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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
Discovering Diverse Content Through
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