Fascia And The Extra-Cellular Matrix
Fascia and the Extra-Cellular Matrix
Fascia refers to the primary connective tissues of the body and can be functionally subdivided;
Superficial fascia is the lowermost layer of the skin in nearly all regions of the body. It consists mainly of loose, areolar, and fatty adipose connective tissue and is the layer that primarily determines the shape of the body. Superficial fascia also surrounds organs, glands and neuro-vascular bundles and is found in many areas as a sort of filler material for unoccupied space. It serves as a storage medium for fat and water, a passageway for lymph, blood vessels and nerves and also cushioning and insulation.
Visceral fascia suspends the organs within their respective cavities. Each organ has at least a double layer of fascia separated by a thin membrane. The outer of these two layers is referred to more specifically as the parietal layer, and the inner the visceral layer. The organs then have specialised names for their visceral fasciae. In the brain, they are known as meninges; in the heart, pericardia; in the lungs, pleurae; and in the abdomen, peritonea. Visceral fascia is less stretchy then superficial fascia and its relative tension or looseness will affect organ function.
Deep fascia is a dense layer of fascia that surrounds individual muscles and divides them into groups and compartments for function. This fascia has a high density of elastin fibre that determines its resiliency. This layer is richly supplied with sensory receptors (nociceptors, thermoreceptors, mechanoreceptors, chemoreceptors and proprioceptors) but its almost avascular. Deep fascia further envelops all bones, cartilage, blood vessels and nerves.
Though historically relegated to the role of packing material, increasingly we are shown a universal connective, and communicative system, reaching right into the belly of muscle and simultaneously to the surface of our skin. It is richly enervated, conductive, and because of its resting tension state and the receptors and free nerve endings it is not only ideal, but a primed structure for organising the movement and understanding of our entire system.* Myofascia refers to the muscles within the connective tissues and it is important to note though perhaps obvious, that it is only through the function of fascia that muscle action is translated to the rest of the body.
Due to its undulated collagen fibres, fascia is able to be stretched and shaped, whilst the elastic fibres allow it to rebound and return to its original resting state. It's structure is best described as a tensegrity, spreading the mechanical load of our daily activity and distributing force through our structure. 'Plasticity' marks the point at which permanent change happens. Where the area is changed such that it can no longer return to where it was.
Fascia responds to persistent strain by bulking or thickening and drawing additional myofibroblasts to the area, making it less flexible but more able to endure the tensile forces through it. Myofibroblasts are utilised primarily in wound healing where their contraction works to draw the edges of the wound together. Contraction of myofibroblasts in our fascia is very different in quality to muscular contraction, building up over a period of minutes to hours and then maintaining for a significant period. In many cases this redistribution can create its own pathology. Plasticity in this sense has no concept of the bigger picture, only immediate requirements.
“As great and greater tensile forces are placed upon the fascia, more and more myofibroblasts develop from the normal fibroblasts of the fascial tissue. For this reason, myofibroblasts are also known as ‘stress fibers.’ These myofibroblasts can then create an active pulling force that the fascial tissue is experiencing. For this reason, myofibroblasts are found in the greatest concentration in fascial tissues that have been injured and are undergoing would healing.
Fascial tissues with high concentrations of myofibroblasts have been found to have sufficiently strong force to impact musculoskeletal mechanics—that is, their active pulling forces are strong enough to contribute to movement of the body.”
The Wider Impacts of Fascial Plasticity and Contraction
Fascia is primarily composed of collagen (approximately 40%) and lubricating ground substance (an amorphous gel-like substance surrounding the cells). When we consider muscle, fascia and ground substance as a whole we see that is approximately 70% water. When the area is mechanically or emotionally affected the water is pushed out; creating a harder and more gel-like ground substance which does not convey the same lubricating abilities.* The result is shorter, thicker and often bound or adhesed collagen fibres to 'splint' the affected area.* However when fascia is in this state it can restrict nerve fibres, lymph ducts and capillaries causing pain, imbalance and decreased healing capacity. Indeed, as this area is richly embedded with afferent, sensory neurons, it is possible for the fascia to signal ‘pain' or other faulty far longer than any evidence of the original wound or inflammation can be traced. The fascia further plays a supplementary role in our immune response through containment of pathogens to allow the body greater time to address the pathogen prior to its spreading which may also contribute*.
When fascia dehydrates we see a self compounding affect, whereby the myofascial restrictions begin to 'weal' out in an increased effort to protect the area. This continuous overload then risks greater compensatory reactions throughout the whole system.* Fortunately, the reflexive nature of fascia means that a return to normal function and tone is possible, provided that a point of plastic change has not been reached, and that even still beyond this plastic point, further plastic remodelling is still possible.
Shultz and Feitis argue additionally that to only consider the physicality of the area is not enough, and of course it makes sense that if the fascia and extracellular matrix are the network that allows for a synergised and autonomous self, that all aspects of the experience must be accounted for within any sort of therapeutic bodywork;
“The physical response to emotion is through the soft tissue… The fascia is the emotional body… feelings are felt in the total body—emotions travel through the fascial web. We then interpret the physiological sensation as anger, affection, love, interest and so forth… Physical work will only partially open that problem unless there is recognition that there may be an emotional origin.”
Kinesiology, The Skeletal System and Muscle Function. Joseph E Muscolino
Anatomy Trains. Tom Myers
The Fasciae, Anatomy, Dusfunction and treatment. Serge Paoletti
Rolfing. Ida Rolf
Fascial Plasticity - A New Neurobiological Explanation. Robert Schleip
Active contraction of the thoracolumbar fascia - Indications of a new factor in low back pain research with implications for manual therapy. In: The proceedings of the Fifth interdisciplinary world congress on low back and pelvic pain. Vleeming Mooney & Hodges