The Essentials
Fascinating Fascia
Since the beginning of the 21st century, the anatomical structure known as fascia has been a hot topic. Foam rollers, fascia balls, fascia massage, fascia yoga and more… but what exactly is fascia?
Fasciae are a connective tissue matrix that encloses all of your body structures (muscles, ligaments and joints, bones, nerves, blood vessels, and organs) like packaging. As a result, fasciae give your body its shape and serve as the first protective layer against external forces.
Frank Liebig creator QS:P170,Q29586018, Cobweb in fir top, CC BY-SA 3.0 DE
Structure of the Fasciae
Your body's fascia can be divided into four different layers. The outermost layer directly under the skin forms the pannicular fascia, often also referred to as the superficial fascia. The pannicular fascia consists mostly of loose connective tissue and fat and covers your entire body (trunk, arms, and legs), with the exception of body openings such as your mouth, eyes, nose, etc.
The second layer is formed by the deep trunk fascia (deep fascia or muscular fascia). Like the panniculus, the trunk fascia develops from the embryonic mesenchyme. It forms the primitive matrix in which all skeletal muscles, bones, tendons, ligaments, and joints develop during embryonic development. In your arms and legs, the trunk fascia is usually called muscular fascia—yet the function remains the same: the dense, mesh-like connective tissue serves as a protective and gliding layer for your musculoskeletal system and transfers part of the force to the joints during muscle contraction.
The third and fourth fascial layers are enclosed by the trunk fascia and are referred to as the meningeal and visceral fascia. The meningeal fascia encloses and protects your nervous system, while the visceral fascia acts as protection and suspension for your internal organs.
It is important to note here that these four layers should not be viewed as individual systems, but rather as a unified continuum of tissue structures.
Your body's fasciae, like joint capsules and intramuscular and intraneural septa, belong to the unformed (mesh-like), dense connective and supporting tissue of your body. Tendons and ligaments, on the other hand, consist of formed (parallel-fibered) connective tissue. The difference lies in the arrangement of the collagen fibers within the tissue: in response to tensions acting in different directions, the collagen fibers in unformed, dense connective tissue create networks that can likewise shift and unfold in different directions. In formed connective tissue, all fibers are always aligned in the same direction—they run parallel to one another due to the constant, unidirectional stress. Therefore, fasciae are much more flexible and mobile compared to ligaments.
Fundamentally, unformed and formed connective tissue consist of the same building blocks: cells and extracellular matrix. The cells are divided into fibroblasts/fibrocytes, chondroblasts/chondrocytes, and osteoblasts/osteocytes. Which type of tissue the connective tissue develops into depends on the mechanical demands exerted on the tissue or rather on the mesenchymal cells.
If tensile forces predominantly act on the tissue, mostly fibroblasts develop, which in turn primarily produce type I collagen fibers and only a small amount of elastic ground substance—meaning tendons and ligaments develop. However, if pressure predominantly acts on the tissue, mostly chondroblasts develop, which produce ground substance exclusively and only very thin type II collagen fibrils. This is basically what you find in hyaline articular cartilage.
In fascial tissue, fibroblasts develop predominantly. These contribute only a small portion to the volume of the fasciae, but they play a crucial role in structure as well as fascial stiffness. The tasks of fibroblasts include producing most of the components that make up the extracellular matrix—with the exception of the abundant water in the fascia—as well as repairing tissue injuries during wound healing.
In addition to fibroblasts, adipocytes (fat cells) are also present in fascial tissue. Adipocytes not only play an important role in estrogen production, but are also important producers of various peptides and cytokines responsible for appetite, insulin, and blood sugar regulation, as well as for angiogenesis (growth of blood vessels), vasoconstriction (narrowing of blood vessels), and blood clotting—vital substances during wound healing. In the fascia, adipocytes are dense and numerous in areas with high shear forces and gliding movements, serving there as cushioning.
Studies have shown that a wide variety of receptors are located within the fascia. Among others, these include myelinated proprioceptive endings as well as a large number of unmyelinated "free" nerve endings. These nerve endings send important signals for the control of movement and posture (proprioception) to your brain, where the conscious and unconscious perception of body posture and movement is formed using information from other sources throughout your body. Looking at the number of receptors in fascial tissue, it is likely just as large as, if not even larger than, the number of receptors in the retina of the eye. You can easily imagine that the fascia is one of your most important sensory organs!
French hand surgeon Dr. Jean-Claude Guimberteau provided us with an effective overview of the structure and function of fascia. Intraoperatively, he used an endoscope to examine how the fibers of the fascia move and behave. In his film "Strolling under the skin," you get a wonderful glimpse beneath the skin.
“PROMENADES SOUS LA PEAU OU A la découverte des architectures de la matière vivante”, Dr. Jean-Claude Guimberteau
Role & Function of the Fasciae
Beyond its role as a sensory organ, the fascia must be able to deform very quickly in different directions and planes and immediately return to its original shape—because the fascia acts as your first protective shield against external forces. Your muscles, bones, and joints generally cannot tolerate too much direct impact without being damaged. Particularly to prevent muscle injuries (such as torn muscle fibers), the fascia must immediately act as a shock absorber during large, rapid impacts, as the musculature itself reacts too slowly to prevent an injury.
One-sided, repetitive movements can lead to adhesions in the fascia. These are known as crosslinks. As a result, the fascia loses some of its glide. Thus, as in the case mentioned above, the fascia can no longer absorb the full force, and a torn muscle fiber can occur.
In addition to its function as a protective sheath, the fascia serves as a gliding and sliding layer due to its layered structure. You can imagine it as individual nerves, arteries, veins, muscles, and even muscle groups being wrapped in and separated by fascia. The fascia thus makes movement possible between the individual structures in your body.
Furthermore, this architecture of the fascia supports your musculature in transferring power between muscles, muscle groups, and joints during movement and exercise—working in what are known as myofascial chains. These chains are named differently by various authors, but they all have one thing in common: each muscle group needs a base to fulfill its function. This base consists of other muscle groups, which in turn are stabilized by further muscle groups, and so on. Certain forms of therapy are based on the theory of myofascial chains, such as Proprioceptive Neuromuscular Facilitation (PNF) by Dr. Herman Kabat. This is a method for treating muscular paralysis in poliomyelitis, based on the idea that paralyzed muscles can be activated in coordination with or via other muscle chains.
Therapy
Why is fascial treatment so important and effective? Picture your fascial system as four layers of tights worn on top of each other, with nerves, blood vessels, and lymphatic vessels woven throughout. To allow movement, these four layers of tights must be able to glide freely against each other in all directions. When crosslinks form between the layers, your mobility is not only restricted, but there is also a direct impact on your nervous, vascular, and lymphatic systems.
If you now pinch the tights at your calf with your hand—just as happens with scar formation in fascial tissue after surgery—you can clearly observe how far the tension spreads across the tights. That is why it is not surprising that an injury, restriction, or scar can cause problems across other joints in an entirely different part of your body.
When you experience pain or restrictions in your musculoskeletal system, the task of a physiotherapist and osteopath is to identify which structure holds the blockage or reduced mobility, and then apply an appropriately tailored technique to relieve your restrictions and pain, helping your tissue return to its normal state.
New research indicates that fasciae can contract and play a vital role in force generation and transmission [1,2]. Alongside muscles, tendons, and joints, they also serve as an absorption mechanism for rapid forces. From our perspective, fasciae must therefore be viewed and treated in the overall context of your muscles. Based on your Conditions, the focus of training and therapy can be directed toward specific structures; however, as mentioned, these are so closely interconnected that your entire body is always being trained.
At BodyLab, we treat fascial and muscular problems through physiotherapy and osteopathy. Using manual therapy, myofascial techniques (Myofascial Release), trigger point therapy and Dry Needling, we release tissue tension and restore mobility. Because fascia adapts to load, every treatment also includes an active component: targeted stretching and exercise to help the tissue maintain its improved mobility and tolerate load again.
Training Your Fascia
Your fascia can and should be trained together with your entire musculoskeletal system to ensure mobility and optimal function. However, in our view, it is very difficult to train the fascia in isolation due to its anatomy and function: you are always training your entire neuromuscular system. The key, however, is to move in all dimensions rather than performing one-sided movements. Training styles such as Pilates and yoga are therefore excellent, but jumping exercises, like jumping rope, are also very helpful. High Intensity Interval Training (HIIT) is another great option for fascial training methods. With HIIT, however, your joints are put under more stress than in yoga and Pilates, which is why we recommend this form of training with guidance from a physiotherapist or personal trainer.
“Faszien - Geheimnisvolle Welt unter der Haut”, all rights reserved by arte.tv
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References
Zügel M, Maganaris CN, Wilke J, et al.
Br J Sports Med 2018;52:1497.
[2] Are muscles mechanically independent?
Robert D. Herbert, Phu D. Hoang, and Simon C. Gandevia
J Appl Physiol 104: 1549–1550, 2008; doi:10.1152/japplphysiol.90511.2008.
Cover Image Credits
anonymous, European garden spider, web backlit, marked as public domain, details on Wikimedia Commons
