In recent years there has been an explosion of research on fascia and how various treatment modalities (acupuncture, acupressure, laser, ultrasound, manual therapy) effect our myofascial system.
Fascia is a dense, irregular connective tissue throughout our body that surrounds and connects every muscle, bone, organ and joint. It forms continuity throughout the entire body that is important in movement organization and posture (Schleip, 2003). It is made up primarily of collagen that forms sheets or bands beneath the skin to attach, stabilize, enclose and separate muscles and internal organs.
There are distinct layers that play different roles. The superficial layer connects our skin to tissues beneath and allows gliding and sliding of these layers. This layer also acts as a heat insulator and thermal regulator. The deep fascial layer is a denser fibrous tissue that penetrates and surrounds the muscles, bones, nerves and blood vessels of the body. This layer transmits forces from muscles to bones, encloses our muscles into groups and assists muscles with tension and pressure regulation. The visceral layer encloses our internal organs and helps to suspend our organs and reduce shock and friction.
These layers form a complex network of tissue that influences and is influenced by every organ, muscle, blood vessel, bone, lymph vessel and nerve. It is a continuous sheath of tissue that moves, senses and connects all structures (Langevin 2005). This matrix also transports nutrients to tissues and helps to flush out toxins in our body. There is an interesting link here to the Traditional Chinese Medicine ideology that our organs are intimately linked to our musculoskeletal system. Barrett (2013) states that “TCM holds that the body’s vital energy circulates through channels, called meridians, that have branches connected to bodily organs and functions.” (Hmmm, pause for thought!)
There are a variety of receptors within fascia that detect and respond to light touch, pressure changes, vibration, stretch, and pain. For example, golgi receptors detect stretch, paciniform mechanoreceptors detect pressure change and stretching forces and nocioreceptors detect pain. These receptors all play a role in pain and proprioception (body awareness) and are thus capable of responding to the external environment and surface stimulation (Schleip 2008).
When there is an area of disuse, overuse or injury – the collagen in fascia becomes thicker in that area and there is less nutrient transfer and less ability to flush toxins. As this thicker fascia becomes less mobile, injury and postural dysfunctions occur. Muscles, ligaments, and tendons have less nutrient transfer, less waste disposal, less water content and become stiffer and fibrotic. Tissue in the deep and visceral layers can form connective tissue adhesions causing pain and “trigger points” (Myers 2001). A release of these adhesions via a variety of mechanical stimulation (cupping, massage, acupressure, acupuncture with needles, stretching, ultrasound, shockwave, electrical muscle stimulation) allows the cells to spring back into shape and function. For example a needle inserted into these collagen fibres causes a “mechanotransduction” stimulating receptors and thus affecting circulation, pain and healing.
Physiotherapists play a vital role in identifying movement dysfunctions and assessing the body as a whole unit. Often an area of pain develops as a result of stiffness or disuse elsewhere in the body. Addressing postural dysfunctions can affect overall wellness, reduce pain, improve energy levels and play a role in preventative health.
We hope everyone had a great summer, albeit a different one, and is ready to tackle what the fall and back to school have in store for us!
Jennifer Gordon (BSc.PT, GunnIMS, AFCI)