The Fascia

Fascia is our largest sensory organ, as it’s filled with nerves and nerve receptors for stretch, pressure, pain, and temperature.

Fascia is a 3-dimensional matrix within our body covering head to toe, front and back.

No beginning and no end, no separating layers.

Fascia gives us our shape as a human.

It makes up the body’s architecture.

The fascial “skeleton” is malleable, controls the perception of movement, muscle coordination, and proprioception.

Fascia is the collagen based connective tissue that covers every muscle, bone, nerve, blood vessel, and organ in the body in one solid unbroken continuum.

It makes up the outside covering of bone and intertwines within the bone.

It surrounds individual muscle fibers, then packages around and groups up individual fibers in a bundle, and then wraps and bundles up those groups into the muscle, called myofascia.

From there in one continuous flow of fascia it merges into the bone and continues into the next muscle creating what is known as a fascial motor unit: groups of muscles connected and coordinated by fascia.

Muscles should not be looked at as an isolated structure, but rather a complex interwoven construct within the myofascial connective tissue matrix.

Fascia plays a major role in muscle recruitment and posture.

Fascia is responsible for our body’s proprioception and coordination in movement, lubrication, support, and muscle force transmission.

Fascia has contractile behavior, like smooth muscle, when it’s stretched.

Altered fascia within the myofascial motor unit will cause:

· Inaccurate muscle recruitment (weak and/or tight)

· Abnormal joint motion

· Stimulates joint pain

Any impediment in the gliding of fascia could alter muscle function resulting in abnormal movement.

Fascia connects all the motor units that act on a joint.

Anatomy Trains, Myers

Any alteration in the fascia results in uncoordinated movement and irritation of the joint pain receptors.

This pain can be diffuse, the entire joint, antagonist muscles, or anywhere along the fascial chain.

At times there can be no pain within the movement, or all movements can be painful.

Fascial restrictions can cause:

· Inflammation around the joint

· Edema, or fluid

· Cysts: develop on the tendon to compensate for abnormal muscle activity

· Hypertonic (too much contraction) of muscles

· Hypotonic (too little contraction) of muscles due to nerve compression

· Clicks: TMJ opening, knee, etc from tension imbalances

· Subluxations or joint misalignments

· Paresthesia: numb-like tingling

· Skeletal/postural deformations

Myofascial restrictions occur when the gel-like substance within the fiber network of the fascia dehydrates and compresses due to inflammation, trauma, poor movement, scar tissue, emotional stress, nutritional deficiencies, etc.

This creates restrictions, adhesions, and densifications of the tissue and obstructs smooth gliding.

These can feel rough, bumpy, and gritty under the skin when you palpate over.

These tissue distortions generate imbalances between the tension and compression caused by the adhesive nature.

Fascia, being one uniform tissue head to toe, can cause problems to spread and travel in the body.

A foot problem can lead to a low back, or a gait imbalance can cause a problem to develop in the opposite limb, or an injury to a shoulder can manifest in a hip.

This is due to the body-wide force transmission of the fascial network.

Manual therapy can be used to restore and reorganize the fascia, improving the movement, glide, and motion of the muscles and joints.

This increases healing, rehabilitation, and movement.

Due to the fascia having a gel-like matrix, it can be reshaped and remolded with the heat generated from friction of manual therapies.

Usually, 2-4 minutes of manual therapy on fascial restrictions is needed to heat the fascial matrix via friction and allow it to reshape and reorganize in a small 2 centimeter squared area.

After a fascial treatment avoid taking anti-inflammatories, ice or heat. Just let it heal over the next 48 hours.

Even the most minute changes in body morphology of fascia can cause a shift in tension/compression promoting optimal and dynamic movement patterns.

Muscular trigger points form within the muscle fibers due to spasms, and many trigger points will form at once simultaneously.

These can also cause patterns of pain referral.

Like fascial restrictions, trigger points also are resolved with manual therapy, often compression on the trigger points, until the spasmed areas give up.

Often you will have trigger points, distortions in the fascia covering the muscle fibers, and dense tissue (like scar tissue) that needs to be realigned so it can begin to heal properly.

Friction from manual therapy helps to mobilize joints.

This is a great way to accelerate your healing and prevent the chronic “weak spot”.

I have found often patients will present for one problem, but I have to treat a different part of their body to resolve it.

It’s as if the body numbs out the old injury, or “forgets” about it, compensates in a new pattern, and covers up the previous injury.

These happen often and with many people.

To summarize:

If you have an injury currently, or in your past, you want to treat the myofascial restrictions to restore normal movement.

This can include anywhere along the fascial chains, or even opposite limbs in the case of gait imbalances.

Oftentimes muscular trigger points will be present that need to be resolved as well.

In addition to restoring normal fascial movement, moving your joints through full range of motion with increasing resistance will help accelerate the healing of your tissue.

The longer you have had the injury, the greater likelihood you have developed compensations, or your injury is a compensation from a previous injury.

So, revisiting old injuries is usually necessary.