Fascia: how a neglected part of the body gained attention – 02/13/2024 – Balance
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We are constantly reminded of how exercise benefits bone and muscle health or reduces fat. However, there is also a growing interest in an element of our anatomy that is often overlooked: the fascia.
Fascia is a thin covering of connective tissue, made primarily of collagen – a rope-like structure that provides strength and protection to many areas of the body. It surrounds and holds in place all organs, blood vessels, bones, nerve fibers and muscles. And scientists increasingly recognize its importance in muscle and bone health.
It’s difficult to see the fascia in the body, but you can get an idea of what it looks like by looking at a steak. These are the thin white stripes on the surface or between the layers of meat.
Fascia performs general and special functions in the body and is organized in several ways. Closer to the surface is the superficial fascia, which lies beneath the skin, between layers of fat. Then we have the deep fascia, which covers the muscles, bones and blood vessels.
The link between fascia, muscle and bone health and function is reinforced by recent studies that show the important role that fascia plays in the working of muscles, helping muscle cells contract to generate force and affecting muscle stiffness.
Each muscle is wrapped in fascia. These layers are important because they allow muscles that are next to or on top of each other to move freely without affecting each other’s functions.
Fascia also assists in the transition of force through the musculoskeletal system. An example of this is our ankle, where the Achilles tendon transfers force to the plantar fascia.
This causes forces to move vertically downward through the Achilles tendon and then be transferred horizontally to the ball of the foot – the plantar fascia – during movement.
A similar force transition is observed in the chest muscles, down to muscle groups in the forearm. There are similar fascia connection chains in other areas of the body.
When the fascia is damaged
When the fascia does not function properly, such as after an injury, the layers become less able to facilitate movement over each other or help transfer force. Injury to the fascia takes a long time to repair, probably because it has tendon-like cells (fibroblasts) and a limited blood supply.
Recently, it has been shown that fascia, especially the layers close to the surface, has the second highest number of nerves after the skin. Muscle fascial coverings have also been linked to pain from surgery and musculoskeletal injuries caused by sports and aging. Up to 30% of people with musculoskeletal pain may have cases involving the fascia or where the fascia may be the cause.
A type of massage called fascia manipulation, developed by Italian physical therapist Luigi Stecco in the 1980s, has been shown to improve pain from patellar tendinopathy (pain in the tendon below the kneecap), both short- and long-term.
Fascia manipulation has also shown positive results in treating chronic shoulder pain.
One of the growing trends to help with musculoskeletal injuries is Kinesio tape, which is widely used in professional athletes. The technique is also being used to supplement the function of fascia and to treat chronic low back pain where fascial involvement is a factor.
Sick fascia?
In addition to being damaged, fascia can also provide pathways through which infections can travel within muscles.
The spaces between the fascial layers are usually closed (think folded cling film), but when an infection occurs, germs can spread between these layers. This is a specific problem in the neck, where there are several layers of fascia through which infections can travel.
In severe cases, surgery is often necessary to remove dead tissue and save remaining healthy tissue.
The common complaint of plantar fasciitis, which causes pain around the heel and arch of the foot, is one of the main examples of how fascia works in health and the challenges its dysfunction can bring.
This incredibly common disease affects 5-7% of people, and the rate increases to 22% in athletes. It is recognized as an overuse injury, causing thickening of the fascial bands on the soles of the feet that help support the arch.
Fascia may also be linked to more serious health problems, such as necrotizing fasciitis. This is a rare but serious infection that can spread quickly throughout the body and cause death.
The condition is almost always caused by bacteria, specifically Streptococcus from group A or Staphylococcus aureus. The initial infection comes from a cut or scrape, and then the bacteria travels along the fascia to areas away from the initial site and multiplies in the ideal environment provided by body heat.
We can see the fascia better now
One of the reasons fascia has been overlooked in health and disease is because it was previously difficult to see using previously available imaging technology.
More recently, however, MRI and ultrasound have been shown to be beneficial in visualizing fascia, particularly in musculoskeletal conditions such as plantar fasciitis, and pathological changes in the fascia of the shoulder and neck.
With the growing interest in fascia and the greater understanding of its contribution to musculoskeletal health, it is sensible to suggest that we care for it in the same way as we do the rest of the musculoskeletal system – by using it.
Simple techniques like using foam rollers and stretching are beneficial for increasing mobility, but there is still a lot to learn about our fascia and the role it plays in everyday health..
This article was published on The Conversation and reproduced by BBC News Brasil under the Creative Commons license. Click here to read the original version in English.
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