Fascia

Introduction

The rectus sheath is an example of connective fascia

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.  [1]

Like ligaments, aponeuroses, and tendons, fasciae are dense regular connective tissues, containing closely packed bundles of collagen fibres 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 fibres has been straightened out by the pulling force. These collagen fibres are produced by the fibroblasts located within the fascia. [1]

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. [1]

The video below gives a fascinating introduction to fascia.

[2]

Structure

There exists some controversy about what structures are considered "fascia", and how fascia should be classified.[2] The two most common systems are:[3]

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. [4]

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. [5]

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.[6] Fascia can 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 .[7]

Physiotherapy Management

Fascial treatment is a manual therapy method focusing on releasing specific localized areas of fascia, which have been assessed and diagnosed as being involved in the pain and movement/functional limitations.  Through the appropriate manipulation of this precise part of the fascia, movement can be restored allowing optimal force transmission within the body so that you can move and function better.

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 studies are necessary to understand how cupping therapy works, if it works, and in what situations it may help.[8]
[9]
  • Foam rolling- a self myofascial release technique, as shown in video below
[10]

References

  1. 1.0 1.1 1.2 Fascia. Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/Fascia (last accessed 13 Oct 2013).
  2. Scishow Fascia Available from: https://www.youtube.com/watch?v=T-UsSmD7miI (last accessed 24.5.2019)
  3. http://en.wikipedia.org/wiki/Fascia
  4. Ruth Duncan . Myofascial release (hands-on guide for therapists ) . 1st ed , 2014 .
  5. Physiospot. Fascia-nated by movement Available from: https://www.physiospot.com/sponsors/fascia-nated-by-movement/ (last accessed 24.5.2019)
  6. Goldfeilds Physio. Fascial Manipulation. Available from: https://www.goldfieldsphysio.com.au/services/fascial-manipulation/ (last accessed 25.5.2019)
  7. Ruth Duncan . Myofascial release (hands-on guide for therapists) . 1st ed, 2014.
  8. Medical News Today. What to know about cupping therapy Available from: https://www.medicalnewstoday.com/articles/324817.php (last accessed 25.5.2019)
  9. O C Physical Therapy Cupping Available from: https://www.youtube.com/watch?v=mKKc8YLTgOY (last accessed 25.5.2019)
  10. Triggerpoint What exactly is foam rolloing. Available from: https://www.youtube.com/watch?v=DzSU2FiFKTM (last accessed 24.5.2019)
  11. Mayo clinic Myofascial pain syndrome. Available from: https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/diagnosis-treatment/drc-20375450 (last accessed 24.5.2019)