What is fascia and what does it do? This is the second piece in our Anatomy Class series. If you missed What Is A Ligament you will find that here. In the series we will take you through all the interesting tissues which make up our musculoskeletal system.
What Is Fascia?
Fascia is the gristle that is found throughout our body.
The pure definition of fascia is complex, as it’s more of a catch all term. Fascia is defined as “masses of connective tissue large enough to be visible to the unaided eye” (Gray’s Anatomy – the book not the show). This can include the wrapping found around all anatomical structures like muscles and organs, as well as nerves and blood vessels.
For physiotherapists, podiatrists and many other health professionals, the subset of fascia we talk about most is the fibrous connective tissue which is part of the musculoskeletal system. The fascia surrounding the other body systems (circulatory, respiratory and gastro-intestinal systems) is also important, but less relevant to this discussion.
It can be found everywhere in the body, and just like all the other tissues (bones, muscles, ligaments, tendons and more) it can become sore.
Well for that we first need to talk about what our musculoskeletal fascia actually does.
What Does Fascia Do?
Our musculoskeletal fascia is thought to provide support for other tissues. It wraps and connects muscles together to form long chains that cross over joints to provide increased power via longer levers for more torque. It can also act like a muscle-lite structure where it can contract and increase stiffness for improved efficiency.
A great example of this is one of the most common types of fascia many people have heard of. One in ten of us will get a condition known as plantar fasciitis (plantar fasciopathy) where the sinew on the bottom of the foot becomes overworked and painful. In the case of the plantar fascia it would usually act to resist pronation of the arch of the foot. This is important through the shock attenuating and balance phases of gait. If you can imagine a rubber band being stretched out when you first place your heel on the ground and lower your toes down, this is the plantar fascia in action.
In other parts of the body it can form long connective chains which provides support to our joints. The ITB (iliotibial band) is a thick fascial connection between the muscles in the upper leg and backside to the outside of your knee.
Within our large muscle groups (the calves, the forearms, the quadriceps etc) we have fascia which separates these muscles into compartments. In this way it is a barrier to protect each compartment from what’s going on in the compartment next door. If an infective organism gets inside one compartment then the fascia can prevent it from getting into another while our immune system fights off the intruders.
This protective barrier is a really useful and valuable role that it can play however it can be it’s own worst enemy. To understand that we need to take our minds back to another really useful and valuable structure.
The Titanic was considered unsinkable due to having a unique hull design where it was made of lots of smaller compartments. You see where I’m going with this don’t you… Unfortunately when the Titanic met the iceberg, these smaller compartments filled and filled which eventually was enough to list the ship, and we all know what happened next.
Your fascial compartments can come up against their own iceberg in the form of nasty infections which can spread rampant throughout that enclosed area. If the infection can beat your immune system and appropriate antibiotic therapy not introduced the entire compartment can become damaged and no longer viable.
Fascial compartment infections are serious business, losing a compartment can mean losing an entire movement as the muscles inside often perform the same function (eg: all point the ankle down). If you lose that compartment, life becomes much more difficult.
Why Is Fascia Important?
Just like in 1912 when the Titanic was the most important ship on the seas, in 2020 fascia is considered by many “fascial enthusiasts” as the most important structure in our bodies.
As a health professional my social media feed is always full of devices and promises that my fascia can be blasted, released or manipulated to leave me feeling totes bliss. Unfortunately for all the hype, this is where the marketing and dollars can get in the way of the evidence. In this way, fascia is important as it’s the carrot for sales of not-so-reputable therapy aids.
We know that fascia is important to hold us together, protect us, support us and increase our efficiency. But when it gets sore it doesn’t need (or should that be knead) a baker’s thumb or carpenters nail gun to resolve our pain.
We simply need to get our fascia back to where it likes to be, it’s happy place.
How Do We Treat It?
To resolve sore fascia a therapist will get it from being overworked, to worked appropriately. It’s not that we want to completely unload it either. Remember that old adage, you don’t use it, you lose it? Well it applies to fascia too.
If you did not use your it to support, protect and stabilise your musculoskeletal system will decrease in capacity.
In the same vein, if you consistently and excessively overload it you will be pretty sore and looking for a physiotherapist ASAP.
What we need to do is work our fascia consistently, towards capacity, but not exceeding capacity too often. If we do this, it will stay strong for as long as we need it to.
The more advanced level of treatment for fascia is resistance training. That’s right, those heavy weights aren’t just for the beach muscles. Strength training activates it’s contractile properties. The more we lift, the more work it will be able to tolerate in the future. The bigger the happy place.
What About Fascial Release?
Great question! Fascial release is the catchy term used by many different types of hands on therapists (physios, podiatrists, myotherapists and more) to describe a hard massage-based technique. With fascial release massage the practitioner is aiming to “release adhesions” within fascia.
Unfortunately for many fascia releasers – when we do the research we don’t find any adhesions, or consistent adhesions within it. And the second nail in the coffin is that when we look at fascia and try to actually move or release any of it (in cadavers) the it is so tight and strong it often takes many scalpel blades to even make a dent in it.
But you can take solace (and start to remove the lid from the coffin) in the knowledge that often manual therapy and massage has been proven to help sore fascia. People who believe it will give them relief report improved pain levels in their fascia after a good rub. It doesn’t need to be hard and painful massage either, often soft, gentle massage techniques are just as, if not more effective at providing pain relief than aggressive fascial release techniques.
What Can I Do About My Sore Fascia?
Besides seeing a physiotherapist (an above the knee expert) or podiatrist (below the knee expert) there’s a few things you can do to get your fascia feeling fine (again).
You can do some self massage on your sore spots. Pressing and moving your fingers or maybe a spiky ball or foam roller around your tender fascia can be a great way to prepare yourself for being active..
Gentle movement based exercise is another great way to de-sensitise painful fascia. Think yoga, tai chi or even walking. Moving fascia within it’s comfort zone with these activities should start to put a smile back on your dial (oh yes that smile is facilitated by some facial fascia too!).
If your painful fascia is in your lower leg then footwear can play an important role in reducing the overload. The plantar fascia works less when the heel is slightly elevated compared to being flat on the ground.
From the author
I hope you’ve found this post a useful introduction to musculoskeletal fascia. If you’ve found this helpful and know someone else who has struggled with fascia problems please share it.