July 31, 2013
What is fascia and why is it so important?
Mainstream medicine has a habit of overlooking and underestimating that which it doesn’t understand. Fascia, shrouded in all its mystery, certainly falls into this camp. The problem with fascia is that it’s difficult to define, you can`t really say where it begins or where it ends. Muscles and bones can be separated and labeled; we can see them on an X-ray or an MRI, we can draw pictures of them and make replica models to study – we know where we are with muscles and bones. Fascia seems to go where it likes and do what it pleases. It’s a bit like the anatomical elephant in the room. You can try to ignore it but it’s not going to go away; it’s too big, it’s everywhere, from the tip of our toes to the top of our heads. Things seem to be changing, however, and in recent years fascia has started to get the attention it deserves from medical researchers, due mainly to improvements in medical imaging and digital modeling.
So what is fascia?
Fascia is an interwoven fibrous connective tissue connecting every part of the body to every other part. It covers muscles, organs, bones and nerves. It binds the body together and makes us whole, allowing for appropriate and harmonious function of muscles and joints. Think of the lining covering and connecting a string of sausages; each sausage has its own compartment and is also connected to the sausage either side of it. In turn each sausage is also connected to all the other sausages in the string by way of its shared lining. If you stretch and twist one end of the sausage string, the rest of the sausages will pull tight and change in shape. Although the change may appear to be very subtle, once we replace our imaginary sausages with functioning organs and muscles, we begin to get a better picture of how subtle fascial adaptations can affect somatic and visceral function. This notion of connection and interdependence is at the heart of fascial function and dysfunction. If you want to feel the connection for yourself, ask a friend or family member to lie on their back and gently hold the weight of their head in your hands. Ask them to point their toes up towards their head, as they do this you should be able to feel a subtle pull on the connective tissue at the base of the skull. This pull is caused by interconnected fascial tissue running the entire length of the body. This exercise demonstrates how dysfunction in one area of the body can impact the function of a seemingly separate joint or structure.
Fascia can become restricted for various reasons, perhaps most obviously due to trauma from accidents or surgery, but also due to poor posture, chronic inflammation and overuse. Dysfunction may manifest as pain, tension or restricted movement. The fascial tissue itself will have become dehydrated and hardened, meaning that structures running underneath it and those attached to it, will be functioning in a suboptimal state. Dehydration of fascial tissue may be caused by local torsions or adhesions, but we should also consider the body’s overall state of hydration. Hydration is controlled centrally by the hypothalamus, located just above the brain stem. The hypothalamus prioritizes essential organs ensuring they remain adequately hydrated. If the body is in a dehydrated state, the hydration of connective tissue (including fascia) will be sacrificed first leading to dehydration, adhesions and increased susceptibility to dysfunction. Another reason, as if one was needed, to drink plenty of water.
Fascia also appears to be integrally related to the autonomic nervous system, i.e. the nervous system which manages bodily functions outside of our direct control. The autonomic nervous system consists of the sympathetic and parasympathetic divisions and plays a significant role in the bodies stress response. A heightened period of stress will lead to increased sympathetic activity. The sympathetic nervous system readies the body for action and over stimulation leads to prolonged increase in muscle tone, affecting smooth muscle tissue within fascia. Prolonged stress or tension can, therefore, also lead to fascial dysfunction.
So, apart from telling you to drink lots of water and avoid stress (easy right), how can your manual therapist help you with pain associated with fascia. Rolfing practitioners believe that when heat or mechanical pressure is applied to fascia, the tissue changes from its dense state to a more fluid state, during which time its arrangement can be changed and manipulated. It has been proven that such change does occur when connective tissue is subjected to long term mechanical pressure, but most practitioners (myself included) claim to feel a more immediate change in tissue texture during treatment. So what can explain this? Fascia is highly innervated by pressure receptors which, when stimulated, cause an adaptation in local sympathetic tissue tone. This reduction in tone and an associated change in viscosity, gives the practitioner a window of opportunity to realign and reset fascial adhesions.
So, when your therapist is seemingly working quite superficially, remember the expanse of wondrous and mysterious fascia that lies in between the skin and muscles below, it may hold the key to unlock your pain.
– Robert Schleip et al, 2012. What is ‘fascia’? A review of different nomenclatures. Journal of bodywork and movement therapies.
– Andrea Turrina et al, 2012. The muscular force transmission system: Role of the intramuscular connective tissue. Journal of bodywork and movement therapies.
– Robert Schleip, 2003. Fascial plasticity – a new neurobiological explanation. Journal of bodywork and movement therapies.