What is "fascia", what goes wrong with it, and how do I look after it?

by Martin Kingston
http://www.massage-therapy-london.co.uk
+44 20 8400 9712 / +44 7710 314432

This article appeared in the newsletter for BodyworkersLondon.com

THIS ARTICLE REFLECTS THE PRIVATE VIEWS OF THE AUTHOR AND SHOULD NOT BE CONSIDERED A MEDICAL REFERENCE..

Coming from the latin, fascia means a "band" or "door-frame" (Pocket Oxford English Dictionary).

About 30% of our bodyweight is made up of connective tissue. Although strictly speaking, "fascia" is a term for a type of connective tissue, it is increasingly used to mean the whole framework.

How it fits in

When we did biology at school, we learned about organs of the body, and the systems that they support, but I bet you didn't get much information about connective tissue. You will have learnt about the skeleton, and maybe muscles, tendons and ligaments. But they were not shown to be part of a complex system of support - the cobweb of supporting bones and fibres that keep us the shape we are, all bathed in a fluid ground substance that keeps it lubricated, nourished and in contact with the rest of the body.

People usually describe something starting from the most familiar point. And so it is with the connective tissue. Because other things were of interest, it was just the "wrapping paper and string" for the main package. A bit of gristle that you scraped off in trying to get to the interesting bit. What was left on the side of the plate.
When people first started getting interested in it, to show their awe, people would describe it as the cobweb of filaments that surround and pervade all organs. But even that description is inadequate, because it suggests that it is still a wrapping, and came after the muscles, veins and nerves.

A better way of looking at it is that fascia comes first in embrionic development, and other tissues form in vacuoles within it. Individual muscle cells develop in spaces in the facia, and anchor onto it. The fascia provides the template for the muscle, and the contractile cells populate the gaps.

Muscle tissue is 50-60% fascia according to John Smith (2005).
Similarly, nerves, arteries and veins develop along sheets of fascia, which provides the structure for them. We are literally formed from a template provided by the connective tissue.

So why is this interesting to an adult? When you are injured, the first thing in the repair process is the build up of the collagen fibre network of connective tissue that provides a structure for other tissue to develop in. If you want to recover from damage, you need a healthy fascia!

So what forms this connective tissue? We make artificial categorisations, to highlight variations, but in reality, there is a continuum from bone through to blood, with cartilage, ligaments, periosteum, fascia, tendons, muscle, loose areolar and adipose tissue as the prevailing markers on the way. And it is all held together by "tensegrity", a new term to describe the integrity of a structure maintained by tension between elements, like a marquee or suspension bridge. It is a very flexible structure, able to withstand distortion, and regain its shape through equalisation of stored pressures and stresses. There are some lovely pictures on the internet if you do a Google Images search on "tensegrity".

What is fascia made of?

Fascia is a composite, and like human composites like reinforced concrete and glass fibre, combines the qualities of its components.

· Fibres of collagen, elastin and reticulin, laid randomly, which individually have varying elasticity, but together build a chaotic structure of great flexibility and resilience;
· Ground substance - a colloid of many water-soluble carbohydrates ("GAGs"), some with proteins added, which can trap up to 1000 times their mass of water, and which can nourish cells and restrict the spread of oxidants and bacteria. Vitamin C, it is now believed, helps reduce the spread of infection by making the ground substance more resilient to pathogens. This ground substance acts as a "spacer" in the composite that is fascia, so the fibres are not pressed too compact against each other and bind. As people age, and if they don't look after themselves (not enough movement, use of poisons like cocaine) the ground substance loses these GAGs and becomes less hydrated. It becomes less able to nourish the other cells of the body, and fibres stick together more easily (building fibrosis).
· Cells, mostly fibrocytes, which make the fibres AND the ground substance. Most fluids in the body are derived from blood plasma, but not the ground substance, it seems. Look after your fibrocytes! They keep you well oiled and in shape! When there is injury, fibrocytes release actin filaments (the contractile protein in muscle), which attach to fibres and retract, pulling tissue together. That is how wounds close.

So the template for your body is made of randomly placed fibres in a thick soup!

So what goes wrong with Fascia

Adherence

Recent research shows over time, fibre will start to adhere to each other, unless movement keeps it free. This can be useful. It may be more energy efficient for a motorcyclist to develop stiff tissues holding him bent forward, so that he does not have to use muscle energy to keep him in that position while on the bike. Not great, however, if he needs to change posture to go sailing! And ultimately, the bent-forward posture is not very energy-efficient, and other parts of the body will strain to compensate. We therefore build up patterns of disfunction, some muscles short and tight, others inhibited.

Clots and Scar tissue can act like glue, gumming up an area and stopping free movement in the fascial web. Like a patch on old clothing, this can tug it out of shape, and cause further strains in remote places, or restricted patterns of movement, which sets off other problems

Chronic inflammation caused by stress and toxins (think before you have that cigarette or line!) can trigger collagen deposits which can become sticky adhesions.

All this can be relieved, however, by movement, which will break up adhesions, and release fibrosis.

Breakdown of GAGs: Dehydration & poor nourishment

Little understood are how GAGs can degrade, and reduce their ability to hold water. Tissue becomes less plump - leading to the appearance of aging. There will be a corresponding reduction in water-soluble nutrients as well.

No doubt the cosmetics industry is investigating, but it is clear that a good diet with plenty of water and minimising toxins will slow down degeneration.

The heart moves blood through the arteries, but outside of that, other movement forces are necessary to pump fluid around. Life is movement - and if we become inert, we interfere with our processes. Important to be aware of that if we are prone to long periods frozen in front of a computer or tv screen!

How do I look after my fascia

Eat well

This is obvious. Your fibrocytes need nourishment to do their job. But do you honestly get your 5-8 portions of fruit and veg EVERY day? There is increasing evidence that fruit and vegetables nowadays contain less nourishment than in yesteryear, so it is even more important to keep up the good work.

Manage Stress and Rest Well

We need a certain stress level to keep active, but just as important as sympathetic stimulation (stress, the adrenalin/cortisol rush) is the para-sympathetic response (recovery, rest, meditation/renewal). Watching TV and internet surfing is NOT rest - it stimulates the sympathetic response generally.
A shameless plug: massage stimulates the para-sympathetic response! Make sure you get some genuine rest time to recover from the day - even if it is some gentle stretching before bed.

Exercise Well - both Active and Passive movement!

Movement! Movement! Movement! Resistance exercises stress the body into building lines of stress, particularly exercises YOU ARE NOT USED TO - guys, how about doing some pilates? Ladies, get in the gym and pump some weights! Why not do a course in something new like sailing or waterpolo or tai chi? Anything to stimulate your body in new directions to counteract the familiar slump.

All that is active movement, but passive movement is also good. And that means MASSAGE:

· Massage will stimulate tissues in directions they are not used to moving in, and break up adhesions in familiar places (how are the outside of your calves, eh? And what about that neck and shoulders?).
· Massage will encourage fluid movement to nourish neglected areas
· Massage selectively stretches abnormally shortened muscles.
· Massage will resolve those trigger points too, if your therapist knows their stuff

Yes, I am afraid massage does stuff that just is not covered in your exercise programme…..

References

Smith, J., (2005). Structural Bodywork, An Introduction for Students and Practitioners. Edinburgh: Elsevier

Pocket Oxford English Dictionary (2001). Oxford: Oxford University Press