These days, the term "Fascia" is widely used by many in the health care and wellness industries. However, it's implications and role in musculoskeletal pain syndromes is not widely understood and often overlooked.
Fascia is connective tissue. Every body structure, including blood vessels, nerves, viscera (organs), meninges (brain), bones and muscles, are wrapped in fascia.
Fascia is comprised of fibroblasts (connective tissue cells) that are suspended in a gelatinous substance known as the extracellular matrix.
This extracellular matrix is what gives our body tissues viscoelastic properties, meaning that its mechanical behavior can be both a solid and a liquid. An interesting fact is that our bodies, including fascia, are comprised of over 70% water.
When I learned Kinesiology, I was taught that movement in the human body occurred predominately through muscles contracting and pulling on bones. Research is now pointing to a new model to describe the movement of biological tissues called Biotensegrity and it is slowly replacing the outdated, "pulleys and levers" theory of movement. Fascia is the framework that allows for our human bodies to be viscoelastic and move into solid and semi-liquid forms depending on how 3-dimensional tension (stress and strain) patterns are interacting with gravity.
Fascia has many functions.
Provides a structural framework
Absorbs shock and transmits force
Provides protection and support to nerves, blood vessels and lymphatic structures
Interacts with the immune system as well as the endocannabinoid (endorphin) system
Provides proprioceptive feedback (unconscious perceived movement in space)
Linked to interoception, which is the process by which the body senses, interprets, integrates, and regulates signals from within itself.
Responsible for preserving the organs in their proper position
Provides vascular support and assists in venous return from the lower limbs
There are many reasons why the fascia may become a pain generator. Hypomobility, or stiffness in the fascia is common and can result in restricted mobility as well as pain. Fascia is highly innervated with small diameter nerve fibers. The nerves in fascia have been shown through research to be affected by local and/or systemic inflammation. In the optimal state, these nerves are responsible for providing body position sense, however they can easily become pain generators in the presence of inflammation. In addition, all fascial layers require hyaluronic acid, which maintains the tissues water content, to slide and glide. If the amount of hyaluronic acid decreases or is not regularly distributed, then tissues can become dehydrated and movement may be reduced. Scar tissue following an injury, surgery or lack of movement from long term postural compensations can impact the distribution of hyaluronic acid in the fascia. In addition, dehydration of fascial tissues does not allow for the waste products of cellular metabolism to be properly removed thus altering the PH inside the fascia to favor a more acidic environment. As you can see, these processes create a negative feedback loop which can result in increased body pain and decreased mobility.
Alternatively, fascia can become hyper-mobile or too loose. Genetic disorders can lead to widespread connective tissue laxity. Some of the more common conditions are Ehlers-Danlos Syndrome, Marfan Syndrome and Charcot Marie Tooth. These people have high rates of musculoskeletal pain and reduced proprioception. In these cases, stability and balance are the preferred methods of treatment over mobility and stretching.
Now that you have a broader understanding of fascia and its implications on musculoskeletal pain syndrome, the next step is to gain an understanding of how to effectively target and train the fascial system.
1. Stretch in ways that emphasize large movement and target fascial planes, not isolated muscles. Many yoga poses incorporate this concept.
2. Chose both dynamic and static stretching. You can also add small contractions and relaxation into the movements. Hold for 5 seconds, relax further into the movement and repeat 4- 5 times
3. Drink water!
4. Reduce inflammatory triggers by eating a healthy diet of mostly whole foods and lots of vegetables as well as lowering stress levels. This includes physical, emotional and mental stress.
5. Aim for 7.5-9 hours of sleep per night to assist with tissue repair.
6. Make sure you are incorporating rest and recovery into your exercise schedule to allow for adequate healing and remodeling of tissues. As we age, we need a higher ratio of rest to exercise days.
7. Mobilize tissues appropriately with foam rollers or other mobilization tools: move slowly and add small movements to enhance mobility. Your fascia acts like a sponge. With the compression you are driving fluids out of the tissues and when the pressure is released fresh fluid enters and rehydrates the tissue.
8. Add small, controlled, plyometric type movements into your routine to enhance the elasticity of your fascia. Healthy fascia is springy!
Reach out to Resonance Physical Therapy to find out more or to book a session to have your fascial restrictions evaluated and treated by a Certified Functional Manual Therapist.
References
Bordoni, B., Zanier., E Clinical and symptomatological reflections: the fascial system. J Multidiscip Healthc 2014: 7 401-411.
Bordoni, B., Simonelli, M., Morabito, B., The Fascial Breath. Cureaus 2019 Jul 11(7) e5208
Langevin, H., Fascia Mobility, Proprioception and Myofascial Pain. Life (Basel). 2021 Jul 11(7) 668
