Fascia, fascia everywhere…

Fascia

/fæʃ(i)ə/

1. Anatomy, Zoology

   a. a band or sheath of connective tissue investing, supporting or binding together internal organs or parts of the body

   b. tissue of this kind

I talk a lot about fascia when I’m working, as many people are not sure what it is or how to pronounce it (I say fah-shuh).  I hope that it’ll be a bit clearer at the end of this post and I’ll try to keep it in simple english.  But first, let me be clear what it definitely isn’t: it is not just confined to the face (that’s facial) nor anything to do with the Far-Right (that’s Fascism).  Confusion with facial and fascism is why I most often talk about Myofascia rather than just Fascia.  The prefix “myo” refers to muscle, so this term include muscles as well as the Fascia. 

The definition of Fascia is very specific (see above) as far as an Anatomist is concerned, and in this post I am discussing the Fascial System, which is a broader definition.  I first came across this in the work of Dr Robert Schleip, initally in his Introduction to the book “Fascia: the tensional Network of the Human Body” (see Bibliography below) and subsequently in a number of his articles.

The fascial system can be considered to be a continual network of fibres that surrounds, supports, and shapes the bones, muscles and organs that make up the body.  It is continuous from the top of your head to the tips of your fingers and toes and goes throughout the inside of our bodies.  It has a slightly different make up in different areas of the body from candyfloss-like and very mobile strands to a thick and unstretchable band.  The fibres are also said to extend down to the cellular level and actually penetrate through the cell membrane to the cell contents.  I’m still sorting through this but it has led to some claims that the work we do has implications down to the intracellular level.  There are also discussions that because these fibres have been shown to extend into the bones, bones should also be included in the fascial system. 

I will often talk about ‘layers’ in the fascia in this post, but this is potentially a misleading term for me to use.  There are no layers present within the body until the anatomist’s knife creates them.  Things merge within the body, and there are definite areas that we can give a particular name to (eg bone, muscle, liver, etc.) but at the edges it become tricky to say where these things finish.  The misleading nature of the term ‘layer’ to describe things was a big discussion point at the Biotensegrity Dissection I went to and one of the things that got me to write the Discussions around truth post.  However, at the moment ‘layer’ is the best word that I can think of to help keep things simple.

What’s fascia made of?

Fascia has three constituent elements which are present in different ratios in different types (see below) and areas of the body.  These are collagen, elastin and the ground substance.  Depending on the location and type of fascia the myofascia will have different combinations of these parts.  I’ll come on to the different types of fascia later on in this blog post.

Elastin is a protein that allows the fascia to stretch (to a certain level) and then return to its original shape.  This is the same sort of property that lycra gives to leggings, and elastic to waistbands.  With use, over-stretching and ageing this will also lose a bit of its bounce and we start to get saggy bits.

Collagen is another protein and this one provides the strength within the fascia.  It is what celebrities are getting pumped into various parts of their bodies, as it is one of the main building blocks of the human body.  Collagen is really strong and we used to think that we could stretch it, until someone did some research into it and realised that to stretch it we’d probably damage all the stuff around it.  Instead it seems to undergo a change in state after about 90 seconds of pressure, and can change shape to be longer or shorter.

Ground substance is essentially water with proteins and sugars in it.  This is not like water in the sea that sloshes around, but more like a gel and is becoming considered as a fourth phase of Water (see the work of Gerald Pollack).  The ground substance bathes all cells within the body, and is how nutrients and oxygen get to the cells, and also how the waste products get moved away to be dealt with.  The protein rich gel behaves as something called a “Non-Newtonian Fluid” which means that it becomes thicker the more energy that is put into it.  An example of this is the thick paste formed by equal volumes of water and cornflour (also known as corn starch) which becomes almost solid as you stir it, but flows out when left alone (yes, I play with my food way too much).

Types of Fascia

There are four types of fascia within the body.  They blend from one to another and the distinctions between them are not always completely clear, but there is a definite shift from one to another.

Superficial fascia.  This is a loose and spacious network and can be found just below the skin.  It has differing depths and contains the adipose tissue (fatty deposits) around the body.  I said spacious, but there are really no empty spaces in the body they are fluid filled.  It is most clearly seen in the work of Dr Jean-Claude Guimberteau, particularly in his video “Strolling under the skin”.  It helps to connect the skin with the underlying structures and has a higher level of elastin compared to collagen which allows it to glide as the body moves and return to its original position.  As it contains the fatty tissues that make us up we may have a less than happy relationship with this layer.  This layer is the one that makes us an individual and which I believe I have heard Gil Hedley describe as the love cushion that makes us us.  I have seen photographs of this removed from a cadaver, and fat can appear yellow, Ruth Duncan described it as a big yellow onesie that we all have.  It varies massively between individuals.

Deep fascia.  This is the dense fascia that sits below the Superficial layer, and is closer to the stuff that a classical anatomist will define as fascia; sometimes it is referred to as true fascia.  If you have seen a raw leg of lamb, you can clearly see the sheath of white membrane that slides over the actual meat: that’s an example of the deep fascia.  It also forms the outer layer of muscles (called the Epimysium) that then divides to separate the bundles of muscle fibres (called the Perimysium) before finally dividing to the individual fibres (Endomysium).  These layers come together at each end of the muscles to form the tendons that connect the muscle to the bone coating fascia (known as periosteum). This is tough stuff with a greater proportion of collagen to give it strength.

Visceral fascia.  This surrounds the organs of the abdomen (the viscera) and is a much looser and somehow fluffier (apparently) so it is likened to candyfloss (cotton candy).  It quite fluid and allows the organs (stomach, intestines, spleen, liver, pancreas etc) to glide past each other with each movement.

Dural fascia.  This is the membrane made up of three layers that surrounds the brain and spinal cord.  It is really strong and helps to hold the cerebrospinal fluid that supports, protects and nouishes the central nervous system.

 Fascia a sensory network?

There is evidence through the work of Robert Schleip that the fascia contains a lot of  sensors, called mechanoreceptors, that provide the brain with information about what is happening to the parts of the body.   The mechanoreceptors help to give us our proprioceptive sense (about where the body is in space and time), nociceptive sense (about warning signs of danger to the tissues that get interpreted as pain) and the interoceptive sense (about what we feel like hunger, warm, cold, attracted to someone).

These mechanoreceptors include:

• Golgi Tendon Organs,  which respond to muscular tension,
• Pacini corpuscles,  which respond to deep pressure and high frequency vibration,
• Merkel’s disks that respond to light touch,
• Meissner’s corpuscles, which respond to low frequency vibration,
• Ruffini’s nerve endings that respond to stretch
• Interstital receptors, which are the most abundant, and respond to pressure, some picking up hard pressure and others lighter pressure.

Together these work to provide information to the brain about what is happening, allowing conscious decisions to occur, but also also reflex actions and subconscious things like changes to heart rate or breathing.  This abundance of sensors has also led some to describe the fascial network as the largest organ in the body; this is another huge area of debate and I’m not sure I will agree as an organ has specialised cells within its volume and fascia doesn’t (as found so far).

There is some discussion about whether the fascial fibres are actually not fibres but micro-tubules through which light gets transmitted.  In which case the fascia could be considered an information distribution and communication network  outside of the nervous system.  Quite what it would be transmitting I am not certain and it is yet another discussion that I am trying to keep an awareness of.

Does fascia become restricted?

The fascial system is continually adapting to the way that we use (and abuse) our bodies.  It is constantly responding to the amount of tension we apply and becoming thicker if we continually use our bodies in a particular way, and thinning if we no longer need it.  Things like the ‘Dowagers Hump’ that can form at the base of the neck due to a head forward position will often have a thickening over the top, which is the body protecting itself by increasing the thickness of fascia here. 

The movement of the body generates a slight piezo-electric current, which helps to organise the body and the formation and orientation of different tissues (see the work of James Oschmann).  This piezoelectric current is how the bones form and respond to use, the body remodels scars after injury, but also creates adhesions and spurs and other unhelpful adaptations.

The fascial system also responds to traumatic events, as well as illness and inflammation in the body.  It has been shown to become thicker and less able to glide in response to trauma (both physical and emotional). These densifications can lead to, and then reinforce, habitual patterns of movement that might eventually cause us discomfort.  It can feel uncomfortable (a feeling of strain) when we try to move differently, as the fascia has adapted to the way we use it. 

At the 2019 Biotensegrity dissection I attended I saw how the myofascial system could be very different from one side of the body to the other: a colleague exposed the abdominal muscles and on the left side the oblique muscles were glistening and looked “healthy”, the other side (which had a minute scar) was vastly different with a more fibrous and matt appearance.  We were all quite amazed at the difference between the two sides, and I could almost feel my own body tightening in the areas that appeared so dry looking.

It seems perfectly logical that this reduction in fluidity of the connective tissue would have an impact on the health of the cells, and the movement of the body’s defence cells.  There is some intriguing research into the role of the connective tissue and the fluidity of the ground substance in the development of tumours and cancers and the inability of the immune system to destroy these abnormal cells and growths.

The nerves are to be found in the loose webs between the deeper fascial layers and they should glide freely in this environment so we don’t feel them as we move. However, it has been shown that the fascia can contract, and can exert up to two tonnes per square inch (roughly equivalent to a rhino standing on a two pound coin).  Just imagine if that was on a nerve or other danger sensor in the body. 

How do I keep my fascia healthy?

Motion! Moisture! Myofascial Release!  I have just made that alliterative memnomic up, but it sums it up my ideas.  The one thing to understand is that changes to fascial health take about six months to a year to become noticeable, so this needs to be as much lifestyle change as anything else.  Robert Schleip uses the analogy of a bamboo forest that is grown by giving the plants a single drop of water each day and over time the most incredible forest develops.

Motion

We are creatures of movement, and  modern life encourages us to be still for longer than our bodies ideally want.  We all have a tendency to stay sitting (or standing) for long periods in habitual positions (think most comfortable) and then suddenly do something completely different.  Whilst I am aware that posture may not be the actual cause of aches and pains like bad backs (see my post about Posture)  I think it is that we stay in these unconscious positions for ages and keep returning to the same habits and then hurt when we suddenly do something wildly different. 

So aim to move about more frequently than you usually do and also in different ways.  This could be running or swimming or yoga or pilates or tai chi or chi gung or ballroom dancing or a combination of them all (probably at different times). 

We want  to get the body moving in different ways and directions; letting our joints experience a safe and normal range of motion.  I would also add in that slower forms of movement (like some styles of yoga, pilates, tai chi or chi gung) allow you to become aware of how you move and any areas that are different from one side of the  body to the other.  This difference may not be as easily noticeable in faster pursuits. 

Something called Rebounding (gentle bouncing) on a trampette seems very intriguing to me as it replicates one of the approaches used in Myofascial Release.  By bouncing on the rebounder you introduce a vibration through the body that gets ripples happening and as it’s on a small trampoline there is less of a jarring impact that you might get running.

Moisture

This is related to the ground substance needing to be fluid.  The body is always keeping itself in balance and will have a level of hydration.  If you start to get the fascia into a more open and free place then it will be able to hold more fluid.  There is also evidence that connective tissue that is restricted and bound to itself is less able to hold water; think of a half squeezed sponge.  So if you get more freedom in the fascia you’ll be able to hold more water in your system and that will help to keep it and the cells within it functioning well. My post about Hydration has some ideas about how much water to drink, and how often.  But in summary: a little and often, but not so much that you are always peeing clear.

Myofascial Release

OK, so this is me being biased. Myofascial Release in the John F Barnes style seems to help because, in my opinion, it works with the nature of key elements of the fascial network.  This approach looks at the body as a whole, and acknowledges where the pain is, but looks elsewhere for the cause.

The fact that with this style of Myofascial Release we hold the tissue at the collagen barrier for between 3 and 5 minutes means we give the collagen a chance to achieve a phase change that allows it to alter shape from a folded over position to a lengthened shape.  There are also other interesting physiological changes that happen at the 90 second mark that include changes to the inflammatory process.  It also seems to generate some piezoelectric responses, which might start other alterations within the system.

The John Barnes approach also allows the hands to sink into the system until the barrier depth is reached. So rather than forcing the tissue we wait for the Non-Newtonian fluid of the Ground Substance to allow us to softly sink in, rather than meeting the resistance of the rapid push. In my experience this feels like the body allows me to get to influence a deeper level, rather than just the surface.

The heat of my hands also introduces another form of energy (i.e. infrared) and that again is something that helps the ground substance to melt and glide again.

This approach is gentle and does not require the creation of pain, and that seems to also help soothe the nervous system and maybe allows changes in the processing of signals from the different areas.

The use of soft balls and movements is something that I suggest to most of my clients so that they can continue the work at home.  

If you are interested in coming to see me for a treatment then please check out where my clinics are and Book and Appointment.

Bibliography

These books and articles have significantly influenced my view on the Myofascial Network.  I am also doing my best to stay on top of current research and so my opinions will change as new information comes to light.

• Barnes, John F. (1990) Myofascial Release: the search for excellence, Rehabilitation Services Inc
• Barnes, John F. (2016) Myofasial Release: Healing Ancient Wounds, the Renegade’s Wisdom, (2nd Edition) Rehabilitation Services Inc
• Barnes, Mark (1997) The Basic Science of Myofascial Release: morphologic change in connective Tissue, The Journal of Bodywork and Movement Therapies.
• Chaitow, Leon (ed) et al. (2014) Fascial Dysfunction. Manual Therapy Approaches, Handspring Publishing
• Covell, Cathy (unknown publication date) A Therapist’s Guide to Understanding John F Barnes Myofascial Release: Simple Answers to Frequently Asked Questions
• Duncan, Ruth (2014) Myofascial Release – A step-by-step guide to more than 60 techniques. Human Kinetics
• Earls, James & Myers, Thomas (2010) Fascial Release for Structural Balance. Lotus Publishing
• Guimberteau, Jean-Claude & Armstrong, Colin (2015) Architecture of Human Living Fascia: The extracellular matrix and cells revealed through endoscopy, Handspring Publishing Ltd.
• Juhan, Deanne (2003) Job’s Body: A handbook for bodywork, Barry Town/Station Hill
• Myers, Thomas (2009) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2^nd Edition. Churchill Livingstone.
• Pollack, Gerald (2001) Cells, Gels and the Engines of Life, Ebner and Sons Publishers
• Scarr, Graham (2014) Biotensegrity. The Structural Basis of Life, Handspring Publishing
• Schleip, Robert (2003a) Fascial plasticity – a new neurobiological explanation: Part 1, Journal of Bodywork and Movement Therapies, Elsevier Science Ltd
• Schleip, Robert (2003b) Fascial plasticity – a new neurobiological explanation: Part 2, Journal of Bodywork and Movement Therapies, Elsevier Science Ltd
• Schleip, Robert et al. (2012) Fascia: The Tensional Network of the Human Body. Churchill Livingstone
• Schleip, Robert et al (2014) Fascia in Sport and Movement, Handspring Publishing
• Schleip, Robert & Bayer, Johanna (2017) Fascial Fitness: How to be Resilient, Elegant and Dynamic in Everyday Life and Sport, Lotus Publishing
• Schultz, R. Louis and Feitis, Rosemary (1996) The Endless Web: Fascial Anatomy and Physical Reality, North Atlantic Books
• Tavolacci, Phil (2013) What’s in your web: Stories of Fascial Freedom, Balboa Press