Your Fascia-nating Fascia
New science is showing that fascia—the webbing that holds your body together—might play a role in far more than just post-exercise soreness
Fascia is possibly the most prevalent tissue in the body. Exactly how much of it we have hasn’t been measured, but it’s everywhere, supporting the skin and covering muscles, nerves and organs. Despite this, until recently, this white stringy substance was seen as so irrelevant to health that doctors would throw it away during anatomy lessons. “But in 10 to 15 years, I think we’re going to look at that as like trying to examine the body and leaving out the liver,” says Professor Carla Stecco from the University of Padova in Italy, one of the world’s leading investigators into the role of the fascia. “We have a huge amount of fascia in our body and to ignore that tissue and its role in the function of the muscles, organs and skin, or in the development of disease is crazy.”
Thanks to the work of Professor Stecco, and other researchers in the field, we now know that rather than being merely an inert scaffold of collagen fibres, fascia is a complex structure with roles we’re only just teasing out. We’ve discovered that there’s not one type of fascia—but four ‘each with different characteristics and roles’. We know that some types of fascia have a nervous system and some contain immune cells. It’s been discovered that it can contract of its own volition (around 30 per cent of the force of a muscular movement is controlled by the fascia rather than the muscle), and that it plays a role in how we feel pain and also in how we determine where we are in space—a key part of how we move.
“There’s not a part of the body that the fascia doesn’t touch—and that it doesn’t affect,” says Alison Slater, a Sydney-based physiotherapist who specialises in the fascia. “It tells the muscles what to do and how quickly and strongly to do it. It’s like the muscles are the brawn of the body—but the fascia is the brain.”
Fascia is possibly the most prevalent tissue in the body. Exactly how much of it we have hasn’t been measured, but it’s everywhere, supporting the skin and covering muscles, nerves and organs. Despite this, until recently, this white stringy substance was seen as so irrelevant to health that doctors would throw it away during anatomy lessons. “But in 10 to 15 years, I think we’re going to look at that as like trying to examine the body and leaving out the liver,” says Professor Carla Stecco from the University of Padova in Italy, one of the world’s leading investigators into the role of the fascia. “We have a huge amount of fascia in our body and to ignore that tissue and its role in the function of the muscles, organs and skin, or in the development of disease is crazy.”
Thanks to the work of Professor Stecco, and other researchers in the field, we now know that rather than being merely an inert scaffold of collagen fibres, fascia is a complex structure with roles we’re only just teasing out. We’ve discovered that there’s not one type of fascia—but four ‘each with different characteristics and roles’. We know that some types of fascia have a nervous system and some contain immune cells. It’s been discovered that it can contract of its own volition (around 30 per cent of the force of a muscular movement is controlled by the fascia rather than the muscle), and that it plays a role in how we feel pain and also in how we determine where we are in space—a key part of how we move.
“There’s not a part of the body that the fascia doesn’t touch—and that it doesn’t affect,” says Alison Slater, a Sydney-based physiotherapist who specialises in the fascia. “It tells the muscles what to do and how quickly and strongly to do it. It’s like the muscles are the brawn of the body—but the fascia is the brain.”
Fascia develops after we’re born once we start to crawl, then stand, then walk. “It thickens in response to the demands we put upon it as we become bipedal,” says Slater.
If it remains healthy during the rest of your life, you probably won’t even know it’s there. The layers of fascia glide effortlessly across each other when we move, and that allows us to move smoothly and gracefully too. However, if something damages the fascia, if the substance (hyaluronan) that lubricates the layers gets sticky, or the fibres themselves start to stiffen and clump together, movement becomes more stilted, and so do you.
Dysfunction of the fascia might also explain some of the conditions that have baffled doctors for years.
For example, a strong case is now being made for the fascia being the cause of unspecified back pain (pain not caused by an obvious injury or issue with a muscle or disc) after researchers at the US National Institutes of Health (NIH) discovered that people with long-term back pain had 20 per cent stiffer fascia in one region of the back than those without pain.
Other estimates suggest that myofascial pain is present in around 30 per cent of people with musculoskeletal pain in the back, neck, shoulder, hip and pelvis or who suffer frequent headaches. “I think we might find a lot of what we blame on the joints and muscles may actually turn out to be disorders of the fascia in the future,” says Slater. It’s also suggested that inflammation of the fascia might be associated with a number of other idiopathic conditions including fibromyalgia, irritable bowel syndrome and endometriosis.
And lastly, there’s a possible link with cancer. Not the development of a tumour, but whether the environment around one plays a role in whether it spreads or responds effectively to treatment. “The fascia around a tumour is now an element looked at by oncologists to determine how aggressive a cancer might be,” says Professor Stecco. “It’s possible that there’s something active in the fascia that is involved with cell signalling and the metastasis of cancer.”
Looking after the fascia is therefore something we should all be integrating into our daily self-care, like brushing our teeth or looking after our heart, particularly as we get older. As we age our fascia naturally stiffens, particularly around the back; and for women, the withdrawal of oestrogen that comes at menopause also alters the fascia. “There may also be a genetic link as to how the fascia behaves,” says Professor Stecco. “We see that if the parent is stiff, their child is stiffer, for example.”
Obesity, which may alter fascial hyaluronan, is also a key risk factor for increased fascial stiffness and pain. Emotional stress, which can cause muscle tension, can also affect and modify the fascia.
The first step in caring for the fascia is stretching. When you stretch fascia in a static position, like you would holding a yoga pose for a few minutes, it actually changes the cells within it. In studies by NIH researcher Helene Langevin, stretching tissue in a lab for two hours doubled the size of cells called fibroblasts in the fascia creating longer, flatter, more relaxed cells. Other studies showed just five minutes of stretching reduced the level of inflammation in the fascia.
Foam rolling is another way to relax the fascia—so far, it doesn’t look as if this has the same long-term effects upon it as holding a static stretch does, but, it does help prevent stiffening, particularly after exercise. “But, you need to roll correctly—like you’re working on delicate pastry—it shouldn’t feel like a search and destroy mission—but a gentle, constant pressure,” says Slater.
Move, regularly. “So many people will go out and do their run or their cycle first thing but then they sit down for the rest of the day and that doesn’t help the fascia,” says Slater. So, change position, stand up regularly and take short walks to keep things supple.
And finally feed your fascia. Staying hydrated helps keep the hyaluronan that lubricates the fascia fluid, and Professor Stecco says that her patients suffering pain also tend to benefit from a more anti-inflammatory diet—which means lots more oily fish, fruit, vegetables and wholegrains and less sugar, fat, alcohol and processed foods.
“I think we are learning that a role of the fascia is to maintain the body health—but for it to work, we must maintain the health of the fascia,” Professor Stecco says. “When the fascia is healthy we feel better in body—and mind.”
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