Fascial Manipulation for Internal Dysfunction® (FMID)

This post is part of a series on FM. Any discussion on FM begins with having at least some understanding of the fascia.  For this I would encourage you to first read FASCIA FACTS as well as FASCIAL MANIPULATION. 

Internal dysfunction (let’s abbreviate it ID) is a heavy term for a heavy topic.  What are we actually talking about?  It refers to stuff that’s not working right related to our internal organ function, causing problems such as constipation, tachycardia, bloating, urinary or fecal incontinence/frequency/urgency, kidney stones, UTI, dysmenorrhea (abnormal menstruation), and gastroesophageal reflux disease (GERD) just to name a few.  If you’re wondering about your problem that I didn’t name here it’s likely included.  (My plan is to address these individually in future posts.)  A staggering number of people grapple with one or more of these issues.  Odds are the majority of those reading this are suffering, or know someone who is (although they may not talk about it).  While easily relegated to the fate of the elderly, brushing these off as a factor of aging doesn’t work for multiple reasons:

  1. Children manifest these symptoms as well (constipated kids keep Miralax in business).
  2. Young adults suffer too, maybe those same children whose problems were never alleviated
  3. Not all older adults struggle with these issues – some are remarkably free
  4. ID can respond to proper intervention.

These are problems many people are embarrassed to discuss, and rightly so.  When I encounter someone who is shouting across the clinic or dinner table about their ID issues I have to wonder…….  While these folks are out there, the majority of people are not so vocal.  Some are embarrassed but manage to discuss their problems with a practitioner.  For some this leads to rounds of tests that may or may not yield information that directs treatment toward resolution.  Others resort to prescription, over-the-counter, and/or herbal aids that may or may not provide some relief.  Many people simply suffer in heartbreaking silence and shame, enduring their issues.  It can be frustrating as well as life-altering.  Urinary incontinence can keep a grandmother from traveling to her granddaughter’s wedding.  Dysmenorrhea has caused many a female to curl up in pain, bleed all over her clothing, and miss school, work, and social events.  Constipation can make people dread going to the bathroom.  Bloating, and gas can force people into incredibly restrictive diets.  People spend a fortune on medications, probiotics, incontinence pads, and even surgical procedures that may yield disappointing results.  Why is the fix so elusive?  Perhaps it’s because many of these interventions focus on managing symptoms but are not addressing the root cause of the problem. 

Patient and provider consultation
Our healthcare system has no shortage of tests, pills, and procedures designed to help internal dysfunction symptoms. Unfortunately for many people they do nothing to alleviate the problem. Photo from Attends website.

Sometimes there is an actual disease or dysfunction of the organ.  Such diseases are what medical tests are searching for and are typically spot-on with identifying, directing necessary and sometimes life-saving care.  Yet in other cases the tests are negative and reveal nothing.  While it can be disappointing to not have an answer, a negative report from these tests is desirable.  It’s good to appreciate that a negative test does not mean there is nothing wrong; it just means the problem or disease the test is designed to detect is not present.  Sadly, at this point many people are sort of directionless:  there’s no clear identifiable problem, so no real solution can be pursued.  Some are labeled with diagnostic labels that read something like this:  “The cause of {yada yada} isn’t well understood. A diagnosis is often made based on symptoms and lack of other findings.” When tests are negative but problems persist, logic dictates something else is driving the problem.  By the same token, when problems recur for no apparent reason over and over and over again (urinary tract infections, kidney stones, reflux) it’s time to expand the search for a cause.

Cartoons related to negative test findings
It’s good to appreciate that a negative test does not mean there is nothing wrong; it just means the problem or disease the test is designed to detect is not present.

My training and experience support that it’s often not the organ (bladder, stomach, colon, uterus, esophagus, kidneys, etc.) at fault but the fascial environment in which these structures are trying to function.  That’s why tests studying the organ are often negative or inconclusive.  They are looking at the organ itself, but this may not be where the problem resides.   In contrast, the fascial environment refers to the fascia surrounding and going into the organs (investing fascia) and the fascia that attaches the organs to the trunk walls (insertional fascia).  I like to explain it this way:  think about the organs in your torso – stomach, liver, spleen, intestines, and bladder.  They are arranged in a pretty consistent manner for all of us, with differences according to male/female anatomy.  When you lie on your side, bounce around in an airplane, or turn a cartwheel those organs don’t get shaken up and rearranged like a snow globe – that’s not sustainable to life.  They are held in place by fascia that connects them to each other and to the trunk walls.  Anyone who has ever butchered a hog or dissected a rabbit has seen this internal fascial structure.

Depiction of fascia, nerves, and stomach
The relationship of the fascia, autonomic nervous system, and internal organs is extremely complex. Here the stomach is depicted with its associated fascia that penetrates into the walls lining the stomach. The nerves embedded in this fascia orchestrate the precise timing of the movement of food to different parts of the stomach as it is processed. The integrity of this timing depends on the associated fascia functioning normally. Used with permission from Antonio Stecco, MD, PhD.

The fascial connections between organs allows them to synchronize their function and know what’s going on with other organs relevant to their function.  For instance the fascia of the stomach is continuous with the fascia of the colon – that’s because they share the responsibility of moving food along the digestive tract.  The fascia of the kidneys is continuous with the fascia of the bladder – this makes sense as these organs must synchronize the filtering of toxins from the blood to be eliminated from the bladder as urine.  The fascia of the uterus is continuous with the fascia of the ovaries for obvious reasons.  In this manner organs that have roles to play that depend on other organs can perceive what’s going on throughout the process.   Such communication is possible because of the rich innervation of the fascia.  So problems develop when the internal fascia becomes densified, much like in the musculoskeletal system.  Whereas densification in the thigh can cause knee pain and degeneration of the joint, similarly densification in the trunk can cause bowel and/or bladder issues.  I like to compare these organ-trunk fascial attachments to Goldilocks:  very picky.  They can’t be too loose, or organs will not be supported properly.  But they can’t be too tight, or organs will not have the vital space and freedom to move (termed motility) which are required to function normally – kind of like being in a straight-jacket or constrained by duck tape.  Movement is life, whether we’re talking about the back, bowel, or bladder. 

This is a great example of rigidity in the trunk fascia affecting the underlying organ. Imagine that this water balloon depicts the bladder. Certainly the volume of fluid in the bladder varies greatly. Ordinarily the bladder can accommodate such fluctuation as long as the fascia investing into it and inserting it to the trunk wall is elastic. But in the presence of a loss of slide in the fascial layers, as depicted by the rubber band around the balloon, the bladder will not be free to vary in volume without generating an abnormal signal – like frequency, urgency, incontinence, or even infection.

In the FMID® model, when key sites (centers of coordination {CC} and centers of fusion {CF}) become densified they can exert an impact on the function of the underlying organs.  Some of these sites relate to the fascial attachment of the organ to the trunk wall, but not all.  Yet even when they are not over a site of organ attachment, they can still exert an impact on organ function simply by causing a loss of elasticity in the trunk.  Think about it this way:  the volume of hollow organs such as the stomach, bladder, uterus, and colon changes as the content of the organ changes.  As long as the trunk connective tissue layers have elasticity and slide, then they can accommodate such volumetric fluctuations.  But when this elasticity is compromised, the trunk cannot accommodate fluctuations in the volume of the organ.  Organs do not like being restricted and get very crabby.  Such loss of motility can manifest as pain, constipation, incontinence, gas, dysmenorrhea, and much more.  This is why tests targeting the organ itself can be negative even when there are symptoms that seem to be arising from the organ.  It’s not the organ that is at fault, but the fascial environment associated with that organ.   

Here we see the Centers of Coordination (CC) and Centers of Fusion (CF) found in the trunk. Densification in one or more of these points can impact the underlying organs by two possible mechanisms. First, the point may be where an internal organ has its fascial attachment to the trunk wall. Second, densification in any of these points compromises the elasticity of the trunk to accommodate volumetric changes in the organs. Pictures courtesy of the Fascial Manipulation Association.

Another element in the FMID® approach is what’s known as a tensor.  This refers to the upper limb (UL) and lower limb (LL), which are key components to normalizing fascial tension in the trunk and preserving vital organ space.  I like to compare the body to a canopy.  The roof of the canopy is like the trunk.  The ropes are synonymous with the arms, legs, and neck.  The stakes driving it in the ground represent the hands, head, and feet.  All it takes is for one element in this structure to be pulling too much or not pulling enough and it will impact the integrity of the entire structure – because it’s all connected.

Perhaps a more sophisticated and scientific way to visualize this is from an engineering perspective, as applied to a bridge.  In this model the trunk is compared to the deck of the bridge, and cars on the bridge are like our internal organs.  The support cables correlate with our abdominal musculature.  The upright pylons supporting the cables are like our pelvic and shoulder girdles.  But by themselves the pylons are not enough to support the deck or the cables, and the bridge would collapse under the weight of the cars.  This is where the tensors come into play. 

In the FMID® model the trunk can be compared to a bridge.  In the picture on the left, this incomplete bridge would collapse under the weight of the cars.  The upright pylons need more support, as in the bridge on the right.  Such support comes from the tensors, which equate to the upper and lower limbs.  All concepts and photos used with permission from Dr. Carla Stecco, MD. 

The tensors serve to sustain the correct tension in the main support cable, also termed a catenary.  Without going too deep into physics and geometry, a catenary is the curve that an idealized hanging chain or cable assumes under its own weight when supported only at its ends. In the case of the trunk, it’s actually an inverted catenary, as it doesn’t sag in like on the bridge but rather out (and for some this outward sag is more apparent than others!).  So the body is an engineering masterpiece when all the elements are perfectly balanced, and, when considering the fascia, all the layers are free to slide and transmit proper tension and force. 

Applying these engineering concepts to the body allows us to see how important the extremities are for maintaining healthy internal organ function. All concepts and photos used with permission from Dr. Carla Stecco, MD. 

Earlier I mentioned that elasticity is vital in the trunk so as to accommodate the variations in volume of the underlying organs. But this is not the case in the upper and lower limbs.  The function of the upper and lower limb requires more stability and less elasticity than the fascia of the trunk.  They are designed more for force transmission.  So it’s conceivable that alteration of the fascia in the trunk could be communicated into the extremity.  Conversely, alteration of the fascia of the lower limb can be communicated to the trunk. Certainly people can have alteration in the fascia of a limb and not be dealing with internal dysfunction of the organs – not everyone with knee pain has constipation.  But it is very unlikely that someone dealing with internal dysfunction does not have some element of dysfunction in the limbs.  Perhaps for those with problems in a limb yet no internal issues it’s just a matter of time until the internal dysfunction manifests.  Perhaps with early attention we might even prevent things moving into internal dysfunction.  I find it fascinating that when I am working with someone with internal dysfunction in the lower half of the body I always find issues with the fascia of the lower limb.  Internal dysfunction in the upper half of the body always seems to have an element in the upper limb.  Yet our traditional medical model does not typically consider this relationship.  Perhaps this is why so many internal disorders and dysfunctions with the yada yada diagnosis are unresponsive to standard care. 

I’ll continue on this topic in a future post exploring what can be done for internal dysfunction.   Until then wishing you health and joy! 


Published by Colleen Murphy Whiteford

I am a physiotherapist, graduate of Saint Louis University Class of 1984. I married my best friend and business partner, Bill, who is also a physiotherapist, in 1988. We have worked together all these years - an example of God's grace! Together we started Appalachian Physical Therapy which continues to thrive. I am a big believer in the power of touch, the manual therapies, and treating holistically. There are many alternatives to medications, surgeries, and testing, but people are often uninformed. My perspective emphasizes the role of the connective tissues including the fascia. Lack of attention to this structure is the source of many physical ailments - our bodies are truly fearfully and wonderfully made (Psalm 139)! I am passionate about helping people of all ages and diagnoses maximize their health, and empowering them to understand their role in management and prevention of problems.

3 thoughts on “Fascial Manipulation for Internal Dysfunction® (FMID)

  1. This information is complicated and astounding, but you explained everything thoroughly. (I have “crabby organs”)
    Enjoy your humor! (often receive a YADA YADA DIAGNOSIS) You know I am a believer in FM….
    Thanks for sharing your knowledge.

  2. Colleen, As you know I am not a health practitioner but this is an incredibly clear and helpful article. It makes so much sense and explains so many issues for me personally. Thanks for your work. Irene Lietz

    On Mon, Jul 26, 2021 at 9:19 AM Fearfully Wonderfully Made wrote:

    > Colleen Murphy Whiteford posted: ” This post is part of a series on FM. > Any discussion on FM begins with having at least some understanding of the > fascia. For this I would encourage you to first read FASCIA FACTS as well > as FASCIAL MANIPULATION. Internal dysfunction (let’s abbreviate” >

Leave a Reply

%d bloggers like this: