FASCIA
WHAT and WHERE IS THE FASCIA?
WHAT DOES IT DO and WHY IS IT SO IMPORTANT?
WHAT CAN GO WRONG and HOW DO WE FIX IT?
The FASCIA is a vital part of the connective tissue system. Other connective tissues are ligaments, whose function is to connect bone to bone, i.e. the joints. Tendons are connective tissues that connect muscle to bone, sometimes at the joints and sometimes elsewhere on a bone.
The fascia is connective tissue that surrounds not only all your muscles and bones, but your internal organs, blood vessels, and lymphatic vessels as well. In fact if one were to remove all the bones, muscles, organs and vessels from the human body, the fascia would stand on its own as a 3 dimensional representation of that person. This is pretty significant, and here’s why:
It serves as a protective layer of all our muscles, organs, glands, vessels, etc.
It is essential for unrestricted joint movement because it surrounds not only every muscle, but each individual fiber of the muscle, and thus allows for glide of muscle on muscle, fiber on fiber, and it inserts into the tendons at or near the joints.
It has proprioceptors: receptors that let us know where our body is in space, and nociceptors: receptors that transmit pain signals to tell us when there is an injury or dysfunction.
It contributes to the strength of muscular contraction; 30-40% of the strength of contraction comes from fascial input.
It is protective because it monitors muscular tension, signaling us when a muscle is being overstretched.
It supports our blood vessels and helps keep them patent.
It provides a pathway for nerves, and prevents them from excessive stretching.
It provides a pathway for our lymphatic vessels, which means that a fascial dysfunction could contribute to an interference with lymphatic drainage, i.e swelling.
All this is to say the fascia’s proper function is essential to our overall wellbeing.
For the purpose of this blog I will limit myself to addressing the dysfunction in the fascia that contributes to musculoskeletal pain, particularly chronic pain.
When I speak of dysfunction in the fascia I am talking about limitation in fascial movement due to densifications that form in the loose connective tissue of the fascia. These densifications are made up of hyaluronic acid crystals that cluster together and disrupt fascial glide. Normally hyaluronic acid is a lubricant that allows for normal gliding between joints and connective tissue. But either due to injury, trauma or chronic stress, the crystals can clump together and densify, resulting in restricted movement. This has been researched extensively via dissection of the fascia and by observing live movement with ultrasound.
ANALYSIS and TREATMENT
Analysis involves taking an extensive case history of all current areas of complaint, but also includes past areas of pain, trauma and/or dysfunction. Unbeknownst to patients, and to many doctors for that matter, current acute or chronic pain can be due to prior, seemingly unrelated, injuries.
A classic example would be chronic low back pain. A patient may have had numerous treatments toward the lower back, with only temporary or no relief. A thorough case history may reveal a prior knee or ankle injury for which the patient had “successfully” compensated. Even though the knee or ankle is no longer painful, it was that initial injury and compensation that led to dysfunction in the fascia, which in turn caused the lower back pain. In this case, if the knee or ankle are not addressed the low back pain cannot resolve. Further analysis involves movement evaluation to determine which movements cause the most pain, or are the most restricted. This clues us in to those fascial planes most involved: i.e. flexion, extension, rotation, side-to-side movement, or a combination.
Once we have that information we palpate (feel) for density in the fascia. The densifications are often very tender, and pain may refer to other places in the body or cause the area of complaint to feel more aggravated. This confirms for us that we’re on the right spot. In order to break up and smooth out the density, I treat it with light friction. This can take anywhere from 1 to 5 minutes -sometimes more- and in a single session I may treat anywhere from 3 to 8 points.
Afterwards, we test for increased mobility and/or strength, along with decreased pain. The beauty of this technique is that it’s very specific, not simply a general flushing of the fascia without analyzing where the problem is stemming from. Moreover, if one’s problem is a fascial one, the results can be phenomenal and fast; meaning 5 to 10 treatments. Of course, people often have a variety of issues, not only fascial. There can be joint misalignments, nutritional deficiencies, etc. In my office we explore all those things.
The human body is extraordinarily complex –an intricate jigsaw puzzle, consisting of “billions and billions” of interconnected pieces. More and more I find that recognizing fascial disruptions can be a huge part of understanding that puzzle.