Fascial Patterns

by Tyler Cymet, DO, FACOFP

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    00:01 So fascial patterns hopefully are ideal.

    00:05 If you’re young, if you’re healthy, and if the body is working well you’ll have equal fascial glide— the fascial movement will be good in all directions.

    00:14 You could turn to the left or you could turn to the right.

    00:18 Sometimes people overdevelop one side of their body.

    00:22 They may become fencers, they may run, or work out in certain ways where certain parts of their body get better developed and others lesser developed.

    00:33 When that happens, the body will start to compensate and they’re still going to need to have a healthy body.

    00:38 You’re still going to need to look straight forward.

    00:40 So if your right side is stronger, you may need to get your left hip stronger.

    00:44 And that’s going to be a compensatory pattern.

    00:47 Still healthy. You still have good flow but your body is compensating.

    00:53 Some of these changes can be congenital.

    00:55 Some people are right handed and are going to overdevelop their right side.

    00:58 Some people are left handed and may underdevelop their right side and overdevelop their left side.

    01:03 These are patterns that the body takes into effect so that it can function well.

    01:09 But that doesn’t always happen.

    01:11 Sometimes, we get stuck.

    01:13 And we always twist to the right.

    01:15 And we always sit on one side of our butt.

    01:17 And we always use one side more than the other.

    01:20 And we get congestion or decreased functioning on the side that’s not used.

    01:25 That’s an uncompensated pattern.

    01:27 And is more common in people who are sick or have chronic illness or have other conditions that limit their activity.

    01:35 And this becomes the spiral downward where if you allow that to happen and you’re not restoring motion, after 2 to 3 years, it becomes harder to change.

    01:44 The body becomes set in that system, in that pattern.

    01:47 And more needs to be done in order to intervene and get the patient back to baseline, and hopefully, to ideal functioning.

    01:56 In people who are in a compensated system, the goal is to get them to an ideal functioning system.

    02:02 Sure, they’ve found a way that they’re comfortable functioning.

    02:05 Sure, they have compensated for the twist and turns of their bodies or imperfections or overdevelopment in some ways.

    02:13 But the goal is to have the body function in any which way it wants to.

    02:17 At any time it wants to.

    02:19 So the goal is to get to ideal functioning.

    02:22 Having said that, 80% of the people that Dr. Zink saw in his office had a compensatory pattern.

    02:29 They did have some strengthening of the right side of the neck and then the left side of the thorax and then the right side of the lumbar, and the left side of the pelvis.

    02:38 So take a minute and look at the common compensatory pattern.

    02:41 The left, right, left, right pattern of compensation.

    02:46 This is the most common compensatory pattern.

    02:50 If you were to guess, 80% of patients are going to have this.

    02:53 And what they have, is their OA on the left is going to be rotated, their cervicothoracic region is going to be rotated right, the thoracolumbar region will be rotated left, and the lumbosacral region will be rotated right.

    03:09 This is the most common compensatory pattern.

    03:12 This is your typical right-handed individual who’s going to have good drainage, good flow, good connectivity, and good functioning.

    03:21 And this is how they’ve compensated.

    03:24 This is one of those things you should know.

    03:26 When you have a patient who’s ill, who just says they’re not feeling right, check to see if there is a change.

    03:32 And on my charts, I know if they’re common compensatory or uncommon compensatory.

    03:38 Just so I know when the change occurs or if things are dysfunctional.

    03:43 People who change from one to the other, may go through a transition.

    03:47 They may not sleep. They may lose weight.

    03:50 And they may gain weight.

    03:51 So people tend to have one compensatory pattern.

    03:56 The uncommon compensatory— the left handedness of compensatory patterns— is found in about 20% of people where the OA is rotated right, the cervicothoracic region is rotated left, thoracolumbar region is rotated right, and lumbosacral is rotated left.

    04:14 That’s the uncommon compensatory pattern.

    04:17 And, again, what is this compensation for? These are where you find somatic dysfunctions.

    04:23 Where you find hypertonicity.

    04:24 Where you have musculoskeletal findings that may or may not reach the need for treatment but are there.

    04:34 The uncompensated pattern is any pattern where you just don’t have a good flow.

    04:39 Where you’ll have congestion, swelling, or just continued hypertonicity, continued swelling, and continued congestion on a single side.

    04:49 It’s not healthy.

    04:50 It doesn’t allow for the patient to feel good energy, good feeling, or feeling right.

    04:58 These are some of those vague complaints where things just don’t feel right. I’m not sleeping right. I’m not eating right.

    05:04 I don’t have the life I want.

    05:05 I don’t have the strength I want.

    05:07 And that’s why this becomes a more philosophic lecture because not everything is over an illness.

    05:14 Some of it is, I’m just not feeling right.

    05:18 So, a quick question.

    05:20 Here we have a 40-year-old male come in with back pain and you find that the OA has a shallow sulcus on the left.

    05:26 Cervicothoracic junction is rotated left.

    05:29 The thoracolumbar junction is rotated right and the lumbosacral junction is rotated left.

    05:35 Which pattern is this according to Zink? And the answer is it’s an uncommon compensatory pattern.

    05:42 This is a simple question, simple knowledge, and something you should have committed to memory.

    05:47 So just to reinforce why this is important.

    05:51 Zink found that patients with one of the common compensatory patterns tolerated stresses, tolerated somatic dysfunctions better and were able to resolve somatic dysfunctions on their own without the aid of a practitioner.

    06:08 So we try and get people to this level.

    06:11 It also gives us a sense of when people need to be seen again.

    06:15 People who have a common compensatory pattern may not need to be seen as frequently as somebody with an uncompensated pattern.

    06:23 If you have an uncompensated pattern, then the doctor’s help is going to be needed to get people to an optimal level of functioning.

    06:33 It also tells us where to focus so the transitional zones are the areas that are going to take the stress.

    06:41 They’re the areas where you’re going to see the changes early and they’re the changes that are going to predict health and illness.

    06:50 So addressing the transitional zones becomes a focus of an osteopathic treatment.

    06:56 The diaphragms are part of the areas that need to be looked at because you know you’re going to have issues there.

    07:04 So before we go further, I just want to take a minute and have you think about yourself and your own body.

    07:11 Are you doing well at compensating? Are you doing well at functioning? And where are you feeling stress? And is it always the same point? Is it always the same area where you going to have the pain when you have problems? Most people can identify 1 or 2 areas— 1 or 2 transitional zones.

    07:30 And they know the diaphragms that are going to give them trouble.

    About the Lecture

    The lecture Fascial Patterns by Tyler Cymet, DO, FACOFP is from the course Introduction to Osteopathic Treatment.

    Included Quiz Questions

    1. Atlanto-occipital rotated left Cervicothoracic rotated right Thoraco-lumbar rotated left Lumbosacral rotated right
    2. Atlanto-occipital rotated right Cervicothoracic rotated left Thoraco-lumbar rotated right Lumbosacral junction: rotated left
    3. Atlanto-occipital rotated left Cervicothoracic rotated right Thoraco-lumbar rotated right Lumbosacral rotated left
    1. Uncommon compensatory pattern
    2. Common compensatory pattern
    3. Uncompensated pattern
    4. Unspecified compensatory pattern

    Author of lecture Fascial Patterns

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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