Originally Published January 21, 2013. Vail Daily
Fascia is not commonly talked about when we discuss recovery from injury and when it does get addressed, it is sometimes a little hard to wrap your head around. Due to space constraints in the Vail Daily column, I couldn't include any images which would have certainly been helpful. I've
posted the article here with accompanying photos to give you a better idea about what fascia is all about.
A few months ago I gave a lecture to the Colorado Athletic Trainers Association on the importance of fascia. Fascia is one of the most common tissues in the body, has a rich innervation, and plays a major role in pain and dysfunction. However, it is still not something commonly talked about or adequately addressed when we discuss injury and rehabilitation.
I thought I knew a lot about fascia. I treat people with muscle and fascial problems everyday, so I assumed it wouldn't be too difficult to put together a presentation. However, fascia has been getting a lot of attention through new research in the past few years, and I was a little humbled to find much of my understanding of fascia turned out to be outdated or incomplete.
Fascia is a connective tissue that is organized in a three-dimensional network that surrounds, supports, suspends, protects and divides the muscles, skeleton and organs of the body. There are three types of fascia in the body: visceral, superficial and deep. Visceral fascia creates compartments for the organs offering protection and lubrication. Superficial fascia is under the skin and creates scaffolding for nerves and blood vessels and allows the skin to move over the underlying tissue. It is elastic so when stretched, like in pregnancy, it can return to its original state over time.
Unlike superficial facia, deep fascia is less elastic and more invested in the muscles and other tissues of the body. We typically think about muscles connecting bone to bone but they also connect with each other via fascial connections. The gluteus maximus, for example, is only 40% directly connected to bones. The rest is connected to other muscles or structures through fascia, which allows different muscle systems to work together and exert influence at a distance. This is how the glutes help stabilize the knee via the ilio-tibial band. If the ilio-tibial band gets stuck or develops adhesions to the thigh muscles, knee stability can be affected, even if the glutes are strong. Clinically, there are many situations where we need to look beyond simply just the site of pain.
One of the most intriguing aspects of fascia that was new to me was that the deep fascia is not an inert tissue connecting muscles, but one that is perceptive and reactive. Rich sensory innervation allows sensation of temperature, tension and of course, pain. Newly discovered smooth muscle cells in the fascia suggest it has the ability to pre-tense independently of the muscles. This may aid in its sensory role, but perhaps also enhance its ability to transmit forces. Thoraco-lumbar fascia, for example, is a thickened diamond-shaped area of the fascia connecting the lats to the glutes and lower body on the other side. When we sprint and swing our arms, tension through tightened fascia pulls on the opposite side of the lower body, improving sprint performance.
No muscle works in isolation. Fascia helps link functional muscles systems together.
Fascia is especially responsive to the stress applied to it. We know that use of manual therapies, like Graston and Active Release Technique, can affect adhesions and scar tissue, but recent research suggests that it can also produce more fibroblasts (the cells that create the building blocks of connective tissue) for remodeling and creating stronger, more functional tissue. (see slides below article)
Bringing fascia back into the conversation about injury and rehabilitation and understanding fascial connections between muscles, the sensory properties of fascia and addressing the fascia to enhance repair and remodeling may allow for faster recovery and better, longer-lasting results.
Comparison of a normal, injured untreated and an injured treated
Increased fibroblast proliferation with instrument assisted massage