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SECTION 4

FASCIA: PART A

Fascia is a connective tissue that is found in all living animals, there are different types of fascia for different purposes, and it can be found around all aspects of the body from blood vessels and nerves to muscles and organs.

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NOTE: Ever prepared chicken – the white tissue that is clear when peeled back, THAT IS FASCIA!

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Stephen Levin and John Sharkey have even suggested that bone is actually ossified fascia[i][ii]. Carla Stecco and Robert Schleip defined fascia using the term ‘fascial system’ which focuses on how fascia works rather than what it is,

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“a network of interacting, interrelated, interdependent tissues forming a complex whole, all collaborating to perform a movement.”[iii]

Imagine wrapping your whole body in cling film, and then trying to walk. As you move forward, the cling film around the legs will move, however, the cling film as high as the neck and shoulders may be affected.

VIDEO (see Instagram example)

Because it wraps around everything in the body and can be found head to toe, scientists and physical therapists have termed this property ‘biotensegrity’ – without fascia, all the components of the body would find it difficult to maintain form, and instead, would at least be loosely connected and far from efficient. Therefore, biotensegrity refers to how the body maintains its integrity no matter the position or movement. This is discussed in greater depth later in this section.

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[i] https://www.researchgate.net/publication/327142198_Bone_is_fascia

[ii] https://functionalfascia.com/bone-is-fascia-discuss/

[iii] Stecco, C., & Schleip, R. (2016). A fascia and the fascial system. Journal of bodywork and movement therapies, 20(1), 139-140. Doi: https://doi.org/10.1016/j.jbmt.2015.11.012.

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VIDEO (SEE INSTAGRAM EXAMPLE)

The concept of how fascia works can be quite difficult to comprehend, so to help this understanding, a bit of physics is required regarding ‘tension vs strain’ and the Tensile Modulus, also known as the Young’s Modulus.

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TENSILE MODULUS:

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In 1660, British scientist Robert Hooke discovered the law of elasticity, and so the eponym was produced and called the law ‘Hooke’s Law’. Hooke found that material can deform under pressure, and this deformation is equal to the pressure applied, and upon releasing the applied pressure, the material returns to it’s original shape – Hooke’s Law, the law of elasticity.

Fast forward a few years to 1807 when British physician Thomas Young discovered how to measure the elastic qualities of materials, that when stretched or compressed, whether the material would withstand the pressure and spring back, permanently deform, or break. Therefore, this measurement, now known as the Young’s Modulus, measures how much stress, or strain, a material can absorb.

For those interested, the equation for Hooke’s Law is:

force = spring constant × extension

• Force (F) is measured in newtons (N).

• Spring constant (k) is measured in newtons per metre (N/m).

• Extension (e), or increase in length, is measured in metres (m).

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The equation for Young’s Modulus is:

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• Young’s modulus (E) is a property of the material that tells us how easily it can stretch and deform.

• This is measured by the ratio of tensile stress (σ) to tensile strain (ε).

• Stress is measured by the amount of force applied per unit area (σ = F/A), and strain measured by the extension per unit length (ε = dl/l).  

• Imagine a hair bobble, if you stretch it (stress), there will come a point in tensile strain where it will no longer return to its original length and place enough stretch (stress) on the bobble and it could break.

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• An inflated balloon is under constant uniform tension, and if you squeeze the balloon (applying compression, thus stress), it will create pressure in the rest of the balloon (tensile strain), but the overall tension in the balloon will remain the same. Apply enough compression (stress) to the balloon however, and the balloon will pop.

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Apply this concept to the human body, you can stretch and compress soft tissue such as fascia, muscles and ligaments. An indivdual’s muscle condition and soft tissue composition will depend on how much pressure it can absorb before injury occurs such as tissue damage (e.g. strains, sprains, muscle tears) and deforming (e.g. bone break/fracture, tendon rupture, skin perforation, fascial tears). You can therefore apply the Young’s Modulus to the human body and Findley et al., (2012)[i] presented a respected narrative review on fascia, taking into consideration reputable research, and applied the Tensile Modulus, with factors such as the Young’s Modulus of a passive muscle stretch is 10 κPa whereas rubber is 20 κPa, demonstrating muscle is softer than rubber.

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Now take this further and consider how your muscles, organs, blood vessels and nerves move together as one unit upon the skeleton, rather than flapping loosely, rubbing against each other and constantly feeling the pull of gravity as each part feels the pressure individually. Your fascia is everywhere throughout the body and enables you to move as one unit, constantly absorbing stress and strain whether it be sat at a desk for seven hours a day or completing an Ultra Marathon, and this is biotensegrity, Thus, your fascia absorbs stress in the form of pulls, stretches, compressions to ensure you move as one entire unit, how well it performs this depends on its integrity, hence the term biotensegrity, how well the body holds together both in parts and as a whole. Furthermore, some people are more genetically dense and tight, compared to some who are double jointed and hypermobile, meaning some people are more elastic than others, and research has found that manual therapy techniques, particularly when combined with strength and conditioning, help to promote healthy biotensegrity.

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[i] Findley, T., Chaudhry, H., Stecco, A., & Roman, M. (2012). Fascia research–a narrative review. Journal of bodywork and movement therapies, 16(1), 67-75.

There are different types of fascia for different purposes, yet all fascia predominantly consists of collagen[i], noting the density, composition and direction will depend on an individual’s ‘nature’ and ‘nurture’. This will be discussed further throughout the program as it is posture and biomechanics based on nature and nurture that can HELP determine soft tissue alignment, and thus the health of the soft tissue.

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NOTE:

Chemoreceptors: A sensory cell or organ responsive to chemical stimuli.

Mechanoreceptors: A sensory cell or organ responsive to compression, tension, stretch and sound.

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Fascia has 2 main properties:

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1. Reduce friction: Superficial fascia surrounds everything like cling film, from blood vessels to muscles, and can be found head to toe. By encasing everything, superficial fascia prevents many parts of the body from sticking to each other. Cowman et al., (2015) [ii] found that Hyaluronan cells (HA) which can be found in fascia, has lubricant properties due to its high-water content. Furthermore, Stecco discovered ‘fasciacytes’, a cell found in fascia that is dedicated to producing the “hyaluronan-rich extracellular matrix”[iii]. Such properties enable movement with cadence (smooth movement with both elasticity and stability). ‘Functional Fascia’i also state how superficial fascia, also known as ‘filmy fascia’ can “probably be classified as a loose aereolar connective tissue” which is a type of loose connective tissue that has no defined form, of which in Latin, ‘āreola’ means ‘small open space’.

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   2. Proprioceptive organ: Proprioception is how the body monitors position and movement of joints and skeletal muscle to provide information             on the body in space. Thus, fascial proprioception absorbs and monitors pressures to enable the body to react most efficiently.

       Fascia contains four different types of sensory nerve endings which are collectively called Fascial Mechanoreceptors: Golgi Organs, Ruffini                 Receptors, Pacini Corpuscles, and Interstitial Receptors[iv].

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Fascial Mechanoreceptors in more detail:

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• Golgi Organs: Nerve endings which wrap around collagen fibers to measure load or tension to ensure the muscle responds efficiently. Noting they only respond under increased tension and thus do not respond under relaxed states such as walking vs feet up and relaxed.

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• Ruffini Receptors: Also known as Ruffini Corpuscles, these nerve endings measure stretch. Stimulating these nerves have been found to lower activity of the sympathetic nervous system.[v]

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• Pacini Corpuscles: An encased sensory nerve ending which measures pressure and vibration.

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• Interstitial Receptors: Type iii and iv sensory nerve fibers and endings which are multi-modal in purpose. Most commonly known for pain receptors (nociceptors) but are also mechanoreceptors, thermoreceptors and chemoreceptors meaning sensitive to movement, temperature and chemical changes. They also seem to have autonomic function regarding heart rate, blood pressure and respiration for examplevii[vi]. 

Different types of fascia have different levels of mechanoreceptors, such as

• Thoracolumbar fascia (lower and upper back): Pacini and Ruffini endings but no Golgi receptors[vii], thus stretch, pressure and vibration but not load/tension. Research has also found that at least thoracolumbar fascia also contains pain receptors known as nocioceptors[viii]

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• Antebrachial (forearm), crural (deep fascia of the leg), and abdominal fasciae; and in the fascia of the masseter (jaw) and the lateral thigh: increased concentration of Pacini and Ruffini receptorsiii[ix].

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• Deep dorsal fascia of the hand (back of the hand): Dense distribution of Ruffini receptors[x] meaning increased amounts of endings for pressure and vibration.

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It has also been found that Ruffini (stretch) endings are densely distributed amongst tissues that are associated with regular stretching such as the outer layer of joint capsules and ligaments of peripheral joints[xi]. Regarding the knee joint, Ruffini endings are found particularly at the front and back ligamentous and capsular structures, compared to Pacini Corpsucles (pressure and vibration) which are more densely found at the inner and outer aspects of the joint [vi].

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Mechanoreceptors enable the tissue to respond to mechanical pressures including balance, movement including reactions, and overall performance.

[i] https://functionalfascia.com/whats-it-all-about/fascia-facts/

[ii] Cowman, M. K., Schmidt, T. A., Raghavan, P., & Stecco, A. (2015). Viscoelastic properties of hyaluronan in physiological conditions. F1000Research, 4. Doi: 10.12688/f1000research.6885.1

[iii] Stecco, C., Fede, C., Macchi, V., Porzionato, A., Petrelli, L., Biz, C., ... & De Caro, R. (2018). The fasciacytes: a new cell devoted to fascial gliding regulation. Clinical Anatomy, 31(5), 667-676. https://www.ncbi.nlm.nih.gov/pubmed/29575206

[iv] Schleip, Robert. "Fascia as a sensory organ." World Massage Conference Webinar. 2009. http://files.academyofosteopathy.org/convo/2018/Presentations/DeStefano_MyofascialHandout.pdf

[v] van den Berg, F., & Cabri, J. (1999). Angewandte Physiologie – Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Stuttgart, Germany: Georg Thieme Verlag.

[vi] McCord JL, Kaufman MP. Reflex Autonomic Responses Evoked by Group III and IV Muscle Afferents. In: Kruger L, Light AR, editors. Translational Pain Research: From Mouse to Man. Boca Raton, FL: CRC Press/Taylor & Francis; 2010. Chapter 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK57268/

[vii] Tesarz, J., Hoheisel, U., Wiedenhöfer, B., & Mense, S. (2011). Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience, 194, 302-308. Doi: https://doi.org/10.1186/2056-5917-1-S1-A2

[viii] Mense, S., & Hoheisel, U. (2016). Evidence for the existence of nociceptors in rat thoracolumbar fascia. Journal of bodywork and movement therapies, 20(3), 623-628. https://doi.org/10.1016/j.jbmt.2016.01.006

[ix] Stilwell Jr, D. L. (1957). Regional variations in the innervation of deep fasciae and aponeuroses. The Anatomical Record, 127(4), 635-653.

[x] Van den Berg, F. (1999). Das Bindegewebe des Bewegungsapparats verstehen und beeinflussen. Band 1 Angewandte Physiologie.

[xi] Van den Berg, F. (1999). Das Bindegewebe des Bewegungsapparats verstehen und beeinflussen. Band 1 Angewandte Physiologie.

INSIGHT: PROPRIOCEPTION

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“Proprioception is defined as the conscious or unconscious awareness of joint position, whereas neuromuscular control is the efferent motor response to afferent (sensory) information”[i]

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Explained: In order to maintain balanced, the body has advanced feedback mechanisms relaying information to and from the spinal cord - brain and the MSK tissue. This ensures the body responds as optimally and efficiently as possible to whatever the situation. So whilst your nervous system and muscles work together to respond to sensory information, the body also uses proprioception to ensure the body works as a whole whether you are conscious of it or not.

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• Imagine walking down a set of stairs and you go to move down the last step to realise you are already on the floor, and that there was not another step. It is your fascia through proprioception that enables you to absorb the majority of pressures , so the muscles, ligaments and tendons are able to function more beneficially. The more a person has postural and biomechanical deviations, the more likely someone is to lose their balance in this scenario, and the more likely they will incur some kind of residing pain symptom or injury as a consequence.

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Proprioception aids balance and equilibrium, to which modern society is making the system less efficient as postures adapt. Posture is important!

[i] Kevin E. Wilk PT, ... Christopher Arrigo MS, PT, ATC, in Physical Rehabilitation of the Injured Athlete (Fourth Edition), 2012

YOUR SCORE:

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Know Your Body