FDM: A pathological model, not a technique
Fascial Distortion Model (FDM) was elucidated and developed by Steven Typaldos, DO. It describes six separate fascial pathologies that give possible mechanisms for musculoskeletal pain and dysfunction. It is strongly rooted in the belief that the patient will tell you where the dysfunction is and that their body language will describe the particular distortion. Dr. Typaldos learned to read this language and apply techniques to treat them. While few patients will have one distortion causing their pain and dysfunction, many will have layers of distortions that cause their issues. I met Dr. Typaldos at the St. Louis Convocation in 1999, spoke with him for a while, and purchased his book. As a medical student, I was excited about these novel techniques for treating a Triggerband or a Herniated Triggerpoint.
What I failed to grasp was the full scope of the model and how all the distortions manifest. Perhaps my biggest failure was to not let the patient tell me what the pathology was. I felt my “superior” palpatory skills were more important than what the patient was telling me, and thought that I will treat the patient because I know better.
Since finishing medical school, I have taken three FDM courses. The first was around 2009, the course was not very well laid out, and it tried to accomplish too much in one session. That course emphasized the techniques first, while the explanation of the model (with the phrase “stay in the model”) seemed like an afterthought. This year I attended my second and third FDM courses, and they have changed a great deal. The Model is first, the technique follows. The pathology is explained in-depth, and the integration of more traditional techniques are better taught. In fact, it is one of the few courses that encourage the participants to apply and even demonstrate their favorite techniques within the Model so that all can learn.
Training in osteopathy teaches us to use our senses to evaluate the patient and notice asymmetry and restrictions of motion. We then apply techniques to free those areas and restore function and allow the body to heal itself. What I believe is lacking in the traditional models is that we do not have an explanation for why the asymmetry and the restriction of motion develop. FDM attempts to explain why those restrictions exist. When you take an FDM course, they emphasize “stay in the Model” to understand the pathology. Yes, new manual techniques exclusive to FDM are taught, but they also teach new ways of applying old techniques within the Model. HVLA, strain/counter strain, muscle energy, balanced ligamentous tension, and all other techniques, including cranial, fit beautifully in the Model. FDM does not supplant other techniques
The array of techniques I use in my day-to-day practice has not diminished. Instead, they have expanded and are utilized more wisely. I still utilize the Zink’s Common Compensatory Pattern model to assess the whole patient, and I am still heavily influenced by strain/counter strain, ligamentous articular strain, and other approaches I learned during my early education. I use FDM to better integrate them. I also use Neurofunctional Acupuncture in my practice, this also fits well within the Model. Since fully embracing the Model I have seen a dramatic improvement in my practice efficiency. My patients see longer lasting results, enjoy better outcomes, and they have a better understanding of what is causing their issues.
Being in a leadership position in the military, I am able to customize my practice to a degree. I see patients with chronic issues for 1-hour appointments in the afternoon. In the morning we still do the standard military sick call. These are very quick visits for a variety of issues and have the dual purpose of treating the patient as well as determining their fitness for the day’s work, much like an occupational medicine clinic. FDM allows me to quickly treat and return these service members to full duty, enabling them to perform their work quickly and efficiently, whereas “standard of care” would place them on light duty, leaving work undone for a prolonged period of time. Uncompleted tasks and service members on light duty both affect the operational readiness of the unit.
By embracing and staying in the model, FDM is a powerful tool to better understand the underlying pathology and helps the provider focus their therapeutic intention. It is not meant to be a stand-alone technique, but a pathologic tool to focus all techniques for the betterment of the patient.
Paul Langevin, DO, DIMM, MPH