Fascia – The Undiscovered Tissue

This last week the 2nd International Fascia Congress went ahead in Amsterdam. For four days the leading researchers presented their most recent findings to a mixed group of scientists and clinicians. After the congress there were a series of workshops, many of them very practical in nature. I am very excited to learn that the 2012 the fascial congress will be hosted by my professional organization, the British Columbia Massage Therapy Association of BC in Vancouver. To heighten my delight the 2012 congress will focus on the clinical application of current fascial research. I will be at that one, doing a little happy dance.

I expect many of you are trying to figure out what this fascia stuff is and why I am all giddy about it. Well, to steal the explanation my first fascial instructor gave me – fascia is the bag we walk around in. Imagine all the different bits in your body that you know about as being what is in the bag and that fascia is the bag. Recent research has shown that these are contractile bags – something that wasn't known when I first started studying fascia. A type of cell called a myofibroblast is responsible for this type of constriction - more on this later.

Fascia surrounds all nerve fibres, nerves, muscle fibres and muscles, organs, bones, joints and underlies our skin. Fascia acts to protect and separate structures, help maintain posture, and allow structures to glide upon one another. Problems in the fascia therefore create all sorts of problems in the body and often create mobile pain, pain that migrates far from its source and or moves around in the body without apparent cause.

The term fascia encompasses most of the connective tissue in the body and is the most pervasive substances in our bodies. Yet many people have never heard of it and our scientific exploration has just begun to bring fascia into the light. The western reductionist approach to our bodies and the treatment of them has allowed fascia to languish unexplored. Fascia coexists in form and function with all of our bodies systems and our piece-by-piece, system-by-system approach to treating our bodies meant that there has been virtually no exploration of this fascinating tissue. Basically, no one owned fascia because everyone owed fascia.

They owed fascia for the protection, lubrication and separation of the system in which they specialized. Fascia is the ultimate in multi-taskers. It can be thick, dense and organized, lending support to and separation between structures. It can be gossamer thin and allow structures to glide over one and other smoothly. It can be almost free of blood vessels and nerves or richly supplied with blood and sensory functions. Fascia can be so many things that initially anatomists did not realize it was all the same thing. So we have many names for the structures that are composed of fascia and a dearth of understanding of how all these different structures with their different compositions and functions can be discussed together.


On the bright side, there is a huge amount of research being done to increase our understanding of fascial tissue and its myriad impacts on the body. Some of the interesting directions that are being explored include the contractile nature of fascia, how tension is transmitted into the lumber fascia and how healthy fascia can move the way it does in the body without tearing.

Current research by Dr. Robert Schleip of the University of Ulm in Germany is exploring variability of myofibroblast density in fascia. Myofibroblasts are a contractile cell that are found in fascia and at wound sites. At wound sites the myofibroblast aid in wound closure, which speeds healing. However, in scar tissue these myofibroblasts sometimes stay around and continue to create contraction where it is not needed or wanted. What does this mean to fascia? If these cells are too active would they create undue restriction in the tissues they surround? Would this create tension and perhaps pain the the surrounded tissue?

Priscilla Barker and her associates have shown that contraction of various trunk muscles, including the transversus abdominis, create tension in the lumbar fascia, which then contributes to stability in the lumbar spine. Which explains why you are told to contract your tummy when you lift heavy objects.

One of the most visually arresting explorations of fascia comes to use from Dr. Jean Claude Guimberteau. Dr. Guimberteau has collected images, via laproscopic camera, of live fascial tissue and recorded the movement that occurs in the fascia and the neurovascular (nerves and blood vessels) tissue when a tendon is pulled on. The result is a video called "Strolling Under the Skin" and a book of the same title.

As a manual therapist I am excited by this research and what it tells us about one of the most frustrating things manual therapists experience. I have a client come in, I do all the indicated treatment and they leave feeling great – only to have the same pain and discomfort return almost immediately. Often, though not always, this type of pattern indicates fascial distortion or restriction. The good news is all this research that tells us about the function, structure and responses of fascia helps us to more easily recognize and successfully treat fascial issues and leave our clients with long term improvement in the performance and comfort of their bodies.

So there is a quick overview of the world of fascia and the reason I get so excited about this coming congress in Vancouver. What a wonderful opportunity to engage with and learn from the leading lights of fascial research. What a wonderful opportunity for the growth of understanding and good clinical application of that research by bringing together those who are exploring the science and those who are applying that science for your benefit.

Stay tuned for more on you and your body. Please let me know if there are wellness topics you are interested in or confused by.