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Fascia: The Glue That Binds Us

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Fascia Up DogFascia is all the talk in bodywork circles these days. Most of us intentionally incorporate some aspect of fascial work in our practices, but in reality ALL manual therapists affect fascial tissue to some extent, whether they know it or not. I have had many clients come in who have either never heard the term before, or have heard it, but have little or no idea what it is. My hope is that this article will help inform those who are less familiar with this important facet of our bodies to understand what it is, its myriad functions, and how important it is to maintain the health of this system.

The term ‘fascia’ is generally defined as “a layer of fibrous tissue. Fascia is a structure of connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together, while permitting others to slide smoothly over each other”[1].

fascia back

Fascia is everywhere inside us. It is the thin, filmy layers that wrap the bones, joints, organs and compartments within the body, holding all the parts in place, and allowing independent or interdependent movement of tissues. It is the thick, tough layers that give the back strength, stabilize joints and attach muscle to bone. It permeates muscle tissue, giving it its shape and contractile properties. It forms the sheaths that surround nerves, and become the arteries and veins. Superficial fascia, the layer just below the outer skin, is very loose and porous, with significant amounts of adipose (fat for energy, padding and insulation) and vast numbers of nerve endings. This superficial fascia is what gives us our outward appearance, and keeps us in tune with the outside world; it makes us “who we are” to everyone else.

Fascia is so integrated and integral that some have suggested  you could remove all the other structures, and the body would hold its form. And yet, for centuries, this tissue has been relegated to the scrap heap, the stuff that “gets in the way” of understanding the “real” functional parts. We are now beginning to understand that this pervasive material is significant to every other system, providing stability, nutrients, instantaneous information and possibly even movement [2] into the minutest areas. With this new understanding come new perspectives on the function, adaptations, and dysfunctions that are the daily work of bodywork professionals.

fascia muscle structureMuscle without fascia is relatively shapeless protein, like ground meat. The fascial layers within and around that protein give it its shape and the ability to contract, causing movement across a joint. These layers come together as they approach the ends, forming the strong tendons which merge with the fascial bag of the bone to which they attach. This “bone bag” (periosteum) becomes the joint capsule and ligament at the place where two bones meet, giving stability and protection to the joint.

fascia sweaterThe interconnectedness of each segment gives fascial tissue an interesting property; one part affects all the surrounding parts. It has been compared to a sweater or nylon stocking. When you pull on one corner, that pull creates a change in the weave pattern of the entire piece. Similarly, if there is a restriction in connective tissue in the foot, it has potential to create tension in the back or neck.

Depending on the functional requirements asked of the tissue in a particular area, its properties vary. Fascial layers surrounding and integrated in the belly of a muscle will be much more elastic, while the tendonous ends that require more stability are much thicker. Ligament, with its primary function being to limit joint movement, is very dense and strong, with almost no elasticity.

If you grab a little piece of skin from the forearm and pull gently, you will find that there is a fair amount of movement in any direction (go ahead…try it… you know you want to…). Drag gently away from the elbow, and you can feel the tissue at the elbow and around the arm pulling. With a straightened elbow, you can actually feel the pull across the elbow and into the upper arm.fascia web There is easy movement up to a point, but also an end point beyond which  the tissue doesn’t seem to want to go. Continue to pull gently, and see if the tissue doesn’t lengthen slowly. This is a perfect example of the dynamics of the looser superficial fascia, and in a very simplistic way, how myofascial release technique works on all areas of the body. Because of the interconnectedness of the tissue, with a pull in the superficial layers and with enough time, we can create change in the deepest layers of the fascia.

fascia tensegrity

Our bodies are all about balance of tension. Based on a principle called Tensegrity (a term used by Buckminster Fuller to describe a type of structure with an integrity based on a balance between tension and compression components), we are able to move through space independent of a fixed point on the ground. Bones make up the compression parts, and soft tissue, primarily fascia, make up the tensional units. For every joint in our bodies that moves, there are ligaments, fascial bags and muscle that work in balance to control that movement. An easy one to think about is elbow flexion. The elbow joint essentially allows movement in one plane; lower arm closing toward upper arm or lower arm opening away from upper arm. The musculature that controls this movement is located on the front (biceps group) and back of the upper arm (triceps). When biceps tightens, the two boney parts come together bringing the hand toward the shoulder. When triceps tightens, they move away from each other. An aspect of this simple movement that might not be so evident is that when the biceps muscles are bringing that hand toward the shoulder, triceps are working to control how far, how fast and with what force the hand gets there. Without counterforce, every time we tried to bring the hand toward the shoulder, it would spring up to full flexion uncontrolled. One can imagine the impact if one side of the equation becomes bogged down from injury or overuse.

fascia anatomy trains

Tom Myers, accomplished practitioner, developer and teacher of the KMI Structural Integration program, and author of Anatomy Trains, has taken this tensegrity concept a few steps further. Through observation of tensional patterns within the body, and backed by cadaver dissection, he has found that there are continuities between fascial tissues that create lines of pull from the top of the head to the bottom of the foot on the front, back and sides of the body, as well as lines that spiral as they wind their way up the legs, torso and neck. These tensional lines work quite well to explain how plantar fasciitis on the bottom of the foot  can affect hip and rib cage balance, and pull in the neck. Issues anywhere along the tensional line have impact above and below, as well as on the opposing side of the body.

fascia computer posture

When there  is inactivity, trauma or long term stress to a part of the body, the fascia tends to dry out and thicken, causing a reduction in movement and blood flow to the area. These restrictions cause recruitment of other muscles nearby that are likely not the best suited for the job. When the secondary muscles become exhausted, they begin to dry out and become stuck as well. Trigger points, painful contractures in the tissue, form. The longer the restriction is held, the more dried out, immobile and irritated the area becomes.

One of the reasons (in my view) that we have so many issues with low back, shoulder and neck pain has to do with our daily work activities. Many of us spend long hours sitting (using the muscles of the back hips as cushions instead of their intended purpose) in front of a computer, straining to see what we are doing. We are likely under stress to finish that project, adding stress hormones to the mix. Postural adaptations that are held for long periods become normalized in the tissue. Combined with physical inactivity, restrictions build, and become very resistant to change.

fascia golf swing

I firmly believe that our primary purpose as bodyworkers is to assist in reducing restriction of movement, and increasing circulation where it is needed, restoring tensional balance as best we can. The challenge is that we can only go so far. Our clients need to take some responsibility for their own well-being as well. Stretch breaks during the work day are a great place to start. Finding physical activities that are fun and enjoyable to do on a regular basis is very important. Diet and sleep are other important factors that might be better explored in another place, and with individuals with more expertise than myself. And of course, regular massage helps get to those areas that are slow or too injured to respond to stretching.

As always, comments are welcome and appreciated.

[1]Dorlands Medical Dictionary

 [2] Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics

R. SchleipW. Klingler, F. Lehmann-Horn

Department of Applied Physiology, Ulm University, Albert-Einstein-Allee 11, 89069 Ulm, Germany

Received 7 March 2005; accepted 9 March 2005. published online 29 April 2005.

 

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