Fascia is becoming a buzzword in the world of movement and manual therapy. Fascia is a connective tissue that surrounds and supports muscles, organs, blood vessels, and nerves throughout the body. It forms a continuous web of fibrous tissue that helps maintain structural integrity, provides protection, and facilitates movement.
An intricate fascia network within our bodies is crucial to our overall movement and well-being. From providing support to facilitating flexibility, the fascia is a key player in maintaining our body's structural integrity. However, when subjected to injuries, the repercussions can be profound, affecting not only our movement patterns but also resulting in persistent pain.
A common question I get from my clients is how is fascia injured and how they can recognize fascial injuries. In this article, we delve into the causes and effects of fascial injuries, shedding light on what you need to know to better understand and address these issues.
Understanding 3D Continuity of Fascia
Before we explore the impact of fascial injuries, let's take a moment to understand the basics of fascia. The fundamental characteristic of fascia is its 3D continuity. Fascia's 3D continuity refers to its interconnected, three-dimensional network that spans the entire body, enveloping and connecting muscles, bones, nerves, blood vessels, and organs. This web-like structure ensures that fascia is not just isolated to specific areas but forms a continuous system, linking different parts of the body from head to toe. Through this 3D continuity, fascia facilitates the transmission of mechanical forces and movement across the body, helping maintain structural integrity and balance. This also means that an injury to one part of the fascia doesn't always immediately produce symptoms as it is compensated by other parts. However, such compensation creates imbalances to the body. When the body becomes overwhelmed by other events or added stress to the imbalanced system, it can no longer compensate and the body becomes symptomatic. The symptoms can arise in any part of the body not just the injured part.
Causes of Fascial Injury
Fascial injuries can occur due to various reasons, ranging from sudden trauma to repetitive strain and mental stress. The most intuitive reason is mechanical stressors such as physical trauma, surgery, burns, and pregnancy. Overuse can also cause damage to fascia via micro-tears and inflammation. Poor posture, structural and muscular imbalance, and aging are also known causes of fascial injuries. Systematic causes like infections and toxins can also lead to fascial injuries. Less intuitive but common causes of fascial injuries are mental and emotional stress and environmental stresses.
Impact of Fascial Injury
Fascial injuries can manifest as palpable densification, fibrosis, and/or adhesions of affected tissues.
Densification means solidification of ground substance. Ground substance in fascia is like a gel that fills the spaces between cells and fibers within the connective tissue. It’s made up of water, proteins, and sugars, and acts as a lubricant and shock absorber, helping the tissues stay flexible and hydrated. This gel-like substance allows the fascia to move smoothly with the muscles and other tissues while also providing a cushion to protect them from damage. It plays a key role in transporting nutrients and removing waste from the surrounding cells, helping to keep the tissue healthy. When the body moves or stretches, the ground substance helps the fascia adapt and glide, supporting smooth motion and reducing friction between muscles. Solidification of ground substance is problematic for not only the local tissue but also for systematic circulation.
Adhesion means collagen fibers fray and form crosslinks. Collagen fibers in fascia are like strong, flexible threads that give structure and support to the body’s connective tissues. These fibers help fascia hold everything together—like muscles, bones, and organs—while still allowing flexibility. Think of collagen fibers as the building blocks that provide strength, similar to how cables support a bridge. They are arranged in a wavy pattern, allowing them to stretch and then return to their original shape, which is important for movements like bending and stretching. When you move, collagen fibers help the fascia handle the stress and tension, keeping the tissues resilient and able to return to their normal state. Fraying of collagen fibers and the formation of crosslinks significantly affect the strength and flexibility.
Fibrosis means that collagen fibers increase along the lines of tension and injury. Excessive buildup of collagen makes the fascia rigid and less elastic. Stiff fascia doesn't move as smoothly, increasing the likelihood of muscle strains, sprains, or other injuries during physical activities. In addition to reduced strength and flexibility, fibrosis can cause more systematic problems as the thickened fascia can cause poor circulation and compression of nerves and muscles. Pain and discomfort can also be casued.
These structure changes can occur not only at the point of initial injury but also far from the actual point of injury while the tension spreads far along a fascial chain. Therefore, fascia commonly leaves a puzzling trail to find the true source of pain and dysfunction. For this reason, it is important to pay attention to the following overall dysfunction of the body.
Altered structural alignment
Restricted range of motion
Altered movement mechanics or compensating movements: The fascia is densely innervated with sensory receptors that relay information about tissue tension and movement to the brain. When the fascia is compromised due to injury, these sensory signals can become distorted, leading to altered movement patterns and increased sensitivity to pain.
Hypertonus and Pain: Fascia contains nerve endings that send signals to the brain. When the fascia is injured, these nerves become more sensitive and start sending more frequent "pain" signals, even when you’re doing normal activities that wouldn’t usually hurt. Tightness of fascia can also put extra pressure on surrounding nerves and muscles, making even light pressure feel painful.
Sympathetic overload: Sympathetic nervous system overactivity happens when your body’s "fight or flight" response stays activated for too long. It is often manifested as constant stress or anxiety, rapid heartbeat, shallow or fast breathing, digestive problems, increased sweating, difficulty sleeping, irritability or mood swing, high blood pressure, muscle tension or pain. Sympathetic overload decreases blood flow to certain organs and skin. This also affects the process of glands, hormonal secretion, and the body’s way of controlling the size of blood vessels to regulate blood flow and maintain proper blood pressure. This stress on homeostasis can eventually cause degeneration of tissues.
Chronic disease: Although fascia is not always a cause for a chronic disease, fascia is almost always involved with the chronic disease due to its systemic function. A change in viscosity of the ground substance disrupts movement of nutrients, waste, and signals within and between cells. This can affect the structure, function, and chronic irregularity of the tissues including the tissues for immune function. This can lead to disease.
Accelerated aging process: Aging fascia is often reflected by wrinkles, which is the sign that there is a loss of fibroblasts (special cells in your body that help build and maintain connective tissue) and collagen cells. The collagen fibers become disorganized and lose their ability to recoil. A sedentary lifestyle can also make the healthy collagen crimp and become disorganized, accelerating the aging process.
Addressing Fascial Injuries
Rehabilitating fascial injuries requires a comprehensive approach that addresses both the physical and biomechanical aspects of the issue. Manual therapies, such as myofascial remodeling and soft tissue mobilization, can help restore the suppleness of the fascia and alleviate restrictions. Additionally, targeted exercises that focus on improving strength, flexibility, and coordination can aid in rehabilitating the affected area and preventing future injuries.
Conclusion
In conclusion, understanding the impact of fascial injuries on movement and pain is essential for maintaining optimal physical function and well-being. By recognizing the causes and effects of fascial injuries, individuals can take proactive steps to prevent and address these issues effectively. Whether through proper movement mechanics, targeted rehabilitation exercises, or manual therapies, there are various avenues to support fascial health and promote overall wellness.
Next time you feel a twinge of pain during movement, remember the intricate network of fascia within your body and the vital role it plays in your body's functionality. By acknowledging and respecting the importance of fascia, you pave the way for a more resilient and pain-free body.
Remember, when it comes to fascial injuries, knowledge is power. Stay informed, stay proactive, and keep moving towards a healthier, pain-free you.
References
Paoletti, S. (2006). The Fasciae—Anatomy, dysfunction, and treatment (English Edition). Eastland press.
Simpson, T. (2022). Advanced Myofascial Remodeling Module. Manual Osteopathic College of Canada.
Very thorough and helpful!