and individual way
sue but also shows its elegance, structural continuity, for each person. This process facilitates the ability to
and coherence within the chaos. It invites the reader to easily recover or adapt to misfortunes or changes (re-
explore its microstructure and to recognize its essential silience).
role and active participation in body movement.
Myofascial Induction™: An anatomical approach to
Within the contemporary conceptual framework the treatment of fascial dysfunction describes the prop-
new terminology differentiates between anatomical erties of the endless and omnipresent fascial network
structure (fascia) and function (fascial system) – a and provides therapeutic solutions for different types
complex biological system responsible for communica- of fascial dysfunction. The material is presented in two
tion (transmission of information) between body com- volumes:
ponents and with the environment.
Volume 1 analyzes in depth the theoretical aspects
The movement of each human (for example, walk- related to fascia and focuses on the therapeutic pro-
ing) is personal and almost impossible to duplicate. cedures of Myofascial Induction Therapy (MIT™) for

xiv
the upper body; Volume 2 summarizes and expands In the practical sections of Chapters 4, 5, and 6, the
on the theoretical aspects and explains the therapeu- reader will find a wide range of manual therapeutic
tic procedures of MIT™ for the lower body, where the procedures which can be selected and used in combi-
lower extremities have the function of supporting the nation to build up the MIT treatments. These processes
weight of the body in the bipedal position and making are explained in detail and are richly illustrated with
movement possible through the coordination of their diagrams and photographs of their practical applica-
powerful muscles. tion on the body and of hand contacts on samples of
dissected tissues.
The chapters of Volume 2 cover the theoretical as-
pects of fascial system behavior in the lower body seg- The final chapter summarizes practical aspects of
ment. The later sections of Chapters 4, 5, and 6 detail clinical applications, discussing subjects such as:
the practical applications of Myofascial Induction for
• the basic goals of the therapeutic process
the lower body.
In the theoretical sections, after defining the fascia as • touch as a therapeutic modality
a complex multifunctional biological system, its role of • the hand as a therapeutic tool
communicator between body systems is discussed in
relation to the following issues: • practitioner skills

• human existence as a biological behavior • patient’s skills.

• the role of fascia in exteroception, interoception, The introduction to each chapter offers the reader
proprioception, and nociception some philosophical background as a reminder that
philosophy allows us to relate the strictly scientific
• the influence of fascia on homeostasis with the empirical. Praxis and empiricism are the ba-
• the response of fascia in relation to General Adapta- sis of science.
tion Syndrome I invite you to join the scientific fascial adventure that
• the important role of fascia in allostasis and devel- allows us to uncover areas of knowledge which may
opment of allostatic load have been forgotten or which are not yet recognized as
being related and which might still reveal relevant in-
• thoracolumbar fascia as the heart of the matter
formation. Once discovered, these facts can help us to
• the role of fascia in pelvic girdle behavior better understand the kinesis of our body and so help
• fascial dynamics related to pelvic floor dysfunction the individual to change their body image and to im-
prove their quality of life.
• fascia and nerve entrapment syndromes of the lower
extremity Andrzej Pilat
• the complexity of the fascial compartment system. Madrid, December 2022

xv
 ONLINE VIDEOS

Chapter 4 Video 6.5

Video 4.1 Longitudinal stroke applied to the anterior and
Dynamics of the abdominal fascia lateral compartments of the lower leg

Video 4.2 Video 6.6

Transverse stroke applied to the psoas Deformation of the deep fascia related to
movements of the patellofemoral joint

Chapter 5
Video 5.1 Video 6.7
Continuity of the gluteal fascia with the Anatomical relations of the deep fascia of the
thoracolumbar fascia and fascia of the thigh thigh and the epimysium of the quadriceps

Video 5.2 Video 6.8

Relationship of the sciatic nerve and the Longitudinal stroke applied to the posterior
piriformis muscle in the subgluteal fold border of the iliotibial band (demonstrated with
knee extended)

Chapter 6
Video 6.1
Anatomical continuity of the skin, superficial
fascia, and deep fascia in the knee area

Video 6.2
Anatomical structures of the deep fascia of the
thigh

Video 6.3
Cross-section of the metatarsal zones

Video 6.4
Longitudinal induction applied to the plantar
fascia

xvi
 ACKNOWLEDGMENTS

The discovery of the double helix of DNA, whose struc- of scientific information to solve seemingly insoluble
tural coherence hides in code the morphogenetic and in- problems.
formational potential of life, opened the way to modern
• I would like to thank the ETM Tupimek team, par-
biology. It also marked the beginning of the close col-
ticularly my son Mártin Pilat, Germán Digerolamo,
laboration between biology, physics, and progressively
and Eduardo Castro-Martín for their extensive help,
other disciplines such as computing. The relatively sim-
reviews, and critical reading of the manuscript as
ple interactions between different pairs of nucleotides
well as their contributions on issues that I was una-
reveal the almost infinite capacity to store information
ware of. Also, I am grateful to Javier Rodríguez and
in the DNA heteropolymer. It is the intimate connec-
Jorge Sánchez for their help in preparing the illustra-
tion between interaction and information that consti-
tive material and to Rafael García for his help in the
tutes the fabric of living matter. Biological complexity is
search for scientific information.
based on specific interactions between molecules. These
interactions create complex networks that are balanced • Thank you to the PROMPT team, especially Franc-
by their interconnection. These networks control and esco Testa, Iván Arellano, and Andrea Fiorucci for
regulate the exchange of signals that govern intracellu- developing the illustrative material for the book and
lar functions and multicellular behavior throughout the reflecting my thoughts in the drawings.
development and functioning of the organism.
• I am extremely grateful to the late Professor Dr. Ho-
This fascinating advance of science forced the change racio Conesa for allowing me to live the adventure of
of paradigms and integration of scientific streams. The discovering the enigmas of the fascia in anatomical
analysis of the behavior of the fascia, as the integrating dissections.
structure of the body, did not escape these requirements.
• I would like to thank Dr. Nicolás Barbosa for his art
Thus, the act of writing this book on fascia turned into of dissecting fascia during the long hours of anatom-
a long and fascinating scientific adventure. Although ical work that we shared.
not an expert in the aforementioned disciplines, I was
fortunate to have the advice and help of friends who • I would also like to thank Professor Dr. Maribel
made this trip possible and enabled me to finally dock Miguel-Pérez and Dr. Albert Perez-Bellmunt for
at the destination harbor. My sincere thanks to all list- their critical review of my anatomical interpreta-
ed below for having accompanied me on this long and tions.
winding journey. • Thank you to Dr. Ramón Gassó for his analysis and
• First of all, I would like to thank the editorial team helpful opinions on fascial physiology.
at Handspring Publishing (Mary Law, Andrew Ste- • I thank the photographer Óscar Ruiz for his art of
venson, Sally Davies, Bruce Hogarth, Morven Dean, capturing therapeutic applications in photographic
and Hilary Brown) for their dedication, patience, subtlety.
professionalism, and attention to detail in search of
editorial perfection. • Thank you to Ailén Botta Mazzone for her patience
and grace in modeling the applications of therapeu-
• I would like to thank my family for allowing me the tic procedures.
long months (years) dedicated to writing the book,
especially my wife Yulita, for her unconditional sup- • I would like to thank Javier Álvarez for introducing
port and her contribution to so many tasks, and also me to the world of the analysis of fascia through im-
my children Eva, Mártin, and Kamil. ages and for obtaining the samples for the book.
• Thank you to my friend, architect Michele Testa, for • Finally, my special thanks to all who have been part
teaching me to select and synthesize the avalanche of this adventure.

xvii
 Connecting and moving forward: Fascia as a multifunctional system 1
KEY POINTS
• The physiological properties of fascial micro- and macrostructures in relation to body movement
• The characteristics of movement
• Definition of the internal environment
• The participation of fascia in homeostasis and allostasis behavioral responses
• Correlation of movement with the processes of exteroception, proprioception, and interoception
• Analysis of the nociceptive role of fascia

Introduction In traditional anatomical and biomechanical research

performed on embalmed cadavers, muscles are present-
The discovery of the double helix of DNA, whose struc- ed as independent units. This suggests a series of unre-
tural coherence conceals the morphogenetic and infor- lated elements instead of a unique and continuous con-
mational potential of life in code, opened the doors to figuration linking the structures of the body (Pilat et al.
modern biology. It also marked the beginning of close 2016). Such an approach makes the analysis of the dis-
collaboration between biology, physics, and progres- sected elements difficult when integrated into a higher
sively other disciplines such as computing. The rela- level of organization (Huijing 2009). This leads to an
tively simple interactions between different pairs of understanding of human body movement based on
nucleotides reveal the almost infinite capacity to store segmental anatomical and biomechanical knowledge.
information in the DNA heteropolymer. It is the inti- However, a body is more than the sum of its parts and it
mate connection between interaction and information is so by virtue of the new properties that arise from the
that constitutes the fabric of living matter. Biological relations between parts. The specificity of body behav-
complexity is based on specific interactions between ior comes from the complex integrated functioning of
molecules. These interactions create complex networks its entirety, and not just from the structural and func-
that are balanced by their interconnection. These net- tional nature of the separate components.
works control and regulate the exchange of signals that In parallel, in the traditional model the concept of
govern intracellular functions and multicellular be- “fascia” is related to some anatomical structures such
havior throughout the development and functioning of as the tensor fasciae latae, the palmar fascia, the thora-
a living organism such as the human body. columbar fascia, and muscle sheaths:
Each person is characterized by the individuality of In this perspective, muscle forces are transmitted serially,
their movements that adapt according to the demands and the torque developed around a joint depends only on the
of their body and the environment and to the resources muscle’s torque arm geometrical configuration. Movement
available at a given time. Movement patterns vary from patterns are therefore, analyzed through a linear framework of
person to person. Equally, the same individual modi- isolated muscle groups, based on singular muscle attachments
fies their movement pattern when performing the same and isolated joint actions. (Garofolini & Svanera 2019)
task multiple times. These differences in movement Anatomical studies of unembalmed cadavers have pro-
patterns are more apparent amongst people suffering vided a new perspective on fascia, which differs from
from the same dysfunction or disease (e.g., mechanical the traditional “fibrous sheet” that “hides” the muscle
low back pain). (Pilat et al. 2016).
1
Without minimizing the importance of treatment The physiological basis of movement is summarized
protocols, it is worth highlighting the need to custom- below, justifying the need to focus on systemic rea-
ize applications according to the individual patient’s soning in relation to body movement (see Volume 1,
requirements. These processes accentuate the need to Chapter 2). The objective of this chapter is to argue for
understand body movement as a set of synergies that the personalization of therapeutic procedures and to
facilitate the exchange of information, communica- justify the inclusion of fascia in this process.
tion, and interaction between each other (see Volume
1, Chapter 17). “Motor synergies represent the coordi- The fascial system and
nation of neural and physical elements embedded in
our bodies in order to optimize the solutions to motor communication between body
problems” (Garofolini & Svanera 2019). systems
At the base of movement organization there is a (somatic) In Volume 1, Chapters 1, 2, and 3, fascia is defined as
equilibrium point that exists on the fascia where the an omnipresent, highly hydrated, richly innervated,
neurologically- and mechanically-generated tensions vascularized network with a contractile capacity – a
dynamically balance out. This somatic equilibrium point is at prodigious complex biological system, which provides
the base of postural control, afferent flow of information to mechanoreceptive information to the body, facilitat-
the nervous system about the state of the muscles, and of the
ing communication, interaction, adaptation, and pro-
tection (Fig. 1.1). From an anatomical and functional
coordinative pre-activation of muscular contraction sequences
perspective fascia is characterized by the continuity
specific for a synergy. (Garofolini & Svanera 2019)
of its path, although its morphology changes along its

CONNECTIVE TISSUE FASCIAL SYSTEM FASCIA

Biological definition Functional definition Morphological definition

Loose connective tissue

holds organs in place and is made up of interpenetrates and surrounds
extracellular matrix and collagenous, all organs, muscles, bones and nerve a sheath, or any other dissectible
elastic, and reticular fibers fibers, endowing the body with a aggregation of connective
Dense connective tissue functional structure, and providing tissue that forms beneath the skin to
makes up tendons and ligaments and an environment that enables all body attach, enclose and separate
consists of a higher density of collagen fibers
systems to operate in an integrated muscles and other internal organs
Specialized connective tissue (Adstrum 2017)
e.g. adipose tissue, cartilage, bone, blood and lymph
manner (Adstrum 2017)
(Kamrani et al. 2022)

Figure 1.1
Systemic interrelationships of the fascia as part of connective tissue

2
 Connecting and moving forward: Fascia as a multifunctional system 1
course, adjusting to mechanochemical requirements a constant exchange of matter and energy). Bernard
and the different conditions and situations of each re- stated that stability of the internal environment is the
gion of the body (see Volume 1, Chapters 2, 3, 6, 7, and essential condition of “free life” (Haldane 1929, Gross
8). Thus, fascia acts as a single functional continuum, a 1998). Figure 1.3 shows the relationship of the body’s
nonfragmentable, complex biological system (Chen et systems with the internal environment (Batuecas 2018,
al. 2021). Vaticón 2018).
The main component of the internal environment
Intersystem links is the interstitium which is composed of extracellu-
The evidence for the anatomical continuity of fascia is lar matrix (ECM) (the substance of the interstitium),
discussed in detail in Volume 1, Chapter 3. However, ground substance, and cells with specialized functions.
in recent years, research has also provided new and The interstitium is a network of fluid-filled cavities that
extensive information on the intrinsic continuity and lies under the skin, covers all organs and cells, and
intersystem dynamics of the fascial system. acts as a shock absorber to prevent tissues from being
torn by the movement of muscles, viscera, and vessels.
The internal environment These cavities are formed from an external structure of
Effectiveness means achieving goals with an appropri- collagen and elastin (proteins that give the structure its
ate (optimal) choice and performance of resources in resistance and elasticity).
any circumstances, mainly in unexpected, emergent
situations (Fig. 1.2). In order to function optimally (be Benias et al. (2018) found that freezing biopsy tissue
effective) each cell of a multicellular structure (such as before fixation preserved the anatomy of the structure
the human organism) needs: and thus demonstrated that the interstitium is sup-
ported by a complex network of thick collagen bundles.
• an integumentary tissue (border tissue) that delim- The authors state that: “These anatomic structures may
its its contents in relation to the external medium be important in… mechanical functioning of many
through which it exchanges matter and energy or all tissues and organs,” including the fascia. Recent
• an internal liquid medium, characterized by optimal research by Cenaj et al. (2020) affirms the continuity
physical-chemical parameters that constitute its im- of interstitial spaces of the colon and mesenteric fascia
mediate environment within and across organ boundaries, including within
perineurium and vascular adventitia traversing organs
• an effective communication system that allows it to and the spaces between them “with significant implica-
act in coordination with other cells, so that the or- tions for molecular signaling, cell trafficking, and the
ganism functions as an integrated whole. spread of malignant and infectious disease.” Interstitial
At the end of the 19th century, Claude Bernard called fibrosis (a progressive condition that is characterized
this liquid internal medium, which is in continuous by fibrous connective tissue replacing normal tissue)
dynamic equilibrium with the external medium, the is produced by injury, infection, and infiltration of in-
internal environment (in contrast to the external en- flammatory cells into the small spaces between tissues.
vironment with which the organism must maintain It can create alterations in the ability of tissues to glide

EFFICIENT EFFICACIOUS EFFECTIVENESS Figure 1.2

Systemic properties: the effectiveness of
RESOURCES GOALS FUNCTION the system

Emphasis on goals
Fulfillment of tasks
Resource protection
+ Emphasis on results
Rationalization
Process improvement
= Optimum development
in tasks with minimum
energy expenditure
Reactive approach Proactive approach
(from past to present) (from present to future)

3
1
O2
CO2
Nutrients
Salts
Water

scular system
Cardiova

INTERNAL
ENVIRONMENT

Unabsorbed
matter

EXTERNAL
Skin ENVIRONMENT

Subcutaneous tissue
(superficial fascia)
with fatty lobes
Organic waste
Excess salts
Water

Figure 1.3
Relationship of body systems with the internal environment (Batuecas 2018, Vaticón 2018)

over one another and compensa­tory processes leading macromolecular network composed of collagens, pro-
to subsequent dysfunction, which can ultimately lead teoglycans/glycosaminoglycans, elastin, fibronectin,
to various pathologies. laminins, and several other glycoproteins. Matrix com-
An essential component of the internal environ- ponents bind each other as well as cell adhesion recep-
ment is the extracellular matrix (ECM) (see Volume 1, tors, forming a complex network into which cells reside
Chapter 4) which “is a non-cellular three-dimensional in all tissues and organs” (Theocharis et al. 2016).

4
 Connecting and moving forward: Fascia as a multifunctional system 1
Mechanotransduction cromatin structure (the complex of genomic DNA and
associated proteins in the nucleus of the cell) (Fig. 1.4)
Cells perceive (sense) their physical environment (the
(Jaalouk & Lammerding 2009).
ECM) through the mechanotransduction process, con-
verting mechanical impulses (forces and deformations) Recent research on the ECM points to the impor-
into biochemical signals, thus activating various signa- tance of its interaction with the contractile structures.
ling pathways. Mechanotransduction has crucial roles “Emerging evidence shows that cells are able to sense
in physiology. “In mammals, embryonic development, and store a memory of their past mechanical environ-
touch, pain, proprioception, hearing, adjustment of ment” (Mathur et al. 2020, Chalfie 2009). As already
vascular tone and blood flow, flow sensing in kidney, described in Volume 1, Chapter 5, fibroblasts are essen-
lung growth and injury, bone and muscle homeostasis tial cells in the dynamics of the ECM and are con­stantly
as well as metastasis are all regulated by mechanotrans- adapting. Their behavior is related to the process of
duction” (Coste et al. 2010). biological memory. Kirk et al. (2021) define biological
memory as “the process of a sustained altered cellular
Adhesion complexes at the cell surface physic­ ally state and functions in response to a transient or persis-
(mechanically) link the ECM to the cytoskeleton (which tent environmental stimulus.” This process is related to
extends from the cell nucleus to the cell membrane) the fibroblasts’ positional, mechanical, inflammatory,
through focal adhesions, comprised of integrins, talin, and metabolic memory and has implications in body
and vinculin, and connect the ECM to actin filaments. homeostasis and disease (Kirk et al. 2021).
Intracellular forces are then transmitted through the
cytoskeletal network (i.e., actin filaments, microtubules, In response, these mechanical signals can adjust cellular
and intermediate filaments). The cytoskeleton is coupled and extracellular structure and functions, such as migra-
to the nucleus through nesprins (proteins located main- tion, proliferation, adhesion, invasion, differentiation, ap-
ly in the outer membrane of the cell nucleus). Finally, optosis, and gene expression, that are vital for maintain-
ing homeostasis (Jaalouk & Lammerding 2009). Changes
lamins (nuclear proteins which have a structural func-
in cellular structure and organization, or changes in the
tion and line the inside of the nuclear membrane) bind
cellular environment, can disturb the mechanotransduc-
DNA, thus completing force transmission between the
tion process and result in altered cellular function.
ECM and the interior of the nucleus and reaching the

EXTRACELLULAR FORCE

Cell membrane plasma Nuclear envelope complex

EXTRACELLULAR MATRIX CYTOSKELETON NUCLEAR NETWORK
Focal adhesion Cytoskeleton network
• Integrins • Actin filaments
Extracellular • Talin Cytoskeleton • Intermediate Nuclear
mechanosensitive • Vinculin mechanosensitive filaments mechanosensitive
protein response protein response • Microtubules protein response
• Collagen • Actin filaments • Nesprins
• Laminin • Lamins
• Fibronectin • Cromatin*

Figure 1.4
Mechanotransduction process: force transmission from the extracellular matrix to the cell nucleus structure (see Volume 1, Chapter 8). *Chromatin is a complex of
genomic DNA and associated proteins in the nucleus of the cell.
After Jaalouk DE & Lammerding J (2009) Mechanotransduction gone awry. Nature Reviews Molecular Cell Biology 10(1):63–73

5
1
PIEZOS (and TRPV1) can induce chronic inflammatory diseases in multiple
The 2021 Nobel Prize in Medicine was awarded to body systems (Fig. 1.6). PIEZO2 is the main mechani-
­David Julius and Ardem Patapoutian for the discovery cal sensor for touch. Proprioception, which is also based
of temperature and touch receptors, which has provid- on PIEZO2, is the recognition of the body and its seg-
ed insight into how heat, cold, and mechanical force ments in three-dimensional space. Piezos are involved
can initiate the nerve impulses that allow us to perceive in mechanotransduction in several critical processes,
and adapt to the world. Julius identified the TRPV1 ion including tactile sensation, balance, and cardiovascular
channel as a heat-activated nociceptor in the peripheral regulation (Mahmud et al. 2017). PIEZO1 also plays an
nervous terminus, providing insights into the molecular important role in regulating CNS processing (Fig. 1.7)
mechanisms of thermoreception (Ernfors et al. 2021). and participates in the regulation of the baroreceptor
reflex (Fig. 1.8). This discovery was considered a land-
Patapoutian discovered a new class of sensors that mark finding in the understanding of the important life
react to mechanical stimuli in the skin and internal activity of mechanical force in mammals. Changes in
organs, revealing “crucial missing links” in under- mechanical forces (such as osmotic pressure) that main-
standing the relationship between the senses and the tain life activities can influence cellular dynamics as a
environment. He took a giant step in developing the result of alterations in piezos, consequently triggering
research of Joseph Erlanger and Herbert Gasser who different pathological processes:
received the Nobel Prize in Medicine in 1944 for their
“discoveries related to the differentiated functions of
• Haliloglu et al. (2016) report that: “Sensory ataxia
and proprioception defect with dorsal column in-
single somatosensory nerve fibers. These discoveries
volvement together with arthrogryposis, myopathy,
established important principles for the propagation of
scoliosis and progressive respiratory failure may
action potentials along skin and muscle sensory nerve
represent a distinct clinical phenotype, and indicate
fibers” (Ernfors et al. 2021).
recessive mutations in PIEZO2.”
Patapoutian identified the mechanically sensitive
piezo ion channels. These channels contain two struc-
• Mahmud et al. (2017) report that the dominant mu-
tations in PIEZO2 can cause different forms of distal
turally and genetically similar proteins, PIEZO1 and
arthrogryposis.
PIEZO2, which are mechanically activated and medi-
ate touch perception, proprioception, and vascular de- • García-Mesa et al. (2017) demonstrate the “occur-
velopment. A mechanosensitive ion channel is an ion rence of Piezo2 in cutaneous sensory nerve for-
channel that can sense changes in the mechanical force mations that functionally work as slowly adapting
of the cell membrane and react quickly. It is suggested (Merkel cells) and rapidly adapting (Meissner’s cor-
that piezos consist of two segments – the extracellular puscles) low-threshold mechanoreceptors and are
and the intramembranous components. When a me- related to fine and discriminative touch but not to
chanical force acts on the cell membrane, the extracel- vibration or hard touch.”
lular component will drive the intramembranous seg- • Mikhailov et al. (2019) suggest the involvement of
ment thus opening the orifice for ion flow. This reaction mechanosensitive PIEZO1 in peripheral trigeminal
of the ion channel can convert the mechanical signal nociception, which provides a new view on mech-
sensed by the membrane into an electrical signal or a anotransduction in migraine pathology and suggests
chemical signal (Creative Diagnostics 2021). Each type novel molecular targets for antimigraine medicine.
of receptor has a slightly different use (Fig. 1.5). ­PIEZO1
is part of the blood pressure monitoring system as well • Wang & Hamill (2021) conclude that: “Our pro-
as other internal systems that rely on pressure sensing, posed, non-synaptic, intrinsic mechanism, where
such as the respiratory, gastrointestinal, or urinary Piezo2 tracks the highly predictable and ‘metro-
systems. PIEZO1 receptors are also found in the inner nome-like’ intracranial pressure pulses… would
lining of blood vessels and can detect increased blood have the advantage that a physical force rapidly
flow during physical exercise. The P ­ IEZO1 channel also transmitted throughout the brain also contributes
responds to a variety of mechanical force activation and to this synchronization.”

6
 Connecting and moving forward: Fascia as a multifunctional system 1
• He et al. (2021) investigated the role of the mech- or link to other unexplored intercellular and intra-
anotransduction of PIEZO1 in hypertrophic scar cellular signaling pathways in pain circuits.
formation. They observed that PIEZO1 was overex-
As fascial tissue is the safeguard of body homeostasis,
pressed in myofibroblasts from scar tissue. In vit-
an alteration in mechanotransduction can affect organ
ro cyclic mechanical stretching revealed increased
development and function and can trigger pathological
­PIEZO1 expression in human dermal fibroblasts. The
processes giving rise to inflammatory, autoimmune,
authors state that the involvement of mechanical force
and degenerative changes and tumor progression
is a key regulator in hypertrophic scar formation.
(Jaalouk & Lammerding 2009).
• Shin et al. (2021) suggest that PIEZO2 is widely ex-
pressed by neuronal and non-neuronal cells of the Homeostasis
peripheral nervous system and by neurons in the In 1926 the physiologist Walter Cannon coined the
spinal cord and brain. They conclude that PIEZO2 term homeostasis, defining it as: “The capacity that
is not only involved in the detection of external me- living organisms have to maintain constant the char-
chanical stimuli in the skin but may also serve to de- acteristics of their internal environment” (Cooper
tect internal mechanical cues in the nervous system 2008). Batuecas (2018) points out: “Cannon uses the

TRPV1

Pain from
Temperature
heat

Core body Inflammatory Neuropathic Visceral Protective

temperature pain pain pain reflexes

A
PIEZO1 PIEZO2

Mechano- Proprio-
Touch Touch
sensitivity ception

Nonsensory Lymphatic Vascular tone Mechano- Mediation of Breathing Blood Mechanical Urination Skeletal
tissue valve control Blood pressure sensors chronic pressure pain remodeling
mechano- control in central inflammatory
reception nervous diseases
system related to
capillaries mechanical
stress

B C

Figure 1.5
Expression and function of the newly discovered mechanically sensitive piezoelectric channels in multiple tissues and cells. The human body is permanently exposed to
mechanical forces, either passively applied or generated inside cells. Cells can sense whether the mechanical stress of the microenvironment changes and can adapt to
altered mechanical demands. Most physiological processes are related to mechanical force, which is also one of the initiating factors of tissue damage and inflamma-
tion (Fang et al. 2021, Ernfors et al. 2021, Liu et al. 2022, Kendroud et al. 2021)
A Response of TRPV1 thermal sensitive ion channels
B Response of PIEZO1 mechanical sensitive ion channels
C Response of PIEZO2 mechanical sensitive ion channels

7
1
MECHANICAL FORCES

PIEZO1 channel Mechanotransduction

Neural Vascular Respiratory Articular Obesity Urinary Immune

Glial cell Myocardial Vascular Lung Nucleus Chondrocyte Fat cell Endothelial cell Immune cells
activation inflammation endothelial inflammation pulposus inflammation inflammation dysfunction
cell inflammation
inflammation

Neuro- Myocardial Athero- Hyper- Pulmonary Spine Osteo- Insulin Cystitis Immune
inflammation fibrosis sclerosis tension fibrosis degeneration arthrosis resistance regulation

Neuro- Cardiac
degenerative hypertrophy
diseases

Figure 1.6
The PIEZO1 channel responds to various mechanical force activations and can induce chronic inflammatory diseases in multiple body systems.
After Liu et al. (2022) Piezo1 channels as force sensors in mechanical force-related chronic inflammation. Frontiers in Immunology 13:816149

word ‘constant,’ which, if interpreted in a strict sense, Exteroception

means ‘invariable.’ However, the same author, when
Exteroception can be defined as sensing the outside.
calling this property ‘homeostasis,’ points out that the
The environment plays a critical role in the mainte-
prefix ‘homeo’ means ‘similar,’ and not ‘homo’ which
nance of normal cell, tissue, organ, and body features
means ‘the same.’ Cannon highlights with this clarifi-
related to movement. The brain learns through the
cation his idea that the values that define the composi-
performance of movements. The more an action is re-
tion and other properties of the internal environment
peated, the better the brain anticipates it and sends the
can vary, although within narrow margins.” It can be
correct commands to the rest of the body. The sensory
concluded that homeostasis means the maintenance
inputs do not trigger motor action, rather they cor-
of a stable dynamic state in a system through internal
rect the prior estimated probability (prediction error)
regulatory processes that counteract external distur-
to create the posterior probability of the final action
bances of balance.
(prediction remodeling) (Bubic et al. 2010). It should
The appropriate fluctuation (feedback) of/between be noted that the brain does not see the future, ­rather
the homeostatic parameters and the consequent opti- it uses past experiences to anticipate the probable fu-
mal performance of body movement depend on the ef- ture. Thus, it makes it easier to face dangerous situ-
ficient functioning of the three sensory systems exter- ations by making intelligent predictions about what
oception, proprioception, and interoception that make could happen in the immediate future even when the
up a coherent and integrated body map (body matrix) attention is elsewhere. The fact that the prediction of
(Fig. 1.9). events is independent of the state of attention suggests

8
 Connecting and moving forward: Fascia as a multifunctional system 1
PIEZO1
Figure 1.7
The role of PIEZO1 channels in the regulation
of CNS processing. The mechanical behavior
of the neural stem cell substrate affects the
behavior of PIEZO1 channels. This process leads
to neuronal differentiation and the development
of neurite morphology and neuron-astrocyte
Substrate stiffness Neural stem cell
interactions.
After Fang et al. (2021) Structure, kinetic proper-
Neural differentiation ties and biological function of mechanosensitive
Piezo channels. Cell & Bioscience 11(1):13

PIEZO1 suppression PIEZO1 activation

Neuron-astrocyte interaction

Neuron

Astrocyte

Substrate roughness

an automatic process. In addition to the visual cor- consciously thinking about our environment. Intersti-
tex, this process of anticipating the immediate future tial receptors (free nerve endings: Aδ and/or C fibers)
involves the hippocampus, which is linked to mem- and muscle spindles participate in this process. Neu-
ory which is also involved in anticipating the future rons sense touch, and acceleration, and respond rapidly
(­Ekman et al. 2017). to specific mechanical signals. Thus, when we move our
brain senses the effort, force, and heaviness of our ac-
Proprioception tions and positions through the sensory receptors locat-
Proprioception, or kinesthesia, is the body’s ability to ed on the skin, joints, and muscles and responds accord-
sense its location, movements, and actions. It is based ingly (Proske & Allen 2019, Basmajian & De Luca 1985).
on a continuous loop of feedback between sensory re-
Fascia is vital for the proper functioning of the pro-
ceptors throughout the body and the nervous system.
prioceptive system (Stecco et al. 2007). The presence
It is the reason we are able to move freely without
of mechanoreceptors (Aδ and/or C fibers) (Magerl et

9
1
Figure 1.8
The role of PIEZO1 and PIEZO2 in the regulation of
the baroreceptor. The increase in blood pressure
causes widening of the aorta and carotid artery
and is detected by the abundant PIEZO1 and
PIEZO2 channels in the nodose-petrosal-jugular
ganglion complex. This complex contains the
cell bodies of the aortic baroreceptor neurons
that send information via the vagus nerve to the
nucleus of the solitary tract in the medulla (as
do the carotid receptors via the glossopharyn-
geal nerve). The baroreceptor reflex is an
integrated reflex that allows changes in blood
pressure to be corrected, mainly by varying
PIEZO1 cardiac output and peripheral resistance to
PIEZO2 the passage of blood. The force of high blood
Glossopharyngeal
pressure is transformed into an electronic signal
nerve
through the activation of PIEZO1 and PIEZO2,
which is transmitted to the spinal cardiovascular
Nucleus of the
center. Stimulation of the nucleus of the solitary
solitary tract
tract inhibits sympathetic activity toward
Nodose-petrosal-jugular peripheral blood vessels producing a depressant
ganglion complex effect. Consequently, blood pressure and heart
rate are reduced.
After Fang et al. (2021) Structure, kinetic proper-
ties and biological function of mechanosensitive
Piezo channels. Cell & Bioscience 11(1):13
Vagus nerve

High blood Cardiac Inhibition of

pressure parasympathetic sympathetic
activity activity
Carotid sinus

Depressant effect
Aortic baroreceptors (low pressure)

Low heart rate Peripheral vessels

10
 Connecting and moving forward: Fascia as a multifunctional system 1
MOVEMENT Figure 1.9
Movement and the integrated body matrix
response – integration of the three senses
(exteroception, proprioception, and inter-
EXTEROCEPTION PROPRIOCEPTION INTEROCEPTION oception). Activation of the interoceptive
(primary senses) (sense of movement) (internal senses) adjustments can lead to an autonomic
nervous system response (sympathetic or
parasympathetic) or can allow the perfor-
e.g., sound, light, e.g., body location e.g., physiological mance of a habitual action such as drinking a
discriminatory touch in space condition of the body
cup of coffee.
1
General rules intended to regulate behavior
or thought.
2
Steps in reasoning, moving from a premise
to logical consequences.
Emotions Autonomic After Quattrocki E, Friston K (2014) Autism,
Precepts1 Inferences2 Motion Progress (sense of self) response
oxytocin and interoception. Neuroscience and
Biobehavioral Reviews 47:410–430

Kinesthetic and
Sensory prediction Interoceptive
proprioceptive
adjustments prediction adjustments
prediction adjustments

al. 2021, Langevin 2021, Fede et al. 2020, Mense 2019, receptors. Numerous neuromuscular diseases affect
­Corey et al. 2011, Tesarz et al. 2011) and muscle spindles muscle spindle function contributing, among others,
(Banks & Barker 2004) embedded in the fascial tissue to an unsteady gait, frequent falls, and ataxic behavior
suggests active participation of the fascia in proprio- in affected patients (Kröger & Watkins 2021, Blecher
ception, force transmission, and motor control (Mense et al. 2017).
2019). The proprioceptive role of the fascial network
means that it can update the central nervous system Interoception
on mechanical tension so that it operates motor units Earlier concepts have usually related interoception to
at the right time, rate, and stage of force. According to visceral sensations. However, interoception is cur­rently
Mense (2019), the lack of corpuscular proprioceptors in defined as the feeling of the physiological condition of
the fascial tissue is not an argument against a proprio- the whole body.
ceptive function of the fascia. As humans, we perceive and feel our bodies in rela-
Muscle spindles are present in the vast majority of tion to our state of well-being, our energy and stress
muscles and are considered the most important propri- levels, and our mood and disposition. In order to suc-
oceptors (Proske & Gandevia 2012). Banks and Barker cessfully navigate the world, we must constantly shape
(2004) estimate the presence of approxi­mately 50,000 and reshape motor outputs to best reflect the demands
muscle spindles in the entire human body. These fine of the environment. When environmental demands
receptors (embedded in the muscular peri­ mysium suddenly change the reshaping of motor outputs re-
and endomysium [Stecco & Stecco 2019]) inform the quires dynamic subsecond changes in action plans to
CNS about the contractile condition of muscles (the adaptively meet the new constraints of the environ-
length and speed of stretching of the fascicles), muscle ment (Brockett at al. 2020).
force, heaviness, stiffness, viscosity, and stress (Kröger Interoception plays an important role in the percep-
& Watkins 2021, Licup et al. 2015). Motor control, tion, anticipation, and generation of pain. Tissue mi-
our posture and locomotion are in charge of these crotrauma, inflammation, and fibrosis can not only

11
1
change the biomechanics of soft tissues (e.g., increasing
their rigidity), but can also profoundly alter the sen­sory Insular cortex
input derived from the affected tissues. Alterations in
interoceptive awareness are clinically related to the se-
verity of chronic pain. Lateral spinothalamic tract
(direct projection)
Research has identified an afferent neural system in
primates and humans that represents all physiological
aspects of the physical body. This system constitutes Is a new phylogenetic
a representation of the material self and could pro- Prebrachial nucleus acquisition exclusive to
vide a foundation for subjective feelings, emotion, and primates and humans?
self-awareness (Fig. 1.10) (Craig 2003) (see Volume 1,
Chapter 8 and Fig. 8.6). Interoceptive awareness pro-
Lamina I
vides a measure of sympathetic and parasympathetic in dorsal horn of spinal cord
activity, as well as a potential marker for deficits in
self-regulation, and can modulate the exteroceptive
representation of the body through interoceptive pre-
diction. In this sense, interoceptive prediction is a re- Homeostatic afferent system
Aδ and C fibers (free nerve endings)
ality, as is exteroceptive prediction. Since the brain is (afferent neurons related to interoception and pain)
a generator of “expectation” affecting the entire body
system, all of its subsystems act according to this prin-
ciple (Barrett & Simmons 2015) (Fig. 1.11). Figure 1.10
The spinothalamocortical interoceptive pathway (see Volume 1, Chapter 8 and
Collagen network Fig. 8.6).
After Craig AD (2003) How do you feel? Interoception: The sense of the physi-
In recent years numerous research papers on the be- ological condition of the body. Nature Reviews Neuroscience 3(8):655–666
havior of collagen have been published. This is due
to the cooperation between different branches of sci-
ence, such as molecular biology, chemistry, physics,
and computer science. Researchers underline the im-
portance of analyzing the mechanical aspects of col-
tendons, can deform by about 20 percent before rup-
lagen and its participation in the mechanotransduc-
ture. By contrast, collagen networks can deform by up
tion process.
to 85 percent before they break (Iqbal et al. 2019, Burla
Collagen is the main load-bearing component of the et al. 2020).
fascial tissue. It is a structural scaffold network (see
The design of a distributed collagen network implies
Volume 1, Chapter 5) which establishes the shape and
that communications are carried out between cross-
stiffness of tissues and protects them from mechanical
link points without establishing an intermediary that
failure. It manages the alterations of external loads by
is in charge of central information management. There
modifying (adjusting) its structural alignment through
is no central server, but each user becomes a server
the chemical components that modify the design of its
for their own information and transmits it to others
interfaces (cross-links).
(Sharma et al. 2016). Thus, after a deformation of the
Each individual collagen bundle is relatively rigid, al- fascial network reversibility is possible due to the re-
though its spatial arrangement can provide some resil- ticular grid-like arrangement of the collagen bundles
ience, as collagen molecules self-assemble into a fibrous (Mense 2019). Burla et al. (2020) report that: “Collagen
continuous and dynamic dispersed network (“network networks possess a hierarchical structure that can dif-
of networks”), at all levels of their construction and can fer at the network level (mesh size), fibril–fibril inter-
harden with increasing stress. Individual collagen fib- action level (junctions formed either by branching or
ers in regular dense connective tissue, such as those in fibril-fibril crossings), and fibril level (diameter) and

12
 Connecting and moving forward: Fascia as a multifunctional system 1
Interoceptive stimuli Exteroceptive stimuli

Cognitive processing of body signals Responsiveness to external stimuli

is the key to the body's self-awareness

Figure 1.11
Processing of interoceptive and exteroceptive stimuli by the brain.
After Khalsa et al. (2018) Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging 3(6):501–513

molecular level (intrafibrillar cross-linking via telo- The elasticity of the collagenous network can also be
peptide end regions).” affected by the intrinsic dynamics of the cells. Myosin
filaments can actively stimulate actin filaments (an-
The connectivity, plasticity (adaptability), breaking
chored in the network by cross-linking) and through
strength, and efficiency of networks is controlled by
them modify the internal tension and behavior of the
their connectivity (shape and number of cross-links
tension network. Stiffness changes occur in a non­
and/or branches) rather than the properties of an iso-
linear manner and are distributed through cross-links
lated fiber (Burla et al. 2019, Koenderink et al. 2009).
between actin filaments (Koenderink et al. 2009).
Optimal configurations are between three or four
cross-links of each fiber per intersection. A higher Alterations in the secretion of collagen by fibroblasts,
number of cross-links makes the collagen networks as a result of mechanical changes (prolonged patholog-
less elastic, thus stimulating the development of their ical stress over time) and chemical adjustments (exces-
rigidity (Burla et al. 2020). sive secretion of transforming growth factor beta-1),

13
1
can also alter fascial dynamics. The process arises due • Chemical input: Aging increases the amount of type
to modifications of the environment (the ECM) of the I collagen fibers in the extracellular matrix (ECM)
mechanoreceptors and can alter other processes, such of the epimysial fascia and thus increases its stiffness
as the transfer of interoceptive and proprioceptive (Pavan et al. 2020).
information (Fig. 1.12) (see Volume 1, Chapters 7, 8, • Mechanical input: Immobilization and hypomobil­
and 9). ity produce a pronounced thickening of the muscu-
lar connective tissue, which affects the elasticity or
The intrinsic structure of a collagen fibril is complex, stiffness of the muscle (Slimani et al. 2012) and con-
facilitating mechanical and electrical (piezoelectric) sequently leads to dynamic changes in joints (Wilke
properties in interaction with other tissue compo- & Tenberg 2020).
nents. This phenomenon allows collagen to modulate
the structure of the tissue and therefore its behavior. Fascial mechanosensitivity
Collagen can function effectively in a wide variety of Fascia when subjected to deformation has the extraor-
tissue configurations providing exceptional mechan- dinary ability to change drastically from a smooth
ical performance and fitting specialized applications. and elastic movement to a state of maximum resist-
For more information see Volume 1, Chapter 13 and ance according to the intensity of the impulse received
above in this chapter. (Burla et al. 2020). This ability is crucial for biological
function: When tissue is elastic cells can move. At the
Collagen structure can be modified as a result of var- same time, the tissue protecting the cells must not
ious inputs: break; therefore, it becomes stiffer when the deforma-
tion is excessive (Burla et al. 2019, Burla et al. 2020).
• Hormonal input: Fibroblasts have specific receptors After a deformation of the fascia, reversibility is possi-
on the plasma membrane for estrogen and relaxin, ble due to the lattice-like arrangement of the collagen
which could regulate the production of collagen I, bundles (Mense 2019, Iqbal et al. 2019). The elasticity
collagen III and fibrillin (Fede et al. 2019).

Figure 1.12
Fibroblast–collagen behavior and the changes
in fascial dynamics (see Volume 1, Chapter 5).
Based on a drawing by Eduardo Castro Martín

14
 Connecting and moving forward: Fascia as a multifunctional system 1
and internal stress generated by hyaluronic acid (HA) Tissue microtrauma, inflammation, and fibrosis can
are crucial in this task (gliding behavior), significant- not only change the biomechanics of soft tissues (e.g.,
ly changing the mechanical response of the compos- increasing their rigidity), but can also profoundly alter
ite networks of the fascial system (Stecco et al. 2013, the sensory input derived from the affected tissues.
Stecco et al. 2018). HA is the reservoir of water and The properties of the fascial mechanoreceptors, Aδ
lubricant in areas of gliding movement, such as joints and C fibers, are widely discussed in Volume 1, Chapter
(synovial fluid), tendons, pleura, pericardium, and the 8. Inflammation of direct or neurogenic origin in­creases
intermuscular spaces. Its participation in scar forma- the density of nociceptive fibers which may explain pain
tion, ovulation, fertilization, transduction, and tumor when fascia is altered (Mense 2019). These fibers are re-
physiology is relevant (Pratt 2021). Fasciacytes (a form sponsible for transmitting nociceptive afferent signals
of fibroblasts) are the cells involved in HA synthesis. and can project the traumatizing stimulus to the insu-
HA deficiency causes changes in the viscoelasticity of lar cortex instead of the primary somatosensory cortex
fascial tissue and modifies the activation (irritation) of (which is the projection of proprioceptive sensations).
interstitial receptors. This process can alter innerva- Free nerve endings are capable of bidirectional signal-
tion patterns (increased receptor density) and can be ing, and therefore they can contribute to the processes
involved in nociception (Fede et al. 2021b). In recent of peripheral and central pain sensitization (Fig. 1.13).
research Stecco et al. (2022) suggest that accumulation Continuous activation of nociceptors can worsen fibro-
of HA in the ECM can increase fluid viscosity, lead- sis and inflammation, causing further tissue stiffness
ing to a lack of gliding between muscle fibers, reduced and consequent movement impairment (Strigo & Craig
force transmission, and consequently increased resist- 2016, Ikeda et al. 2003, Koltzenburg 1999).
ance or stiffness during attempted movement. Final- Helene Langevin, the renowned researcher in the
ly, they suggest that the consequent alteration in the field of fascial dynamics, points out in her recent paper
structure and function of the muscle, defined as con- (Langevin 2021) that “fascial mobility, proprioception
tracture, is related to the excess of HA from the ECM and myofascial pain are three topics that until now
that was later replaced by collagen, leading to perma- have not been covered in the scientific literature, how-
nent and irreversible thickening of the endomysium ever they have a lot to do with each other. Myofascial
and ­perimysium. pain is an emerging discipline that requires the devel-
opment of robust tissue biomarkers, to facilitate the de-
Fascia and nociception velopment of effective treatments.” Fortunately, in re-
The network of fasciae is an important part of the cent years, extensive and interesting research has been
musculoskeletal system that is often overlooked. Fascia published in relation to the nociceptive role of fascia:
mobility, especially along shear planes separating muscles, • Mense (2019) points out that the fascia nociceptors
is critical for musculoskeletal function and may play an are the beginning of a nociceptive pathway from the
important, but little studied, role in proprioception. Fasciae, soft tissues to the spinal dorsal horn and probably
especially the deep epimysium and aponeuroses, have recently further to higher centers.
been recognized as highly innervated with small diameter • Fede et al. (2020), in a precise and detailed micro-
fibers that can transmit nociceptive signals, especially in the scopic study of patients with persistent pain after
presence of inflammation. Patients with connective tissue successful hip joint replacement surgery, shows that
hyper- and hypo-mobility disorders suffer in large number from the most intensely innervated tissues are (in de-
musculoskeletal pain, and many have abnormal proprioception. scending order): the skin, the superficial fascia, and
The relationships among fascia mobility, proprioception, the muscles. The tendon and the joint capsule were
and myofascial pain are largely unstudied, but a better found to be poorly innervated.
understanding of these areas could result in improved care for • Magerl et al. (2021) point out that “the balance between
many patients with musculoskeletal pain. (Langevin 2021) pain-inhibiting and pain-facilitating mechanisms

15
1
Inflammation Neurogenic
<pH inflammation

FASCIAL TISSUE Aδ AND NEURONAL SOMA

INJURY C FIBERS Ganglion of the HORN CNS
posterior root

• Release of neuronal
action potential and Release of Hyperexcitability • Adaptive (plastic)
decrease in neuropeptides changes in cortical
• New synapses
excitation threshold toward affected structures
• Spontaneous
• Activation of "silent" tissue and posterior • Creation of
activity
mechanosensitive medullary horn dysfunctional motor
• Amplification of
nociceptors (substance P, CGRP) pattern
receptor fields
• Edema
• Inflammation

Peripheral sensitization Pain

Primary hyperalgesia Central sensitization
Allodynia
Secondary hyperalgesia

Influences
Cognitive, emotional, behavioral, cultural, social, family, genetic, environmental...

Figure 1.13
The nociception process. CGRP – calcitonin gene-related peptide
Based on a drawing by Germán Digerolamo

differs between fascia and muscle, making the fascia related muscular tissue.” The authors conclude that
a more likely source of hyperalgesia ­induction.” “our observations may denote that the deep fascia
and its various components could be a source of
• Weiss and Kalichman (2021), analyzing the contri-
pain in different pathologies and various pain syn-
bution of the deep fascia to various painful condi-
dromes.”
tions from histological and experimental studies,
report that “different components of the deep fascia, • Sinhorim et al. (2021) reviewed the conclusions of
both in humans and animals are richly inner­vated, 257 articles (of which 10 met the inclusion criteria)
with some differences between body segments. based on histological, immunohistochemical, elec-
These fascial components usually exhibit dense in- trophysiological, behavioral, and clinical evidence.
nervation, encompassing amongst others, nocicep- The authors report that: “Noxious chemical injection
tive afferents. The application of different types of or electrical stimulation into fascia resulted in longer
stimuli, i.e., electrical, mechanical, and chemical to pain duration and higher pain intensities than injec-
these fascial components produces long-lasting pain tions into subcutaneous tissue or muscle.” They con-
responses. In some cases, the intensity and severity clude that: “Studies showed histological evidence of
of pain produced by the stimulation of fascia were nociceptive nerve fibers terminating in lower back
higher than ones produced by the stimulation of the fascia, suggesting a TLF contribution to LBP.”

16
 Connecting and moving forward: Fascia as a multifunctional system 1
• Fede et al. (2021a) in histological research examined Plasticity (ability to adapt)
the differences in innervation between the aponeu- Humans, like other vertebrates, have to adapt their
rotic and the epimysial fascia. The authors suggest physiological condition to environmental changes.
“that the two fasciae have different roles in proprio-
ception and pain perception: the free nerve endings
inside thoracolumbar fascia may function as pro- The nervous system and connective tissue (fascia) are
prioceptors, regulating the tensions coming from characterized by the ability to change over time and the
associated muscles and having a role in nonspecific potential for reversibility.
low back pain, whereas the epimysial fasciae works
to coordinate the actions of the various motor units
of the underlying muscle.” To define this process William James introduced the
• Vogel et al. (2022) suggest that pain radiation is term plasticity, stating that “the laws of Nature are
not simply an effect of increased peripheral input nothing but the immutable habits which the different
but may afford an individual disposition for the elemen­tary sorts of matter follow in their actions and
pain ­radiation response. Substantially higher pain-­ reactions upon each other” (James 1890). Although the
sensitivity and wider pain areas support fascia as an concept was defined in the field of psychology, it was
important contributor to nonspecific low back pain. Santiago Ramón y Cajál (1911) (the father of modern
neuroscience) who suggested the anatomical substrate
Neural code of plasticity at the end of the 19th century. Current-
The activity of the neurons of the cerebral cortex rep- ly, we have extensive evidence of the capacity for ana-
resents the sensory information that we acquire from tomical and functional modification or adaptation of
our environment, as well as the fundamental motor the organism throughout life. Research focuses on the
and cognitive functions. We can hypothesize that cellular and molecular basis of neural plasticity that
mechano­chemical alterations of the fascial tissue can is made up of the neuron and glia. Neural plasticity is
influence the dynamics of the neural code and the con- induced by the experience of a wide range of stimuli,
sequent decision-making related to movement. The such as environmental pressures, modifications in the
neural code is the set of combinations of activated neu- internal condition of the organism, or injuries (Nieto-­
rons that represent in the brain the reaction to a set of Sampedro 1999, Nieto-Sampedro & Nieto-Díaz 2005).
stimuli (Li & Tsien 2017). It represents the direct rela- The glial cells, among which we should highlight the
tionship between the activity of neurons, the activity of astrocyte, have recently been shown to be involved in
the muscles, and the behavior of the subject (see Vol- many nervous system functions such as neuroregen-
eration processes (Katiyar et al. 2017). Astrocytes are
ume 1, Chapter 8). The neural code changes every mo-
mechanosensitive cells. They detect mechanical chang-
ment: “it is liquid and constantly flowing” (Yuste 2015).
es through the mechanosensitive ion channel protein
The same set of stimuli can be represented with differ-
PIEZO1. They participate in synaptic activity (plastici-
ent neural codes. The neural code affects the function-
ty) and in the processing of information in the brain.
ing of neural networks in relation to learning (Miguel-
They also maintain the density of capillaries in the
Tomé 2019). In this way spatial objectives and the exact
muscles, thus participating in the capacity for physical
performance of movement are related to planning and
activity (Velasco-Estevez et al. 2020).
higher level aspects rather than to the details of motor
execution. From homeostasis to allostasis (Fig. 1.14)
From this brief analysis a question arises about the Homeostatic basal conditions (heart and respira­tory
adaptation of movement in the face of a traumatizing rate), blood pressure, hormonal levels, and blood glu-
event, particularly when maintained for an extend- cose level alter depending on the needs that arise (e.g.,
ed period of time or repeated over time (stress). Are during activities such as sports training or hard physi-
the prolonged and frequent adjustments available to cal work, when facing aggression or danger, or during
homeo­stasis enough to protect the organism? pregnancy).

17
1
Well-being State of alert Danger Instability
Stability Disturbance

Baseline conditions Quick response – short Elevated glucose levels Neuroimmunoendocrine

regulated by the duration Immune system response
circulatory, respiratory, ANS1 sympathetic division depression
excretory, digestive, Limbic system
endocrine, and nervous Noradrenaline –
systems adrenaline Distress (long-lasting
alarm response)
Acute short aggression Long-lasting aggression Expectation
STRESS/DISTRESS ALLOSTASIS3
HOMEOSTASIS FIGHT OR FLIGHT2
Anticipation of fight Diversity of stressors Predictability
or flight Nonspecific response Anticipation
Intense motor activity Cortisol Alteration of
Reflex action at lower Increased energy within sensory input
levels of the brain: the (not always) limits compatible with life Continuous activation
olfactory bulb of the of nociceptors
brain and the pons Cardiac output
No need for conscious Blood pressure
participation Blood glucose

ALLOSTATIC LOAD

Neurogenic response
Chronic pain

Permanent state
of alert

Figure 1.14
From homeostasis to allostasis and allostatic load
1
ANS – autonomic nervous system.
2
In our species the fight-or-flight response frequently does not indicate a motor response. However, when it is prolonged over time it becomes successively a stress
and then a distress* response. All the phases of stress and distress carry a degree of “allostatic load.” In distress this load can be triggered excessively.
3
Allostasis is not a process that acts in isolation, rather it includes, adapts, and maintains the original homeostasis (stability). Allostasis is thought to enhance the
function of homeostatic resources.
*
Distress is oppressive fear without a precise cause. It is an unpleasant emotion, feeling, thought, condition, or behavior that can affect the way we think, perceive
impulses, and act. Its accumulation over time can affect the way we make decisions and our attitudes to health and well-being. People may express distress through
sadness, anger, fear, helplessness, and/or despair. They look insecure, depressed, anxious, or overly worried and are easily panicked.

The distinguished physiologist Cannon (1915) con- experience that involves the limbic system (Batuecas
cluded that in most cases dangerous and short-term 2018 quoting Cannon).
aggression requires an intense motor response which
When the response to aggression is prolonged over
he called fight-or-flight response. This response requires
time, its fundamental protagonist is the hypothalamic–­
simultaneous participation of the sympathetic division
pituitary–adrenal axis. Its characteristics were discov-
of the autonomic nervous system (ANS) that provides
ered by Selye (1956) who called it General Adaptation
the muscles with a large amount of energy in a very
Syndrome or stress response. The stress response is a
short time, to always guarantee that the characteristics
nonspecific response that is activated against alarm
of the internal environment remain within the limits
factors (stressors) of a very diverse nature. Stress is
compatible with life. In addition, this response already
characterized by an increase in the amount of cortisol,
has a conscious component based on instinct and

18
 Connecting and moving forward: Fascia as a multifunctional system 1
the main consequences of which are an increase in glu- impairment. Allostatic load is the price that the body
cose levels and depression of the immune system. pays for being forced to adapt to adverse conditions
that should be turned off at the end of stressful cir-
Prolonged stress that leads to high levels of cortisol
cumstances. An excessive allostatic load accumulates
and catecholamines maintained over time is a non­
resulting in a “distress response” (chronic stress).
adaptive response (long-term alarm response or dis-
tress) that is associated with functional alterations Allostasis and the fascial system
with undesirable consequences (Selye 1974). This phase
The allostasis approach fits with the modern concepts of:
is characterized by a considerable functional overload
of the cardiocirculatory system, a notable alteration in • sensory physiology (how cells convert the extero-
the endocrine profile (the concentration of hormones ceptive signals to relay information about stimuli to
increases or decreases inappropriately), immunosup- the nervous system)
pression, cognitive dysfunctions, and unpleasant mood • neural computation (behavior of a set of artificial
states (anxiety and/or depression). neurons, connected to each other to transmit signals)
Taking into account the changing needs of the organ- • optimal design (the benefit of adapting to the selec-
ism, a new model of physiological regulation termed “al- tive stimulus of the environment).
lostasis” was proposed (Sterling & Eyer 1988). Allostasis
consists of the ability of complex biological systems to The morphofunctional characteristics of the fascia
preserve their organization not only through reactive (summarized in this chapter), as well as its integration
responses but also through anticipatory maneuvers into the nervous system, allow it to be highly adaptive.
When the system operates according to the principles
(predictive responses). Prediction requires each sensor
of tensegrity, it can adapt a pre-tension state. Thus, it
to adapt its sensitivity to the expected input range (neg-
can maintain the connectivity between its constituent
ative or positive sensitization) and also that each effec-
elements, which accordingly allows it to transmit or
tor adapts its response to the expected range of demand
transfer forces applied to the whole system, and to al-
(identification of the expected response pattern).
ways react globally to mechanical and chemical stimuli
Allostatic theory is based on a permanent relation- (see Volume 1, Chapter 6).
ship between the brain and the rest of the body’s com-
The fascial system is capable of predicting and re-
ponents (Sterling & Eyer 1988, McEwen 2000). In this
sponding to mechanical events by adjusting its ten-
process the key concept is that the brain is capable of
sion availability to functional requirements. To
predicting the physiological needs of the organism well
achieve this goal, it uses prior recognition of a move-
in advance. Thus, previous experiences and behaviors ment pattern (advance control), through chemical
will mark future actions resulting in a much more ef- resources (release of growth factors) that modulate
ficient and economical response based on flexible and its tension state. This process also uses an organized
coordinated physiological control. In this context, the “efferent copy” through permanent updating of the
stress response is activated in anticipation of various nervous system through mechanoreceptors and free
challenges. nerve endings (see ­Volume 1, Chapter 8 and above in
Inflammation, pain, and hypomobility are allosta­ this chapter). It should be noted that there is a perma-
tic responses that should conclude when the emer- nent state of synergism (reciprocal action) between
gency is resolved. The intensive and recurrent use of the dynamics of the receptors and the tension state of
allostatic resources creates an allostatic load, which the system. However, it also should be noted that an
is the state in which normal allostatic processes wear appropriate request for adjustments (higher tension)
out when physiological systems are no longer able to can increase its effectiveness, while over-demand or
adapt. The allostatic load generates adverse health con- immobility will decrease it. These processes can trig-
sequences associated with alterations of the nervous, ger the progressive onset of dysfunctions that over
endocrine, and immune systems, thereby leading to time can alter movement, affect function, and develop
mortality, morbidity, and also functional and cognitive into pathology.

19
1
As mentioned at the beginning of the chapter, body individualized in a healthy body, and particularly in
movement is a process of synergisms which, although movement dysfunctions and pathologies.
following physiological patterns, are simultaneously

20
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by the very sight of the well-known cover. Even if they are too ill to
read it, they like to have it near them ready for the moment when
returning strength gives them the incentive to take even a glance at
some of its pages.
We have found that men who have not naturally been readers
have acquired the habit of reading in our Hospital, and there have
been many instances of men who have become out-patients asking
for permission to continue to use the library. It has been one of our
great pleasures to see old friends strolling into the recreation room
and picking out for themselves some book by an author whom they
have learnt to know and appreciate. Another gratifying feature of the
work has been the anxiety of many of our readers to have a book
waiting for them after an operation, so that as soon as possible they
may begin to read it and forget some of their pains and sufferings. In
many instances the author or the subject has been deliberately
chosen beforehand.
Our experiences, in fact, have tended to show that a library
department organised and run by people who have some knowledge
of books might prove to be a useful asset in any hospital, both
military and civil, and be the means of affording not only amusement
and distraction, but even definite education, induced of course, not
insisted on. To obtain satisfactory results it would seem, however,
that even a good and carefully chosen collection of books of all kinds
does not suffice. In addition, an official librarian is needed who will
supply the initiative, which in the circumstances is of necessity
lacking, and whose duty it is to visit the wards, study the
temperaments, inclinations, and possibilities of the patients, and thus
find out by direct personal intercourse what will amuse, help,
stimulate, lift—and heal.
 LOST HORSES.
A month or so after the traitor Maritz had made his flamboyant
proclamation in German South-West Africa, a small body of mounted
Union troops was operating in a district which may be described as
‘somewhere near Upington.’ Probably such secrecy of places and
names is not at all necessary, but it lends an appropriate military
flavour to the small events I describe. I may go so far as to say that
the setting I have provided is fictitious, though similar events did, no
doubt, occur in the operations against Maritz and Kemp and their
heroes. The characters of the roan horse and of the boy Frikkie are
true to life, and the small adventures did occur much as described,
but in another country in South Africa and upon a different occasion.
Accept the story as fiction, not as history; it will at any rate serve to
throw a light upon one of the aspects of the fighting in that dry land,
and it illustrates the close relationship between horse and man in
that country of long distances and sparse population and infrequent
water-holes. The conditions are the absolute antithesis of those in
Flanders and the trenches.
The risk of losing his riding or pack animals is constantly present
to the veld traveller. Fortunately it is seldom the cause of anything
more troublesome than a temporary inconvenience, but there are
occasions when serious hardships result, the loss of valuable time or
of your animals, or risk to your own life. In most cases the loss of
your beasts is due merely to the fact that they have strayed. They
have, as a rule, either followed the lead of some restless animal who
is making back for his stable, or else they have wandered away in
search of grass or water.
A horse is less hardy than his hybrid half-brother, and more the
slave of his belly. Thirst and hunger pinch him at once, and he is
quick in search of comfort; he is therefore more likely to stop and
suffer capture at the first patch of good grass he comes to. His
superficial character, moreover, generally affords some indication
both of the reason he has strayed and the direction he has taken.
There are, however, a few horses who are inveterate and
troublesome wanderers; they are generally old animals whose
accumulated experience has developed a cunning foreign to their
normal character. Such animals often possess an irritating facility for
choosing the most inconvenient time to stray and the most unlikely
direction to go.
If horses are the most frequent offenders, their sins in this respect
are seldom serious. In my own experience mules are more liable to
travel back along the road they have come than horses; they are
more creatures of habit, their memory is more retentive, and they
have greater natural intelligence. When a mule has acquired the
habit of absenting himself from duty he is a perpetual trouble. The
most malignant form of this disease occurs when the beast has
developed an insatiable longing for one particular place, a definite
goal from which nothing will turn him. This haven of his constant
desire is generally the place where he was born, or where he passed
the pleasant days of his absurd youth.
There are traits in most horses which, in conjunction with this
foundation of congenital simplicity, go to make ‘character.’ Men who
have dealt with horses in the less frequented parts of the earth know
this well. They will remember one animal who had in a highly
developed degree that instinctive correctness of demeanour which
can best be described as good manners; a second had a heart like a
lion and checked at nothing; another was a prey to an incurable
nervousness; while yet another was just simply mean. These mean
horses are a perpetual menace; you never know when they will let
you down. Sometimes they are clearly actuated by malice;
sometimes, however, there is a subtle quality and timeliness in their
apparent stupidity which gives you a horrid suspicion that you’ve
been had, and that your horse is more of a rogue than a fool. Such
an animal is always an old horse, never a young one.
I am not quite clear as to what a scout should look like. The typical
scout of the North American Indian days, as exemplified in the
person of Natty Bumpo, wore fringed buckskin and moccasins and
coon-skin cap, while Texas Bill and his vivid companions had a more
picturesque costume still, in which great silver-studded saddles and
jingling spurs and monstrous revolvers bore a conspicuous part. I
must confess that my own nine sportsmen were scrubby-looking
fellows compared to their picturesque predecessors at the game.
(The khaki trousers issued by an administration which was always
more practical than picturesque do not lend themselves, in this
generation at any rate, to romance.) But they were a hard and useful
lot, much sunburnt, and with gnarled, scarred hands. Deerslayer
himself probably could not have taught them much about their own
veld craft. Every one was South African born; three of them were
younger sons of loyal Boer farmers. One was a coloured boy, a
quiet, capable fellow. He was with us nominally as a sort of groom,
but his civil manners and extraordinary capacity soon won him an
accepted place in the scouts; though he rode and ate with us, he
always sat a little apart in camp. He had spent three or four years up
country, where I had first come across him in fact, and had shot
some amount of big game; he was excellent on spoor and had a
wonderful eye for country, and I really think he was the quickest man
on and off a horse, and the quickest and most brilliant shot I ever
saw. He stood on the roster as Frederick Collins, but was never
known by any other name than Frikkie.
The commandant of the rather nondescript commando, which was
officially described, I believe, as a composite regiment, had a sound
idea of the value of a few competent and well-mounted scouts, and
had done us very well in the matter of horse. We had been ‘on
commando’ now for nearly five weeks, and had got to know our
animals pretty well. During the confusion and changes of the first
fortnight I had got rid of a dozen horses I saw would be of no use for
our work, though suitable, no doubt, for slower troop duty, and by a
cunning process of selection had got together a very serviceable lot,
with four spare animals to carry kit and water on the longer trips
away from the main body. Your spirited young things, though well
enough to go courting on, are apt to get leg-weary and drop
condition too soon on steady work, and all my mob were aged and
as hard as nails. I will describe one or two of them presently.
 Things were getting a little exciting about that time. Three rebel
commandos, or rather bands, were known to be in the
neighbourhood, and it was essential to find out what their strength
was and who their leaders were. There was not much reason to fear
attack, for they were not well found in either guns or ammunition,
and their ragamuffin cavalry were concerned to avoid and not invite
a stand-up engagement. Rapidity of action was essential to the loyal
troops, for the longer the rebellion dragged on the more risk there
was of it spreading. It was necessary to find out at once the actual
movements of these bands, and the best way of doing so was to
keep tally of the water-holes. Men can, if necessary, carry water for
themselves, but horses, especially those from the moist high veld of
the Transvaal, must have water regularly or they go to pieces very
quickly in that dry, hot land. And so the remote and forgotten pit at
Ramib had suddenly become of importance, and I had been told to
send two men to examine it at once.
It lay within the rocky belt which came down south of the Orange
River somewhat to our right; it was supposed to be twenty miles
away, but it might prove five miles less or ten miles more. It was
known to have held water fifteen months before, and our business
was to find out if it still held water, how long that water would be
likely to last, and if any of the rebels had been to it recently. No one
in the column was aware of its exact location, but I myself knew
enough of those parts to guess roughly where it must lie. I decided to
take one man and a pack-horse, and to take the patrol myself. No
native guide was available, and the Colonel did not, for obvious
reasons, care to make use of any of the few local Boers who carried
on a wretched existence as farmers in that barren country.
My own horse was a big bay, an uncomfortable beast, but capable
of covering much ground; like many big men, he had little mental
elasticity and no vices. Frikkie had an unassuming bay of ordinary
manners and capacity, and with a natural aptitude for routine and a
military life. The third horse was a king of his class. He did not
belong to the scouts, but I had borrowed him to carry the pack on
that patrol. He was mean all through; in colour a sort of skewbald
roan, and in character an irreclaimable criminal. He had a narrow
chest, weedy white legs, and a pale shifty eye; he was very free with
his heels, and an inveterate malingerer. He had never carried a pack
before and we were prepared for trouble, for his malevolent spirit
had already acquired a wide reputation.
The patrol left the column a little before sunset, after a windless,
baking day. The horses were in excellent fettle. The roan had given
some trouble with the pack, but before he could throw himself down
or buck through the lines he was hustled out of camp to an
accompaniment of oaths and cheers in two languages. Once away
and alone he went quietly, but doubtless with hate in his heart, for his
beastly eye was full of gall.
Dawn found us hidden on the top of a low stony kopje, the horses
tied together among the brown boulders below. It was bitter cold as
the light grew, and the sun came up into an empty world. I waited
there for half an hour, partly to find any signs of white men, and
partly to work out the lay of the land and the probable direction of the
pit. Nothing was moving in the whole world. It was clear where the
water must be. On the right was the usual barren desert country we
had come through during the night, low ridges of stone and shale,
and a thin low scrub of milk bush and cactus. On the left the land
grew much rougher towards the river; the rocky valleys stretched for
miles in that direction. Presently we led the horses down off the
kopje, and an hour later saw us looking down at the chain of small
holes, still full of good water. I stayed with the hidden horses while
Frikkie cut a circle round the pools. There was no sign of life, he
reported, only the old sandal spoor of some natives; no horse had
been down to the water for weeks, probably for months. We off-
saddled in a hidden corner some way from the water, and got a small
fire going of thin dry sticks. The horses were given a drink and
turned loose. It was criminal foolishness not to have hobbled or
knee-haltered the roan, for ten minutes after they were let go Frikkie
called out that the horses had completely disappeared.
One realised at once that there was no time to be lost. It was
probable that the roan had led them away, and that he meant
business. The saddles and pack were hurriedly hidden among some
rocks with the billy of half-cooked rice, the fire was put out, and we
took up the spoor.
It was soon evident that the animals were travelling, and were not
straying aimlessly in search of feed. The spoor of the discoloured
strawberry beast was always in front—his footprints were like his
character, narrow and close. Above his tracks came those of Ruby,
the police horse, round ordinary hoof-marks, and well shod; my own
horse’s immense prints were always last, solid and unmistakable.
Mile after mile the tracks led into a rockier and more barren country.
What little stunted and thorny scrub there was had not yet come into
leaf, and there was no shade and no sign of green anywhere. Ridges
of sharp gravel and small kopjes of brown stone alternated with
narrow valleys without sign of green or water. In the softer ground of
these valleys the spoor was plain and could be followed without any
trouble, but on the rocky ridges the tracks became difficult to hold
where the horses had separated and wandered about. The trail led
eastwards, into a rocky, waterless, and uninhabited country. There
was no reason for the roan’s choice but just native malice, for he had
come from the west the previous day. Doubtless the main camp
would be his ultimate destination, but it seemed apparent that he
intended to inflict as deep an injury as he could before he set his
sour face again to the west.
It was within half an hour of sundown before I came up with the
horses, and then only the two bays; the roan’s spoor showed that he
had gone on about an hour before. They were standing under a
bunch of thorn trees, the only shade they had passed since they
were let go that morning. For the last mile or two the tracks, which
had become more aimless as the hot afternoon wore on, had turned
a little to the north. Probably, as the allegiance of his small following
had weakened, the leader’s thoughts had turned to the
companionship of the camp, and when they had finally refused to
follow him any further he had abandoned the rest of his revenge and
had turned frankly for home.
We rounded up the two horses and thought of our camp, probably
eight miles away in a direct line. Though they were tired and empty
they would not be caught, and it was soon evident that they would
not be driven either. I will not ask you to follow the dreadful hour
which ensued. This crowning flicker of rebellion at the end of a
disastrous day nearly broke our hearts. It was well after dark when
we finally abandoned the horses in an area of steep rocky ridges and
narrow valleys covered with cactus; it was quite impossible to cope
with them in the dark in such a country. We reached camp about ten,
but were too tired and disappointed to make a fire. A tin of bully-beef,
and the mass of opaque jelly which had once been good Patna rice,
were the first pleasant incidents of a baking, hungry day.
The second day began before dawn with as large a breakfast as
we could compass: black coffee, the little bread that was left, and a
large quantity of rice. I have seldom eaten a more cheerless meal.
Three or four pounds of rice, some coffee, a tin or two of bully, and a
little sugar were all that remained to us, and there was no chance of
getting more. I must confess that at this stage a tactical error was
committed which cost us the long day’s work for nothing. A golden
rule where lost animals are concerned is to stick to the spoor, but as
I thought it very probable that the horses would turn north and west
again during the night and make for their last place of sojourn, I tried
to save half a dozen hours by cutting the spoor ahead. It was nearly
noon, and a mile or two beyond where the roan had left the others,
before it became a certainty that the horses had done the unlikely
thing, and had gone either south or further east into the broken
country. At that moment they were probably ten miles away. I then
did what one should have done at first, and went to the point where
we had last seen them. That afternoon was hotter and emptier than
the last, and sunset found us on a cold spoor going north. We had
wisely brought rice and coffee and water-bags with us that morning,
and Frikkie had shot a klipspringer—baboons and klipspringer were
the only animals we had seen the last two days. If you suppose that
we had used any of the water for washing you are making a mistake,
though Heaven knows that we both would have been the better for a
bath. We slept on the spoor, and bitter cold it was without blankets;
there was not scrub enough for a decent fire.
Matters were getting serious. We were then twelve miles from the
saddlery and, so far as we knew, the nearest water, and twenty more
from the camp. If the horses were not found and caught that day
they would have to be abandoned, and we would have to pad the
hoof home via the disastrous pools at Ramib.
But fortune does not frown for ever; it is a long worm that has no
turning. Within an hour of sunrise we came into the quite fresh tracks
of the horses crossing their own spoor. Frikkie exclaimed that there
were three horses, and an examination showed the narrow tracks of
the red horse with the other two; they had not found water and were
evidently on their way back to Ramib. We came on to the animals a
few minutes afterwards. Except that they were hollow from want of
water they were none the worse, and apparently they were not sorry
to see us. By the time the sun was in the north they had had a good
drink and were finishing the little grain in the pack. Midnight saw us
riding into the main camp—only to find it deserted, for the column
had marched. The camp was apparently completely empty, and it felt
very desolate under a small moon. I expected I would discover a
message of some sort for me at sunrise; in the meantime the
obvious thing was to keep out of the way, so I went half a mile off
into the veld, and the boy and I kept watch by turn until dawn.
Nothing moved in or round the camp till near sunrise, when three
men rode out of some shale ridges about a mile away on the
opposite side, and came down to the water. By the white bands
round the left arm—the sign of loyal troops—I knew them for our own
men; indeed we had recognised the horse one of them was riding.
They gave me the message they had stayed behind to deliver. We
were to stay and watch the camp site for three or four days, and to
patrol daily some distance to the south-east. The water was
important, for it was quite probable that one or other of the rebel
commandos would come to it. The men had hidden provisions for us
and some grain for the horses; they themselves were to hurry on to
the column with our report of the Ramib pits. We rode a few miles
along the column spoor with them, and then turned off on some
gravelly ground and fetched a compass round back to the place in
the shale ridges where the men had slept and where the provisions
were. We took no more chances with the strawberry horse; he was
closely hobbled.
 The loss of the animals had been a serious thing, and we were
extremely fortunate to have got out of it so easily. It did not lessen
the annoyance to realise that it was my own fault for not hobbling the
roan, but only a rogue by constitution and habit would have carried
his hostility to so dangerous a length. But within a week he was to
provide another taste of his quality. This time nothing more serious
was involved than the risk of his own loss, for we were never led far
from water in so menacing and barren a country as that beyond
Ramib.
Most of that day was spent in the stony krantz, from which a view
could be obtained over the whole dry, grey landscape, and the pools
a mile away. In normal times the laagte was frequently used for
sheep grazing, but in these days of mobile and ever-hungry
commandos the few farmers in the vicinity were grazing their meagre
flocks nearer their homesteads. Except for a few wandering Griquas,
and possibly a band of ragged rebels on tired horses, it was not
likely that our watch would be interrupted. A rough shelter made of
the stunted spiny scrub served as a sentry box; the saddles were
hidden in a narrow cleft on the lee side of the ridge, and the horses
were kept down in the valleys.
In the afternoon we saddled up and rode south and east, keeping
for the most part to the rough ridges, and overlooking the level
country along which our column had come, and which was the
natural approach from that side for any body of men having wheeled
transport with them. We did not ride for more than an hour, but my
glasses showed an empty, treeless world for miles beyond. If the
commandos did come our way they would probably trek by night; we
should hear them arrive and laager about dawn, and sunrise would
have seen us well on our way to our own men.
Just at dusk that evening we rode along the lee of the ridge upon
which our poor home was. Frikkie was riding the roan. He was
leading his own animal, for a single horse could not be left grazing
alone, to be picked up, perhaps, by any wandering rebel, or to stray
off in search of companionship. When we passed under the highest
point of the ridge I stopped and sent Frikkie to the top, for he could
spy in both directions from there. I took the led horse from him, and
he threw the roan’s reins over the neck to trail on the ground—the
accepted instruction to every trained veld horse to stand still. I
watched the boy’s slim figure against the sunset sky in the west as
he turned about, searching the veld through his binoculars, though it
was really getting too dark for prism glasses. He called out that
nothing was moving, and presently came lightly down the steep
slope in the gathering dusk. As he reached his horse the beast
turned his quarters to him and walked away; the boy walked round,
but again the horse turned away; and when I put my horse across to
check him he lifted his head and trotted off. We knew that we
couldn’t catch the beast if his views on the matter did not coincide
with ours, so we walked on the half-mile to where the skerm was,
thinking the horse would follow up his mates at his leisure.
This was a new, but not unexpected, trait in an already depraved
character. Some horses, though they are inveterate strayers, are
easy to catch when you do come up with them; others are very
difficult to catch, though they seldom go more than a mile from the
camp; this hectic degenerate apparently combined both these bad
habits.
An hour after dark the horse had not turned up, though our own
reliable animals were knee-haltered and turned loose for a time with
their nosebags on as decoys. At dawn he was not visible in any of
the shallow valleys we could see to the east of the ridge; and to our
surprise and concern he was not in the valley where the water was
and where the camp had been.
Our own horses were knee-haltered short and let go, and we
spent a careful hour examining the margin of the pool, but there was
no narrow spoor to show that the roan had been down to drink
during the night. I spent the morning with our horses and on the look-
out, while the boy cut a wide semicircle round to the south and west
of the water. He came in at mid-day, certain that the truant had not
gone out in those directions. Then Frikkie took over the sentry work,
and I set out to cover the remainder of the circle. I worked
methodically along the soft ground of the valleys outside the range of
the area already fouled by the spoor of our own animals, and where I
would find the roan’s tracks at once. From time to time I climbed one
of the low ridges, for the boy was to spread a light-coloured saddle
blanket over a prominent rock on the side away from the water as a
signal if he saw either the lost horse or anyone approaching from the
south, or in case of other danger. Nothing occurred during the long,
hot afternoon.
That evening, when I got back to camp, I found two Griquas sitting
over the coals with Frikkie. They said they were shepherds, and they
may have done a little of that congenial work recently, but they
looked to me more like sheep-stealers. They were wild people from
the Orange River, and I was sure they had never been any sort of
farm labourers. However, they were friendly enough and promised
help in the morning. The horse had then been without water since
the morning of the previous day. He had not strayed away, for at
sunset he must have been still within four or five miles of the camp; if
he had intended business we would have cut his outgoing spoor
during the day. Horses were too valuable in that country and at that
time for the loss of even such a three-cornered abomination as the
pink horse to be taken lightly.
Morning showed that the horse had not been to the water during
the night. He had then been forty-eight hours without water. The only
thing was to take up the spoor where the animal had last been seen,
and so stick to it till he was found. The Kalahari bushmen have the
reputation of being the finest trackers in South Africa, but these two
cross-bred Griqua bushmen gave us an incomparable exhibition of
skill. I have had some experience of that game, and Frikkie was a
master, but these savages astonished us.
Inch by inch the spoor was picked out from that of the other
animals. No proved mark was abandoned until the next was certified,
often only an inch or two away. The only slight help they had was the
rare and very faint mark where the trailing reins had touched the
ground. The first hundred yards took probably an hour to cover, but
when the spoor reached comparatively clean ground the work was
easier. At this point Frikkie got the water-bags and some food and
joined the bushmen, for it was possible that the horse, driven by
thirst, had taken it into his head to travel far during the previous
night.
 Late that evening the trackers returned with the horse. He was
emaciated and weak, but otherwise quite well, though for some days
his back was tender from the continual ‘sweating’ of the saddle
blanket. His spoor showed that he had spent the first night and day
wandering about the low ridges and hollows not far from our camp,
and that the night before he had commenced to journey away into
the empty country to the east. Somewhere about dawn of that third
day his trailing reins had hooked up on one of the few bushes in that
country strong enough to hold him, and there he was found by the
bushmen, the picture of a natural misery, and too dejected to take
much notice of his rescuers. Nothing but his own gloomy thoughts
had prevented him from going down to the water at any time, or to
the companionship of our camp.
Thirty-six hours after this we were back with the main column. It is
not necessary to add that we were glad to get a bath and a generous
meal, and that I took the first opportunity of handing over the parti-
coloured strawberry to troop duty.
In the first of these two offences it is clear that the white-legged
roan was animated by spite. Such malevolence is rare enough, but
his second performance is much more remarkable. I offer three
alternative explanations. The first is that it was just stupidity. I have
the poorest opinion of the intelligence of the horse, as distinct from
instinct. It is Professor Lloyd Morgan, I think, who defines instinct as
‘the sum of inherited habits,’ and this may be accepted as a sound
definition. Elementary necessity, to say nothing of instinct or
intelligence, should have driven him to the water soon after he had
obtained his freedom. He could not have forgotten where the water
was. If his normal mental process was so dislocated by the fact of
the saddle on his back without the presence of the masterful human
in it, then he was a fool of the first class.
The second solution I offer is that his action was prompted by
roguery; for even a very limited intelligence would have warned him
that he would be captured if he ventured near either the water or the
camp. It may be that when his reins hooked up he was on his way to
the free water at Ramib. The third explanation is that he was a little
daft. In a long and varied experience of horses I cannot really
remember one so afflicted, though I had a pack-mule once that I am
certain was a harmless lunatic. You may take your choice of these
alternatives; for my part I incline to the second.
John Ridd’s rustic wisdom led him to express the opinion, upon
the memorable occasion when John Fry was bringing him home
from Blundell’s School at Tiverton, that ‘a horse (like a woman) lacks,
and is better without, self-reliance.’
R. T. Coryndon.
‘THE PROGRESS OF PICKERSDYKE.’
Second Lieutenant William Pickersdyke, sometime quarter-
master-sergeant of the ⸺th Battery and now adjutant of a
divisional ammunition column, stared out of the window of his billet
and surveyed the muddy and uninteresting village street with eyes of
gloom. His habitual optimism had for once failed him, and his
confidence in the gospel of efficiency had been shaken. For Fate, in
the portly guise of his fatuous old colonel, had intervened to balk the
fulfilment of his most cherished desire. Pickersdyke had that morning
applied for permission to be transferred to his old battery if a
vacancy occurred, and the colonel had flatly declined to forward the
application.
Now one of the few military axioms which have not so far been
disproved in the course of this war is the one which lays down that
second lieutenants must not argue with colonels. Pickersdyke had
left his commanding officer without betraying the resentment which
he felt, but in the privacy of his own room, however, he allowed
himself the luxury of vituperation.
‘Blooming old woman!’ he said aloud. ‘Incompetent, rusty old dug-
out! Thinks he’s going to keep me here running his bally column for
ever, I suppose. Selfish, that’s what ’e is—and lazy too.’
In spite of the colonel’s pompous reference to ‘the exigencies of
the service,’ that useful phrase which covers a multitude of minor
injustices, Pickersdyke had legitimate cause for grievance. Nine
months previously, when he had been offered a commission, he had
had to choose between Sentiment, which bade him refuse and stay
with the battery to whose well-being he had devoted seven of the
best years of his life, and Ambition, which urged him, as a man of
energy and brains, to accept his just reward with a view to further
advancement. Ambition, backed by his major’s promise to have him
as a subaltern later on, had vanquished. Suppressing the inevitable
feeling of nostalgia which rose in him, he had joined the divisional
ammunition column, prepared to do his best in a position wholly
distasteful to him.
In an army every unit depends for its efficiency upon the system of
discipline inculcated by its commander, aided by the spirit of
individual enthusiasm which pervades its members; the less the
enthusiasm the sterner must the discipline be. Now a D.A.C., as it is
familiarly called, is not, in the inner meaning of the phrase, a
cohesive unit. In peace it exists only on paper; it is formed during
mobilisation by the haphazard collection of a certain number of
officers, mostly ‘dug-outs’; close upon 500 men, nearly all reservists;
and about 700 horses, many of which are rejections from other and,
in a sense, more important units. Its business, as its name indicates,
is to supply a division with ammunition, and its duties in this
connection are relatively simple. Its wagons transport shells,
cartridges, and bullets to the brigade ammunition columns, whence
they return empty and begin again. It is obvious that the men
engaged upon this work need not, in ordinary circumstances, be
heroes; it is also obvious that their rôle, though fundamentally an
important one, does not tend to foster an intense esprit de corps. A
man can be thrilled at the idea of a charge or of saving guns under a
hurricane of fire, but not with the monotonous job of loading wagons
and then driving them a set number of miles daily along the same
straight road. A stevedore or a carter has as much incentive to
enthusiasm for his work.
The commander of a D.A.C., therefore, to ensure efficiency in his
unit, must be a zealous disciplinarian with a strong personality. But
Pickersdyke’s new colonel was neither. The war had dragged him
from a life of slothful ease to one of bustle and discomfort. Being
elderly, stout, and constitutionally idle, he had quickly allowed his
early zeal to cool off, and now, after six months of the campaign, the
state of his command was lamentable. To Pickersdyke, coming from
a battery with proud traditions and a high reputation, whose
members regarded its good name in the way that a son does that of
his mother, it seemed little short of criminal that such laxity should be
permitted. On taking over a section he ‘got down to it,’ as he said, at
once, and became forthwith a most unpopular officer. But that,
though he knew it well, did not deter him. He made the lives of
various sergeants and junior N.C.O.s unbearable until they began to
see that it was wiser ‘to smarten themselves up a bit’ after his
suggestion. In a month the difference between his section and the
others was obvious. The horses were properly groomed and had
begun to improve in their condition—before, they had been poor to a
degree; the sergeant-major no longer grew a weekly beard nor
smoked a pipe during stable hour; the number of the defaulters,
which under the new régime was at first large, had dwindled to a
negligible quantity. In two months that section was for all practical
purposes a model one, and Pickersdyke was able to regard the
results of his unstinted efforts with satisfaction.
The colonel, who was not blind where his own interests were
concerned, sent for Pickersdyke one day and said:
‘You’ve done very well with your section; it’s quite the best in the
column now.’
Pickersdyke was pleased; he was as modest as most men, but he
appreciated recognition of his merits. Moreover, for his own ends, he
was anxious to impress his commanding officer. He was less
pleased when the latter continued:
‘I’m going to post you to No. 3 Section now, and I hope you’ll do
the same with that.’
No. 3 Section was notorious. Pickersdyke, if he had been a man of
Biblical knowledge (which he was not), would have compared
himself to Jacob, who waited seven years for Rachel and then was
tricked into taking Leah. The vision of his four days’ leave—long
overdue—faded away. He foresaw a further and still more difficult
period of uncongenial work in front of him. But, having no choice, he
was obliged to acquiesce.
Once again he began at the beginning, instilling into unruly minds
the elementary notions that orders are given to be obeyed, that the
first duty of a mounted man is to his horses, and that personal
cleanliness and smartness in appearance are military virtues not
beneath notice. This time the drudgery was even worse, and he was
considerably hampered by the touchiness and jealousy of the real
section commander, who was a dug-out captain of conspicuous
inability. There was much unpleasantness, there was at one time
very nearly a mutiny, and there were not a few courts-martial. It was
three months and a half before that section found, so to speak, its
military soul.
And then the colonel, satisfied that the two remaining sections
were well enough commanded to shift for themselves if properly
guided, seized his chance and made Pickersdyke his adjutant. Here
was a man, he felt, endowed with an astonishing energy and
considerable powers of organisation, the very person, in fact, to save
his commanding officer trouble and to relieve him of all real
responsibility.
This occurred about the middle of July. From then until well on into
September, Pickersdyke remained a fixture in a small French village
on the lines of communication, miles from the front, out of all touch
with his old comrades, with no distractions and no outlet for his
energies except work of a purely routine character.
‘It might be peace-time and me a bloomin’ clerk’ was how he
expressed his disgust. But he still hoped, for he believed that to the
efficient the rewards of efficiency come in due course and are never
long delayed. Without being conceited, he was perhaps more aware
of his own possibilities than of his limitations. In the old days in his
battery he had been the major’s right-hand man and the familiar (but
always respectful) friend of the subalterns. In the early days of the
war he had succeeded amazingly where others in his position had
certainly failed. His management of affairs ‘behind the scenes’ had
been unsurpassed. Never once, from the moment when his unit left
Havre till a month later it arrived upon the Aisne, had its men been
short of food or its horses of forage. He had replaced deficiencies
from some apparently inexhaustible store of ‘spares’; he had
provided the best billets, the safest wagon lines, the freshest bread
with a consistency that was almost uncanny. In the darkest days of
the retreat he had remained unperturbed, ‘pinching’ freely when
blandishments failed, distributing the comforts as well as the
necessities of life with a lavish hand and an optimistic smile. His wits
and his resource had been tested to the utmost. He had enjoyed the
contest (it was his nature to do that), and he had come through
triumphant and still smiling.
During the stationary period on the Aisne, and later in Flanders, he
had managed the wagon line—that other half of a battery which
consists of almost everything except the guns and their complement
of officers and men—practically unaided. On more than one
occasion he had brought up ammunition along a very dangerous
route at critical moments.
He received his commission late in December, at a time when his
battery was out of action, ‘resting.’ He dined in the officers’ mess,
receiving their congratulations with becoming modesty and their
drink without unnecessary reserve. It was on this occasion that he
had induced his major to promise to get him back. Then he departed,
sorrowful in spite of all his pride in being an officer, to join the
column. There, in the seclusion of his billet, he studied army lists and
watched the name of the senior subaltern of the battery creep
towards the head of the roll. When that officer was promoted captain
there would be a vacancy, and that vacancy would be Pickersdyke’s
chance. Meanwhile, to fit himself for what he hoped to become, he
spent whole evenings poring over manuals of telephony and gun-
drill; he learnt by heart abstruse passages of Field Artillery Training;
he ordered the latest treatises on gunnery, both practical and
theoretical, to be sent out to him from England; and he even battled
valiantly with logarithms and a slide-rule....
From all the foregoing it will be understood how bitter was his
disappointment when his application to be transferred was refused.
His colonel’s attitude astonished him. He had expected recognition
of that industry and usefulness of which he had given
unchallengeable proof. But the colonel, instead of saying:
‘You have done well; I will not stand in your way, much as I should
like to keep you,’ merely observed,
‘I’m sorry, but you cannot be spared.’