David Lesondak, Fascia: What It Is and Why It Matters

core connections fascia Jun 26, 2018

This is the conversation we have all been waiting for (or maybe just me, ha!) David Lesondak and I's shared obsession is… can you guess it… FASCIA!! Join us as we talk about many topics regarding the human body and how they all connect back to the fascia.


David Lesondak, BCSI, ATSI, FFT, FST, VMT is a member of the Allied Health Professional Staff in the Department of Family and Community Medicine at the University of Pittsburgh Medical Center. He is a Structural Integrator and Fascia Specialist at UPMC’s Center for Integrative Medicine; and specializes in chronic pain, pre-and post-surgical issues, physical performance enhancement, and treatment for those suffering from cancer. Since 2010 David has been the chief video documentarian for the University of Ulm’s Fascia Summer School. He lectures and teaches internationally.

Watch Our Conversation Below!!




Erica: With me today is David Lesondak. He is a member of the Allied Health professional staff in the Department of Family and Community Medicine at the University of Pittsburg Medical Center. He is a structural integrator and fascia specialist at UPMC Center for Integrative Medicine. David specializes in working with people in chronic pain, pre- and post-surgical issues, physical performance enhancement and treatment for those suffering from cancer. He is also the author of Fascia: What It Is and Why It Matters. This book is for everybody, not just fascia people like me. David, you did such a good job of making the book fun to read.

David: Thank you very much, Erica, that is exactly what I tried to do, was to write something that was a scientifically accurate as we could possibly make it and accessible to everybody. So, I work at the center for integrative medicine where there are about 80 departments affiliated with university or research hospitals throughout the country. This is the place where you find fascial bodywork, as I do, acupuncture, chiropractic work and different types of psychotherapy + mind-body type medicine. 

Because of what I do, I work with a broad spectrum of people. My focus is on the connective tissue system, otherwise known as fascia. An easy understanding of fascia is that it is a covering; a sheath that goes around every muscle in your body. It also covers every bone, organ and nerve as it keeps everything interconnected, but also keeps everything separate at the same time. It is one tissue, one system that is designed to respond to supply and demand.

It is designed to help support whatever we are doing with our bodies. But as we know, accidents, injuries and surgeries happen. We also don’t always do things with our bodies in the best way that we could, so sometimes we wind up developing our own problems while we are trying to do the things that we think are good for us.

Erica: I pulled out one of your quotes, “perhaps it is time to start rethinking the way we think the human body is structured.” I love that quote because instead of looking at the bones and muscle origins, we need to start looking at it as fascia as it opens this whole new world of possibilities.

David: What I find a lot with what I do is that someone will come in complaining about an area in their body where they have been experiencing pain, and what we find out is that is not necessarily the source of the pain. If nothing is feeling better after working on that one specific area, it is more likely that it is a fascial situation that is happening somewhere else in the body. 

Erica: What got you motivated to write this book because I know it was quite a labor of love. 

David: I was kind of at the epicenter of all this research and exploration as it was blossoming. Along with being in this clinic, I wanted a better understanding of what it was I was doing, why it seemed to be working and what the mechanisms were. It is the way my brain works; not only do I need better answers but also the kind of people that I am interfacing with and that I want to have professional respect for, need better answers than that.

I was taking everything that I was learning from science land, bringing it back to the clinic one using it on various clients that came in. And after a decade of doing this, I was building up a lot of knowledge that, to me, seemed obvious, but to others was not. That is how it dawned on me that I need to figure out a way to put this together. I happened to know the people that ended up publishing my book, and we were talking about how they needed a book just like the one I wanted to write. It was a product of being in the right place at the right time. It is something that I have dreamt about for over ten years.

Erica: Meant to be.

David: Right, but you still got to do the work, even if it’s meant to be. Fascia is starting to become this buzzword as it is finally getting to the tipping point where people are going to start knowing what it is. So, I also wanted to get in front of that because as soon as something gets popularized, it gets watered down. I thought, if we could put a book out there that puts all the basic stuff that we know in an understandable format, then we have no excuses for that.

Erica: Well, it is a wonderful book. Let me tell you I preordered it and sat down one Saturday, and I read it from front to back. And then I read it again. It is fascinating because I like to geek out on fascia and movement of the body as I see a lot of these fascial connections. But the mind-body connection is another powerful piece. I would love to hear you talk more about that as it relates to the fascia. Because that is something that I have noticed when trying to get someone to get connected through their deep core.

David: What do you notice when you do that? 

Erica: I believe that there is this power of visualization. As I teach with cueing my clients, I have them visualize the connections in their body being made and focus on what they are moving. If they don’t feel the connection, I encourage them to visualize that connection happening and I have noticed that it tends to happen a little bit quicker. 

David: Here is something that I think you will appreciate. Part of what I do is hands-on fascia work. For instance, let’s say that I was working on your quadriceps, I would have you slowly bend and straighten out the knee, while I’m doing my manipulations. Through this, you are actively stretching as I’m adding compression at an angle, but we also have the nervous system engaged to get as much of you working on this at one time.

I had a very debilitated person once who had a terrible psoas problem; she was in her early fifties and using a walker and there was no reason why this had to be so. I can remember the third time we got together, I had my hand on her psoas and I told her to imagine that she was raising and lowering because I was so desperate to see that legwork. And darn if it didn’t start happening after a while. The power of that visualization helps to reinforce the body and plays a major role in the exercise rehab relationship. 

Erica: You talk about glia a lot and the microglia. Can you explain what glia is and why it matters? 

David: Yes, so, you have cells called fibroblasts that are responsible for maintaining facial net and they respond to supply and demand. There is this other class of cells in your brain and in your peripheral nervous system called glia and they were discovered at the same time neurons were discovered; however, the neurons were bigger and easier to see so we thought they were to be more important because of size. 

The glia was relatively ignored like the fascia and connective tissue was. So even though it was abundant, it was assumed to be less important. They were thought to be the insulation, the stuffing and packing peanuts of the brain. But it was only within the last 15 years that we have seen glia communicate with each other. They seem to be responsible for, not just maintaining healthy neuronal connections, but they also seem to influence which neurons fire and which neurons don’t. They even seem to regulate how we breathe by constantly monitoring the Ph levels in our body and increasing the respiration.

Now we can start looking at the neuron to glia ratio. You may have heard of this old saying where we only use 10% of our brains. I remember hearing that as a kid and going, “that makes no sense, why would we have all of this and not use it.” It is one of those things that has always bugged me. Well, it’s curious to me that the neuron to glia ratio is one to nine. For every one neuron, you have nine glia. Someone did the math and said we are only using 10% of our brain because 90% of it is these other cells that aren’t neurons and neurons do everything.

So now we are seeing how that maybe not be true. As you go through the animal kingdom, you find that the more sophisticated the organism is, like us, we have much higher glia to neuron ratio. They did an experiment where they took human glial cells and transplanted them into the brains of rats and made them smarter. This associated with the amount of glia and the relative sophistication of the brain is fascinating.

The most interesting piece of research that I have found since 2004 relates to Einstein’s brain. The area of Einstein’s brain that was responsible for visual thinking and higher mathematical functions had much higher glia to neuron ratio than average. If we had a 9:1, in general, those areas of his brain had 27:1.

That would be a fascinating relationship to study in greater depth. I get a lot of comments on chapter five and that was my baby. I love every chapter in that book, but that one is really my baby.

Erica: I want to talk more about fascia and our immune + lymphatic system. This is something where we have the visualization and awareness of the body. But there is also power when someone starts to connect better fascially throughout their body. I see symptoms of autoimmune issues and diseases decreasing with women that are in my Core Rehab due to these fascial connections.

David: I see the same thing and I am not doing exercise to see it. That is a secondary effect on the work that we are doing. If I’m working on someone’s body, but you, Erica, are also working their body in different ways, it helps assist what I am doing. But I have been amazed at the changes that I have seen, autoimmune wise, in those circumstances. Not with every single one of them, but with enough of them.

Erica: When we look at fascia, it is full of fibroblasts. Can you explain what those are and their purpose for the body?

David: Fibroblasts are a type of cell and they are responsible for generating and maintaining everything between the cells in your body. We think of our body as being solid, but there is an interior scaffolding that is made predominantly out of collagen and elastin. Collagen gives fascia its sturdiness and the elastin gives it its stretchability. The fibroblasts are responsible for maintaining the inner framework and organization of your muscles all the way down to the cellular level.

There is interstitial space between your cells, skin, muscles and organs. That space is full of a more loosely organization of collagen that can become stuck and tacked down where that interstitial fluid has to make a detour around. Scar tissue is an example of this. If we loosen those areas up, that is going to improve the microcirculation of the body.

Last week Helene Langevin published a study that had an interesting result. They injected rats with breast cancer tumors. There were two groups, they had rats that did their own thing and then another group that stretched ten minutes each day. The measured the tumor growth two weeks later and in the group that stretched they found a 52% reduction in tumor growth as opposed to the rats that didn’t stretch.

Erica: That’s fascinating. I feel like so much of our immune function can be mucked up by inflammation, which could be affecting the interstitium. By stretching, we are opening up the fascia and creating fluidity.

David: Potentially we are because they have to use it. Just like you can lead a person to greater core strength, but if they don’t activate their core every other hour they aren’t with you, they aren’t going to maintain that. 

Once I start increasing someone’s range of motion, they are sending a signal to those fibroblasts that say, “we need less collagen here because we want more movement here,” or, “we want more collagen there because that is where we need support now.” The fibroblasts will adapt and create different enzymes, both collagen building and collagen eating enzymes. That is true whether you are exercising or doing anything else. 

Erica: That is why it is important to sit and stand throughout our day. If we are always in that shrugged up position, then that is where the collagen is going to go and build up. 

David: Yes, and that is a nine to 16-month process if you are always shrugged up. The collagen turnover cycle has a half-life of about six months. In about six to seven months, about 50% of your collagen completely turns over and builds new cells based on how you are using your body. There are some areas where it is thicker, like your IT band, where it might take closer to 16 months before it gets more of full regeneration of all those collagen cells.

Erica: I am glad you mentioned the IT band because I want you to mention to everybody why it is important to not directly stretch the IT band and the reasoning behind it.

David: Let’s take a step back, the collagen in your fascia has a weave to it. For those of you that are familiar with nylon hosiery, it weaves similarly to that. This is what gives it its pliability and its strength, so you can stretch it without ripping it. Your IT band is a little different as 98% of the collagen fibers in your IT band run parallel. We are the only creature on earth that has an IT band because we are meant to stand up straight and that is why it develops that way. When I treat the IT band now, I don’t treat it as a whole. I play with the edges to the forward part along with the quadriceps to the rearward part along the hamstrings to get it sliding better.

Erica: With the fascial releasing on a foam roller at home, slower is better, and then even slower is better. But you can’t beat that one on one manual work with an amazing physical therapist because you get to pinpoint and work on the specifics. 

As we continue to work on preventing Alzheimer’s and dementia, I want to bring glia back up. Have you seen any correlation between these diseases with the amount of glia in the brain?

David: That is a good question, I have not, and I don’t know that that isn’t out there. What I have come across is ballroom dancing and as it relates to Parkinson’s + Alzheimer’s. There are interesting programs that are starting to come together in some integrative medicine clinics involving dance. That is very much mind-body medicine. Are the glia involved in some way? Probably so, but I have not seen anything that directly speaks to them.

Something that I got to participate in was an African dance workshop. It was taught by a woman whose family had been victims of racial genocide in Africa. She had a lot of anger, sorrow and a lot of emotional stuff to work through. She did a lot of her self-healing through dance. Not only do the rhythms have specific functions, but the dance moves also have specific energetic functions. Their dances are designed to express certain emotions that are hard to express with words, she was able to come to peace with what had happened to her and her family. Just through dance.

When we are holding in emotions that we don’t want to express because we don’t think we can express them or we are afraid that our emotions are bigger than us and that they are going to overwhelm us. There is a lot of physical tension that comes along with that. So, the next time that you are stuck in traffic or you are really annoyed with somebody, stop for a minute, go in your body and feel the fact that you are physically tense at that moment, even though you are reacting emotionally. It should come as no surprise that sometimes when that tension is released, it expresses itself emotionally.

Erica: I feel like a lot of women hold tension in their pelvis and it all has to do with fascia. Do you see that specifically when you work with the female population?

David: What I see in most postpartum situations is that there has been a physical shift in the relationship of the pelvis to the rib cage. That physical shift can manifest in any number of different patterns. I’m thinking of one specific case where a mom had a high riding pregnancy, so after giving birth, their breath was very shallow. She thought that is what happened when you have a baby. But that is not the case, what happened was her ribcage got forced back and didn’t want to come back down after she had the baby.

Erica: New research that I have heard that was done back in January. In a nutshell, it was talking about how women that have uterine fibroids have a lack of telocytes in their uterus.

David: First, you need to send me that when we get off the air, but that makes sense to me. Telocytes are involved in immune function and we do know that they respond as cellular messengers. If we need to carry a message from one cell to another to tell them what is going on and give them the news that they need to know so they can respond appropriately. The fact that there is a lack of telocyes spreading the necessary information on the cellular level and suppressing the immune function makes sense to me that there could be a correlation.

Erica: I am just theorizing here, but if we get women to better connect through their entire body from a fascial perspective, that will help get energy flowing and inflammation decreasing. Would that make the messages send better? 

David: Anything that is going to help the body communicate better to itself and the person communicate better with their own body. Learn to listen to your body and understand the signals of your body. There is a specific form called visceral manipulation, which is learning how to treat the fascia of the organs. I was talking about how the organs are wrapped in sheaths of fascia, they also have ligaments, as our muscular-skeletal system does, that gives them a certain range of physiological movement. If your liver didn’t have a certain amount of mobility in your body, it wouldn’t be very comfortable to do a forward bend. So, it is possible that some of the visceral techniques could be useful in these circumstances in terms of getting things to mobilize and function better.

Erica: You talk about being more aware of your body, which you are referring to as interception that is known as the inner awareness of the body. Can you talk a little more about that?

David: There is also proprioception which is feeling where your body is, as opposed to feeling it tactilely. Being able to feel where your body is without having to look at it. For example, when you are adjusting yourself in a yoga pose without having to look because you feel your body needs to be held in a certain way. Interoception is the feeling on the inside, so heartburn or a full bladder is an example of that. This is another one of those areas that are still relatively new in our understanding of the human body.

There is another interesting relationship between interoception and anorexia because their interoception is faulty. If you give them a pencil and a piece of paper and ask them to draw a picture, they will draw a picture of a fat person. There is something going on in their communication with their own body, how they feel and how they perceive how they feel that is not accurate to the external reality. 

Erica: There is a power in tuning into your body and what your body is doing. That can be a challenging shift for someone to make. As I look at my past, I started more in the fitness industry and I’ve shifted to the more holistic realm of trying to get people to feel and connect inside their body. 

David: What made that shift for you?

Erica: Pilates was a good transition for me; then I started to get clients that were going to physical therapy and I realized that they were missing a whole area of the bodily connections. My initial shift was Gil Hedley’s fuzz video, there was a huge aha movement. 

David: A lot of traditional therapies can get very parts oriented, and in this whole fascia revolution, it is the whole body-oriented. Like you keep saying, it’s all connected, but it helps to know how it is all connected and how it feels to be all connected. Get a sense of how the little parts fit into the big picture, and that is what a lot of traditional therapies miss. 

Erica: I wanted to ask this next question so everyone can get to know you a little bit more. What are your top three things that you do for yourself personally to keep you moving fascially well or in the realm of holistic health?

David: First is yoga. I try to go to a class twice a week, and it is all about finding a teacher that you resonate with. I have been building up strength through yoga and doing things that I wasn’t able to do two years ago. Number two is acupuncture. I can make the argument that acupuncture is a fascial modality because they have done ultrasounds and seen that when you put the needle in and twist the needle, that the individual collagen fibers will grasp on to that needle and pull on it. Number three is awareness. By that I mean, how am I using my body in the moment? Constantly monitoring myself and making adjustments as I find them.

The material contained within is provided for educational and informational purposes only and is not intended as medical advice. You should seek prompt medical care for any specific health issues and consult your physician before beginning a new regiment or purchasing any product(s).

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