While I am sure the topic of fascia was mentioned off-hand during physical therapy school, I am equally sure that it was never mentioned with any kind of practical application. In fact, fascial researchers joke and anyone who has dissected cadavers agree that fascia is the annoying part of the body we all spent countless hours peeling and picking off our cadavers to be able to visualize the important stuff like muscles, joints, bones, and organs. Now after fifteen years of practice, the role of fascia in our body, what it does, and what patients feel when they have dysfunctional fascia is quite obvious. You too may recognize the role of fascia when you consider the following…
1. Ever stretch and stretch and stretch, and your limb or muscle is still no looser?
2. Have you ever had pain when you touch your muscle, but then notice it is also painful in the soft tissue layers that surround the muscle?
3. Wonder why some people are just so naturally flexible, and the little bit of flexibility you once laid claim to abandoned you once you took that office job where you sit all day?
The answer to these questions is simply fascia. When I introduce the topic of fascia to my physical therapy patients, eyebrows go up and questions abound. What is it? What is it made of? Why is it hurting me? How do you know if you injured your fascia? How did I injure it? Will my tight fascia go away? These are all great questions, all of which will be answered in the paragraphs below.
Technically speaking, fascia is dense connective tissue, primarily made up of collagen (a protein with multi-directional filaments), with different layers and locations: superficial, deep, and visceral (organ) fascia. Fascia is everywhere in your body. If the fascia is separated from the rest of the body, it appears very much like a wetsuit- completely covering the trunk and extremities, and even the skull. It is the “plastic wrap” type covering of your muscles, runs alongside and connects your muscles, tendons, nerve sheaths, and blood vessels. It’s essentially a special tissue that is the glue that holds everything in the body together, and envelopes everything, keeping the body organized and inner organs secure.
Collagen is the key component of fascia that determines how tight or loose your muscles feel. While genetics determine your overall level of fascia stiffness based on the type of collagen that is most prevalent in your fascia, it can also be easily altered based on the stresses placed on the tissue. Two structures in our body, the iliotibial tract or band on the outside of your thigh, and the plantar fascia in the foot, are not present in their normal state at birth. However, once infants begin crawling, standing, and later walking, these structures are developed in response to the new level of stiffness required in those regions. If someone is unable to walk and sits in a wheelchair all day, over time the IT band actually disappears because it is no longer necessary.
This ever-changing role of fascia makes a lot of sense in everyday life. If you suddenly get off the couch and decide to start training for a marathon, no doubt there will be changes to your fascia, as these structures adapt to the new stresses you are applying to your body. Stop working out, running, and jumping, and surely the fascia will adapt as well, reducing its role in the IT band as its purposeful use is reduced. Try working out again as you did years ago, it may take a while for this tissue to build back up again.
The plantar fascia that makes up the arch in the foot also can change with these forces, along with internal forces within the body that can change the tensile abilities of the tissues. If you suffer from sciatica, no matter how sedentary your life may be, the plantar fascia will likely be tight and crampy, because the sciatic nerve is sending excess signal to the plantar fascia even at rest, creating a hyperactive state.
How does this concept of adaptability apply to all fascia present everywhere in the body? In much the same way, underscoring the foundation of genetics in the make-up of collagen, certainly if we are well hydrated, are active, and we stretch the fascia, our fascia would tend to be looser. Whereas if we are dehydrated, sedentary, and never perform movements or stretches that affect how loosely or densely packed the collagen fibrils are organized, we can surely expect to feel tight all over.
While the role of fascia just recently became a topic of interest to researchers around the world, one area of fascia that is well-known and researched is the role of collagen, a main component of fascia that makes up tendons, to store energy and demonstrate the elastic recoil that contributes to our ability to jump. When performing a box jump, there is a specific timing that needs to occur in the loading and unloading of the tissue to produce the most force allowing the greatest amount of energy released to create a maximal jump. The catapult mechanism present with the elastic recoil of facial tissues was studied in the 1980’s, when kangaroos were the topic of investigation (Schleip, 2015). How do they jump up to 13 meters at a time without any bulky leg muscles? Certainly the power for their jumps is not coming from the contraction of muscle fibers, but rather from the elastic spring of their very long tendons, storing and releasing kinetic energy to create such magnificent jumps (Karm & Dawson, 1998).
With the recent advent of musculoskeletal ultrasound, we now have a much improved understanding of the role of fascia in humans. Similar to kangaroos, human fascia has a similar kinetic storage that used not only with running and jumping, but also even with walking (Sawicki et al, 2009). Much of the energy we use in movement is derived from elastic storage and springiness of our collagen. This makes total sense when you watch marathon runners cross the finish line. Some runners appear to plod along with great, heavy effort, while others are simply gliding and bounding lightly off the road surface, despite having just completed a 26-mile plus jaunt. The difference in this running form and the type of energy expended is likely explained by the runner with the lightest form better utilizing the natural spring and bounce of the fascia, producing a less fatiguing method by which to propel from one foot to the other in a seemingly effortless leap.
Now that you have a better understanding of the amazing role and untapped potential of fascia in our body, next month, we will consider the problem of dysfunctional fascia and what you can do about it.
References:
Kram & Dawson. 1998. Energetics and bio mechanics of locomotion by red kangaroos. Comparat Biochem Physiol. B120: 41-49.
Sawicki, Lewis, and Ferris. It pays to have spring in your step. 2009. Exer Sport Sci R. 37:130-138.
Schleip. Chapter 10: Fascial tissues in motion: Elastic storage and recoil dynamics. Fascia in Sport and Movement; Edinburgh:Handspring Publishing, 2015.