Fascia has historically been overlooked in our medical society until recently, namely its major contributions to our bodies’ functioning and overall maintenance. I would like this blog to educate the readers about its super powers. It’s not some dumb material that we can foam roll into submission like pizza dough or use ASTYM on one area and expect the entirety of the kinetic chain to respond appropriately. It is a fascinating network of connective tissue and I hope to demonstrate how it helps us function. This blog heavily references Fascia: The Tensional Network of The Human Body by Schleip, Findley, Chaitow, and Huijing. I encourage all manual therapists, and even my more inquisitive patients, to read this book. The nerd in me is giddy writing up this blog post. My patients can tell you that I get obnoxiously excited about explaining how things interconnect to make their bodies work.
We’ve all seen the ads for foam rollers and fascia-blasters. Even in the PT domain, we were taught to use various instruments and skin rolling techniques to “release” restricted fascia. I have one patient who calls her type of roller her “bitch-stick” and I still chuckle at that thought. Now, I own a foam roller, use it to help stretch my back during my lunch breaks, and encourage my patients to use it as well, but does that mean it’s actually breaking up restricted fascia? Let’s look first at what fascia is….and what it isn’t.
Fascia is a term for a form of connective tissue that is widely distributed throughout the body and composed of irregular, interwoven collagenous fiber bundles that vary in density. It plays multiple roles in the body: protection of and lubricating between structures. Between bony structures it appears to provide a mechanism for force transduction (the body’s ability to generate force) and the cellular composition strongly suggests that it plays both an immune function and a neurosensory role.
There are four primary layers of fascia:
1. The pannicular that surrounds the entire torso and extremities.
2. The axial fascia that surround muscles, tendons, and ligaments. It extends to the extremities and provides the lubrication and force transduction.
Within the axial fascia the two final layers reside: (3) The meningeal and (4) visceral fascia which protect the nervous system and visceral organs.
I’ve linked to some YouTube videos at the end of this blog of cadaver dissections that look at fascia in relation to organs and bony alignment. These are human cadavers, so be aware that it’s a bit graphic and might not be suitable for everyone.
Here's a quote that I absolutely love and brings the whole scope of this blog together:
“The fascia’s widespread distribution, its mechanical role and the ability of fibroblasts to communicate via their gap junctions suggest fascia may form a bodywide mechanosensitive integrating signaling system analogous to that of the nervous system” (Schleip 11).
That’s huge! That means this widespread connective tissue is not just a mechanical mule, helping muscles function or just a primary layer of protection….it’s an integral part with our nervous system. Fascia senses movement and pressure and our entire body responds to that.
There is a concept called Interception, which correlates the connection between fascial receptors, emotion, and self-recognition. Previously, it was thought to relate only to visceral sensations (think of having a “gut feeling”). Today, the concept has widened to include other physiological sensations such as muscular effort, tickling, and vasomotor sensations that include: warmth/coolness, hunger/thirst, air hunger, sexual arousal, heartbeat, vasomotor activity, bladder distension, sensual touch, and distension of stomach/rectum/esophagus. The pathway of information from where the pressure is first felt in the body to the brain is as follows:
Stimulus to Nerve Endings In Fascia (interoreceptors) --> Spinal Cord--> Thalamus (in the brainstem) --> Insula (in the cerebral cortex)
In 2009, it was found that “the anterior insular cortex is a peculiarly human brain structure that is crucial for integrating all subjective feelings related to the body, and especially to its homeostatic conditions, into emotional experiences and conscious awareness of the environment and the self” (Schleip 91).
Dysregulation between the viscera and the insula have been shown in people with Irritable Bowel Syndrome, drug and other addictions, anxiety, and depression. There are a surprising number of interoceptive receptors within musculoskeletal tissue when compared to proprioceptive receptors, which provide spacial awareness of your body. One estimate is that for every one proprioceptive nerve ending, there are more than seven endings that could be classified as interoceptive receptors. The majority of these nerve endings are mechanoreceptors, meaning they respond to pressure, tension, shear forces, and light touch (Schleip 89-94).
Hello Manual Therapy!! This is where I, and your foam roller, come in.
As manual therapists, we sense autonomic changes in response to manual therapy. That could be increased blood flow to a region, a change in breathing patterns, lymphatic drainage, pupil dilation, skin color, and muscle tension. It can also elicit an emotional response, causing some patients to cry during a session from underlying trauma their body stored. Tying in manual therapy to fascia, in conjunction with movement therapy is vitally important for people with chronic conditions or people experiencing pain with no positive diagnostic tests. If we can elicit changes in blood flow and lymphatic drive, imagine the effects that manual therapy can have on people with high blood pressure, chronic edema, and other circulatory conditions. This can also be helpful for people with chronic depression, anxiety and malaise to help regulate that sense of self between the body and the brain.
Most of my readers already know that I am a Women’s Health therapist, which involves pelvic floor therapy for issues such as pelvic pain, postpartum care, and prolapse/incontinence. Some people who have been to a pelvic floor PT previously have stated that the therapist only addressed the internal aspects of the pelvic floor through vaginal assessment, and perhaps some biofeedback with a machine. There’s nothing wrong with that assessment and approach to treatment, but it should be only one aspect of assessment and treatment. Most of the time I won’t even do an internal assessment on my pelvic floor patients on their first session because I want to see how the rest of their body is contributing to their dysfunction. Part of this assessment is the fascia that extends from the outer thigh/hip and dives into the pelvic cavity and becomes integrated with pelvic floor structures. If I look at that, then I have to see how their legs, ankles, knees, hips, midfoot, and literally EVERY OTHER joint in their body are functioning. If something is off outside of the pelvis that consistently affects their fascia, what good is repeated internal pelvic treatment if I don’t correct the underlying issue?
Ok, so let’s get back to the original question: are fascia-release products doing what they claim to do? It’s a complicated answer, but I’ll say that it is more likely that we activate those mechanoreceptors in fascia that, in turn, send a signal to our brain for neurological awareness to that area that results in muscle relaxation and improved lymphatic drive that decreases pain and increases mobility. I don’t believe we’re actually breaking up resistant scar tissue because scar tissue is tough and fibrotic, lacking the blood flow or mechanoreceptors to change. The pressure that would have to be applied to deform scar tissue we can not recreate on a foam roller or similar product. That being said, keep using them if it works for you but don’t feel like you’re doing something wrong if it doesn’t help you. As always, feel free to send me feedback!
Summary: Our body is covered with fascia. Within that fascia, we have receptors that respond to pressure, tension and touch called mechanoreceptors. Once those receptors are stimulated, the information goes to the part of our brain that sends feedback to the area to increase blood flow and/or lymphatic drive. It also helps our brain and body communicate our general sense of self- how we perceive ourselves and general well-being. It is found that people with addictions and chronic diseases have a miscommunication between the receptors and the brain. Given that fascia communication is much more complicated than we initially give it credit for, it is not difficult to see how dysfunction in one area can cause pain and dysfunction in another. Foam rollers and other fascia tools are helpful, but are likely not breaking up scar tissue. They are activating mechanoreceptors for the brain to address a dysfunction and can be a great tool for people to use at home.
YouTube videos of cadavers for fascia:
Shoulder scar tissue https://www.youtube.com/watch?v=U1yud-PgxzE
Male abdominal cavity dissection https://amara.org/en/videos/JxSGaiJ5ufki/en/1208152/
Schleip, Robert, et al. Fascia: The Tensional Network of The Human Body. Edinburgh: Churchhill Livingstone Elsevier, 2012. Print