Fascia is ‘fascionable’ for good reason. It’s the versatile connective tissue that holds and nourishes our muscles, bones, organs and supporting systems while allowing each its freedom of movement. Dysfunction in the fascia underlie many of our aches, pains and reduced mobility and frequently supplies answers to problems resisting alternate diagnosis. 10 years of remedial massage has taught me that most people's 'body-age' is younger than they think it is. We don't usually have to live with our aches and pains - many fascial issues are reversible . This article outlines several interesting and little known characteristics of fascia and how remedial massage comes into its own with both maintaining it in peak condition and with its treatment when restricted.
Fascia is our tough, elastic, adaptive, structural material. It is a 3D fractal net of mainly collagen and elastin in which our bones, organs, muscles, nerves, arteries and veins sit suspended and interconnected. It wraps and penetrates every part of the body, even down to the level of individual cells.Tendons, muscle sheaths, and our favourite ITB (Iliotibial Band) are all fascia. A layer of Superficial Fascia also links the skin to the muscular system below, a photo of which appears at the head of this article.
Fascia is found throughout the body in a great variety of forms, shapes and characteristics. To get a quick 'users' understanding have a look at this short video (from “Strolling under the skin” linked below) showing a 3D computer model of a tendon sliding in the layer of Superficial Fascia under the skin.
You can see how the healthy fascial net allows unimpeded blood flow and movement while keeping everything operating in its right neighbourhood. It’s easy to visualise the discomfort, loss of inner freedom and health should this net get stuck. To see the real thing you can watch the full “Strolling under the skin” video which shows fascia in all its beautiful manifestations (please read the warning re queezy stomachs first!).
Some other interesting tidbits:
Healthy fascial layers are able to produce a lubricant, hyaluronic acid, which keeps internal friction minimised.Through healthy fascial fibres seeps a fluid, containing Glycosaminoglycans, which is thought to provide hydraulic pressure balancing of the net. Interestingly Glycosaminoglycans adjust their viscosity in response to physical forces applied.
Fascia constantly adapts to what we ask of it. If we sit for hours a day, fascia stiffens and thickens to make this easier. Unfortunately, it will not become more elastic, toned and hydrated – that’s only what we want it to do. The body develops to make what we actually do easier.
Fascia nourishes and transports waste. Fascia houses lymph ducts and active immune cells. Fascial tissue is critical in defending out health.
The fascial structure acts as springs in the body. "Fascial stiffness and elasticity plays a significant role in many ballistic movements of the human body. How far you can throw a stone, how high you can jump, and how long you can run depend to a large degree on how well the elastic recoil properties of your fascial network are supporting these movements" (5) Interestingly, Double-amputee Oscar Pistorius, was only permitted to run in the 2008 Olympics because his spring-like artificial legs gave him no advantage over able bodied runners with naturally springy lower leg fascia. Animals are keen users of this elastic quality in tendons. Kangaroos primarily uses a 5% recoil in stretched leg tendons to bounce, while cats spring from a standing start by releasing tendons pre stretched by their muscles. We literally can be wound up like springs. Healthy fascia is a major power source for us.
The question naturally arises as to how to keep our fascia optimised. Thomas Myers, a world renown expert in this area, has provided us with 10 tips for training the fascia. I would add to this an 11th which is deal with dysfunction early - restrictions have a tendency to grow more restricted over time.
As with the rest of our bodies though, fascia is susceptible to dysfunction. Our fascial net can adhere to itself or other layers (restricted), dry or thicken due to injury, aging, inflammation, immobility, poor posture, stress and overuse. This is a problem as its many functions are also restricted, not least of which is to allow graceful, unrestricted, painless enjoyment of our bodies. Like pasta, dry fascia is weakened and brittle. Only this week I heard of yet another person who snapped his Achilles tendon in his first week back at the gym. Be aware - fascia is slower than muscle to adapt to a new activity!
Importantly fascia restrictions lead to modified use of joints as adjustments are made to accommodate range of motion limitations. While the initial pain of restrictions may dull, be aware that joints don't like modified usage and they will not reward us if this continues longer term! Its best to attack the issue at the source (fascia dysfunction) before secondary effects manifest (joint damage).
So what does a adhesion actually look like? These two following images showing the skin being removed from underlying animal muscle shows quite clearly stuck layers and give a hint as to why they can cause pain and discomfort.
Fortunately, fascia reacts to mechanical manipulation, even down to the individual cell level. Our cells can actually convert external mechanical signals into internal biochemical reactions (6). Beneficial mechanical manipulation of fascia is found in yoga, stretching, exercise, acupuncture and of course very directly in massage.
Fascial restriction is a primary target of ‘myo-fascial release’ massages. Usually it’s not the muscle itself, or even the generic 'aging', that is the problem, it’s the fascia. Therapists feel for the restrictions and tease them apart. Restoring inner space, fluid flow, range of motion, and critically, removing pain and dysfunction from the body. Restored fascia often leaves us feeling younger in 'body years'.
Now for an unfortunate fact: fascia is 10 times more densely populated with nerve endings than is muscle tissue (4). Separating restricted sections of the net can hurt. The degree of pain and number of treatments tends to be related to how ‘stuck’ an area is and for how long it’s been there. New restrictions can melt apart under a light touch with no discomfort at all. Long term restrictions can however give quite a sting as individual fibres need to tear apart. Its not hard to see the parallel with removing bandaids. These micro-tears will cause some minor trauma to the fascia and this produces the common side effect of soreness for the next day or two following this type of work. Once the fascia quickly repairs only the restored freedom will remain. (I will talk more about our experience of pain in a later note as it’s actually quite remarkable and pliable in its own right.)
Restricted and dry fascia is often behind those frustratingly hard to diagnose long term aches and pains. Obviously not always, but certainly not uncommonly, a solution is found manually addressing the restrictions causing different functional ‘layers’ of the body to ‘stick’ together.
Thickened Fascia can even restrict nerves to the point of causing significant chronic pain. Medical operations can fix this however in some cases early focused massage might prevent this.
In the clear majority of cases, once separated, the fascia remains free for a month or two even without our ongoing care and attention. And it usually only takes a few massages of an area to get as much fascia freed as is possible through physical manipulation of the tissue alone. That’s a good return on an hour-or-two's investment.
Until recently it’s been our imaging techniques that have kept fascia's role in pain out of focus. By not showing on x-rays and CAT scans restricted fascia makes formal diagnosis challenging. The good news is the latest ultrasound equipment is beginning to make live fascia more ‘visible’ and as such more research is being conducted (5) . Historically though, body workers have been long aware of its nature and function through their tool of sensitive fingers.
If you are interested in a more detailed understanding of fascia I can recommend the following videos and links which have provided most of the facts quoted in this article. Please note the Rating information prior to viewing!
1. A German TV documentary that considers fascia’s role in back pain. I’m giving this a PG rating.
2. Strolling under the skin: Warning – though beautiful and providing a very clear understanding of the nature of fascia, this is, as the name suggests, a microscopic look under the skin of a live person! I’ve started it in a relatively safe part of the film – well past the first couple of minutes which are somewhat graphic and well worthy of an R rating!
3. A technical summary - with no icky pictures. Rated GP. (GP: Not likely to turn the stomach of a child but the child should be somewhat precocious to understand the terms used!)
4. Staying fit all life long - 10 tips for fascial fitness - Thomas Myers. GP
5 . Fascia Research from a Clinician/Scientist’s Perspective. Thomas W. Findley, MD, PhD GP
6. From cellular mechanotransduction to biologically inspired engineering: 2009 Pritzker Award Lecture. Ingber DE GP