Fascia

Original Editor - Laura Ritchie

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Introduction

Fascia can be defined as a mechano-metabolic structure containing connective tissue that permeates all organs, muscles, bones and nerve fibres in the human body, forming and supporting them, and providing their continuity.

The video below gives a fascinating introduction to the fascia.

Classification

The International Anatomical Nomenclature Committee (1983) used the terms “fascia superficialis” for the subcutaneous tissue and “fascia profunda” for the denser layer lying under it. In the 1998 edition of "Terminologia Anatomica", the Federative Committee of Anatomical Terminology" (FCAT) (1998), indicates that fascia cannot be generalized into two terms, superficial and deep. Instead, they group fasciae terms according to embryological origins and modes of development. Kumka et al. (2012) find this system impractical in terms of communication in research, education, and clinical practice so they devise a functional classification system that divides fascia into four categories; linking, fascicular, compression, and separating fascia.

Characteristics of Fascia

Sensory Information

Fascia is one of the richest sensory organs in our body, embedded in nerve endings and mechanoreceptors (muscle 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 central nervous system (CNS), then efferent information is relayed to our muscles.

Force Transmission and Elastic Properties of Fascia

Fascia, like other soft tissues, has a variable degree of elasticity that allows it to withstand deformation when forces and pressure are applied as it can recover and return to its starting shape and size. It responds to load, compression and force. 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. Creep is slow, delayed and continuous deformation. At this point, volume change occurs as water is forced from the tissue. When loading ceases, fascia returns to its original shape. The restoration of shape occurs through elastic recoil via hysteresis, (the process of energy use and loss in which tissues are loaded and unloaded). The time needed for the 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.

Clinical Significance

Conditions that Affect Fascia

Fascial dysfunction can occur for a variety of reasons. Lack of movement variations, sub-optimal nutrition, habitual postures and trauma can impact on the fascia’s ability to glide and slide, which normally helps the distribution and transmission of tension across the body.  Compensatory patterns of movement can then occur resulting in more stress on the fascial system.  Fascial dysfunction is associated with pain, stiffness, tissue fatigue and reduced performance and function. Fascia can shorten, solidify and thicken in response to:

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

This is called a binding down of fascia.

Pain

The conditions associated with deep fascia pathology are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome.

The mechanism behind the joint stiffness and pain in the morning could be explained by the nociceptor activation led by the change in the viscoelasticity of the fascial system such as hyaluronic acid becoming adhesive and less lubricating.

Physiotherapy Management

Fascial treatment is a manual therapy method focusing on releasing specific localised areas of fascia found to be involved in pain and movement/functional limitations.  Through appropriate mobilisation and manual techniques movement can be restored allowing optimal force transmission within the body.

Fascial treatment should be supplemented with exercises and additional modalities, e.g. joint mobilisation and strengthening, designed to correct biomechanical deficiencies by addressing musculoskeletal strength and imbalances throughout the entire kinetic chain.

• Myofascial release
• Cupping - There is some evidence to suggest that cupping therapy may be beneficial for certain health conditions. Research into cupping therapy tends to be low-quality and more research is warranted.Please view the following video for a demonstration of cupping therapy.

• Foam rolling- a self release technique, as shown in the video below, has limited evidence support.

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