Fascia

Original Editor - Laura Ritchie

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Introduction

A fascia is a layer of fibrous tissue. A fascia is a structure of connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding some structures together, while permitting others to slide smoothly over each other. Various kinds of fascia may be distinguished.  

Like ligaments, aponeuroses, and tendons, fasciae are dense regular connective tissues, containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull. Fasciae are consequently flexible structures able to resist great unidirectional tension forces until the wavy pattern of fibers has been straightened out by the pulling force. These collagen fibers are produced by the fibroblasts located within the fascia.

Fasciae are similar to ligaments and tendons as they are all made of collagen except that ligaments join one bone to another bone, tendons join muscle to bone and fasciae surround muscles or other structures.

The video below gives a fascinating introduction to fascia.

Structure

There exists some controversy about what structures are considered "fascia", and how fascia should be classified.[2] The two most common systems are:

The one specified in the 1983 edition of Nomina Anatomica (NA 1983)
The one specified in the 1997 edition of Terminologia Anatomica (TA 1997)

NA 1983	TA 1997	Description	Example
Superficial fascia	(not considered fascia in this system)	This is found in the subcutis in most regions of the body, blending with the reticular layer of the dermis.	Fascia of Scarpa
Deep fascia	Fascia of muscles	This is the dense fibrous connective tissue that interpenetrates and surrounds the muscles, bones, nerves and blood vessels of the body.	Transversalis fascia
Visceral fascia	Visceral fascia, parietal fascia	This suspends the organs within their cavities and wraps them in layers of connective tissue membranes.	Pericardium

Force transmission and elastic properties of fascia 

Fascia like other soft tissues has variable degree of elasticity that allow it to withstand deformation when forces and pressure are applied as it can recover and return to its starting shape and size. It response to load , compression and force, as at the beginning of loading, fascia has an elastic response in which a degree of slack is taken up .Over time, if loading persists in a slow and sustained manner, creep develops, which is a slow, delayed yet continuous deformation. After that , an actual volume change occurs as water is forced from the tissue .When loading ceases fascia return to its original shape .The restoration of shape occurs through elastic recoil via hysteresis, (which is the process of energy use and loss in which tissues are loaded and unloaded). The time needed for tissue to return to normal via elastic recoil depends on the uptake of water by the tissue and whether its elastic potential has been exceeded. When loaded for any length of time, tissues lengthen and distort until they reach a point of balance. If loading is sustained, over time, chronic deformation will result.

Sensory Information

Fascia is one of the richest sensory organs in our body, embedded in nerve endings and mechanoreceptors ( muscles spindles, Ruffini and Pacini corpuscles, Golgi endings and free nerve endings). Fascia plays a major role in the perception of posture and movement affecting our proprioception and coordination. Whenever we change our posture or move in any way fascial tissues’ mechanoreceptors deform and activate, sending afferent information into the spinal cord and brain. These messages are interpreted by our CNS then efferent information is relayed to our muscles.

Conditions that affect Fascia

Fascia shorten, solidifies and thicken in response to:

• trauma
• anything physically or emotionally injurious to the body
• inflammation
• poor posture
• or anything that cause the body to lose its physiological adaptive capacity

This called a binding down of fascia .

Management / Interventions

• Myofascial release
• Foam rolling- a self myofascial release technique, as shown in video below

• Stretching.
• Posture training: Improving posture can help relieve myofascial pain, particularly in your neck. Postural muscle exercises that strengthen the muscles help avoid overworking any one muscle and related fascia
• Massage:
• Trigger point therapy
• Instrument Assisted Soft Tissue Mobilization