While we frequently receive reminders of exercise’s positive impact on bone and muscle health, as well as its role in fat reduction, there’s a growing curiosity surrounding an often-neglected component of our anatomy: our fascia.
Fascia constitutes a slender sheath of connective tissue, primarily composed of collagen – a cable-like structure that imparts strength and safeguards various regions of the body. It envelops and supports each organ, blood vessel, bone, nerve fiber, and muscle, playing a crucial role in their stability. Scientists are increasingly acknowledging its significance in maintaining optimal muscle and bone health.
Although fascia is not easily visible within the body, you can visualize its appearance by examining a steak. It manifests as fine white streaks on the surface or nestled between layers of the meat.
Fascia serves both general and specific functions within the body and is organized in various ways. The one closest to the surface is known as superficial fascia, situated beneath the skin between layers of fat. Beyond that, we have deep fascia, which envelops the muscles, bones, and blood vessels.
Recent studies have strengthened the connection between fascia, muscle, and bone health and function. These findings highlight the pivotal role fascia plays in facilitating muscle function by aiding the contraction of muscle cells to generate force and influencing muscle stiffness.
Every muscle is enveloped in fascia. These layers play a crucial role, allowing adjacent or overlapping muscles to move freely without impeding each other’s functions.
Fascia also plays a role in facilitating the transmission of force within the musculoskeletal system. An illustrative example is observed in our ankles, where the Achilles tendon transfers force to the plantar fascia. This results in vertical forces transitioning through the Achilles and then horizontally into the foot’s base – the plantar fascia – during movement.
An analogous transmission of force occurs as muscles in the chest extend down to muscle groups in the forearm. Comparable fascial connective chains exist throughout various regions of the body.
When fascia gets damaged
Impaired facial function, such as post-injury, diminishes the layers’ ability to facilitate smooth movement and force transfer. The recovery process for fascial injuries is protracted, likely due to the presence of cells similar to tendons (fibroblasts) and a constrained blood supply.
In recent findings, fascia, especially the layers near the surface, has been revealed to possess the second-highest concentration of nerves following the skin.
The fascial linings surrounding muscles have also been associated with postoperative pain and musculoskeletal injuries resulting from sports, exercise, and aging, according to research. Up to 30% of individuals experiencing musculoskeletal pain may exhibit fascial involvement, or fascia could be the underlying cause.
A massage technique known as fascial manipulation, pioneered by Italian physiotherapist Luigi Stecco in the 1980s, has demonstrated effectiveness in alleviating pain associated with patellar tendinopathy (pain in the tendon below the kneecap) over both short and long durations.
Fascial manipulation has demonstrated favorable outcomes in addressing persistent shoulder discomfort.
Emerging as a popular solution for musculoskeletal injuries, Kinesio tape, frequently employed in professional sports, is also finding utility in enhancing fascial function. Its application extends to the treatment of chronic lower back pain, particularly when fascial involvement is a contributing factor.
Fascia in disease
Beyond experiencing damage, fascia can also serve as conduits for the spread of infections within muscles.
The spaces between fascial layers are typically sealed (imagine cling film being folded over). However, in the presence of an infection, pathogens can propagate between these layers. This poses a particular concern, especially in the neck, where numerous fascial layers provide pathways for infection to travel.
In critical situations, surgical intervention is frequently required to eliminate necrotic tissue and preserve the remaining healthy tissue.
An exemplary illustration of fascia’s role in health, as well as the complications arising from its dysfunction, is evident in the prevalent ailment of plantar fasciitis, characterized by pain in the heel and arch of the foot.
This highly prevalent condition affects 5-7% of individuals, with a higher incidence of 22% in athletes. Recognized as an overuse injury, it results in the thickening of the fascial bands on the soles of the feet, crucial for providing arch support.
Fascia can also play a role in more severe health conditions, such as necrotizing fasciitis. This is an uncommon yet grave bacterial condition capable of rapid body-wide spread, posing a risk of fatality.
This condition is predominantly caused by bacteria, specifically group A Streptococcus or Staphylococcus aureus. The initial infection typically originates from a cut or scratch, and then the bacteria travel along the fascia to other areas beyond the initial site of entry, multiplying in the favorable environment provided by the body’s warm cavities.
We can see it better now
One reason fascia has been historically overlooked in health and disease is the challenge of visualizing it using existing imaging technology. However, more recently, MRI and ultrasound imaging have proven beneficial in visualizing fascia, especially in musculoskeletal conditions such as plantar fasciitis, and in detecting pathological changes in the fascia of the shoulder and neck.
Given the increasing fascination with fascia and the deepening comprehension of its role in musculoskeletal health, it makes sense to propose caring for it akin to the rest of the musculoskeletal system—by actively engaging it.
Straightforward methods like foam rollers and stretching have been found to enhance mobility, yet there is still ample room for discovery regarding our fascia and its impact on our daily well-being.
This article has been reissued from The Conversation under a Creative Commons license.
