By Gabriel Ariciu, DC
Up until recently not much has been thought about in regards to fascia. You are probably wondering what it is and why I am even writing about it, but it is so important! Simply put fascia is thought to be just a “band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscles and other internal organs.” (1) Fascia has several different layers but for the most part that was all the thought it was given.Enter Drs. Jean Claude Guimberteau and Antonio Stecco and Anatomist John Sharkey.
Via the Thiel embalming method they have been able to more effectively preserve the body’s structures. Dr. Guimberteau has a book detailing some of this work and the group offers seminars for those interested. What they have discovered, specifically Dr. Guimberteau, in terms of fascia is groundbreaking and changes how we look at the human body. Making the human body far more complex and viewing it must be done in a holistic way. They found that the fascia creates a system called multimicrovacuolar collagenous absorbing system or MVCAS for short. This system is present throughout the whole body. They found that we are made up of volumes and we do not move in the traditional three planes of movement. Each movement is unique.
The MVCAS is fibular network made of what Dr. Guimberteau termed as vacuoles. He states it is not the best term to describe it but the system is made up of small “volumes” in a fractal pattern. It is a 3 dimensional structure made up of proteoglycan gel, so it is fluid in nature. No longer can you think of the structure of the body so simply. This intertwining network of fibers is everywhere. It covers all our muscles, bones, etc. from our head to our toes and it is continuous! The proteoglycan gel attracts water due to proteins called glycosaminoglycans or GAGs attached to them. Proteoglycans are the major component of our extracellular matrix, what lies between our cells.
This structure contains a constant volume and is very adaptable. When you move you do not move the same way twice. Say you raise your arm in front of you and then you want to do it again about 10 minutes later. It will not be the same movement. The fibers of this system will have adapted because the external factors have changed. Therefore each movement is unique. Some have termed the movement as gliding.(2)
The body must be looked at holistically now. Not only does this allow structures to move independently of each other but remember the MVCAS is located throughout the entire body and connects all the tissues together. It is a global system. “The tissue that used to be referred to as connective or areolar tissue is totally continuous throughout the fibres and their prolongations. Even the intermediary structures such as the deep pre-muscular fascia are incorporated into this network and are connected with it on their superior and inferior aspects, thereby increasing the shock-absorbing properties of the tissue and allowing the structures to move interdependently. Whether it is in the abdominal, thoracic, dorsal, ante-brachial regions or in the scap, this tissue network is omnipresent.” (3) “Indeed, there is no space within the body where it is not found. Even structures subject to relatively little movement–such as nerves and the periosteum–are surrounded by this fibrillar tissue network although in these cases there are differences in the network itself and in the size of the vacuoles. Indeed, it seems that the MVCAS occurs everywhere in the body.” (3) Pretty amazing that this structure is virtually everywhere in the body and it has been overlooked for so long.
They determined that this framework has three mechanical roles: “to respond to any kind of mechanical stimulus in a highly adaptable and energy-saving manner, ensuring the complete movement of the tendon; to preserve peripheral tissue stability, structures and shapes, providing information during action and springing back to its original shape; and to ensure the interdependence and autonomy of the various functional units.” (3) As I have said before the body must be looked at holistically because it is a complex structure of multiple systems working interdependently with each other. “The brain and every nerve of our body lie within and are profoundly influenced by the liquid/gelatinous ground substance of the fascial system. It is a well-known fact nerves can only transmit signals at slightly over 20 meters per second. Therefore, it is impossible for nerves to stimulate the trillions of cells of our body that each have more than 100,000 reactions per second. The fascial system functions as a fiber-optic network that bathes each cell with information, energy, light, sound, nutrition, oxygen, biochemicals and hormones and flushes out toxins at an enormous speed. The brain and nerves are an important but much slower form of communication. The ion-transfer mechanism of nerve impulses is too slow to account for the massive amount of information necessary for our body-mind to function. Therefore, it is the fascia, your liquid-crystalline matrix, that is the major and most important communication system of our body.” (4)
The fascia fast becoming one of the most important systems in a variety of ways. The omnipresence of the fascia with its framework and gel-like fluid allows it to act as a communication network much like the nervous system. Often we tend to think of the nervous system as the primary if not only system if which our cells communicate with each other. The brain controls everything is how it goes. However, this is not accurate. There are several structures that act in a similar fashion. One is the enteric nervous system often called the “second brain.” There is microbiome which sends chemical messengers to our brain and elsewhere which can be incorporated into the enteric nervous system. The fascia also acts like the nervous system. Our body is truly amazing and complex. Drs. James Oschman and Helene Langevin have described it in this way. That bodily motion can create electric fields that act like nerves. (5) Due to the fluid matrix of the fascia the signals travel very fast and changes can happen almost instantaneously. Within the fascia there are receptors that pick up movement and send signals to give you spatial awareness. They are called mechanoreceptors and proprioceptors. Muscle spindles are one of the important structures we have that are proprioceptors, or helps with spatial awareness. They are abundant throughout the entire body. They are numerous in our feet and in our spine. They help us with proprioception and movement. It is all about perception. How we perceive the world around us and adapt to it. We use these receptors to help know our position and be able to move. We rely on our visual senses to see where we are and where we are going. We also rely on our equilibrium in the inner ear for balance. These three integrate together to give us proprioception. When one breaks down trouble ensues. When we move the mechanoreceptors are being fired. Movement is life. As I begin to unfold the intricacies of fascia you will see the importance of movement and the detrimental effects it not moving can do. You will begin to see why bedridden people deteriorate quickly.
The fascia can also be considered an endocrine system. The endocrine system is the collection of glands that produce hormones that do a variety of processes such as metabolism, growth, reproduction, mood, and many other things. “Since connective tissue plays an intimate role in the function of all other tissues, a complex connective tissue network system integrating whole body mechanical forces may coherently influence the function of all other physiological systems.” (5) Furthermore, “understanding the temporal and spatial dynamics of connective tissue bioelectrical, cellular and tissue plasticity responses, as well as their interactions with other tissues, may be key to understanding how pathological changes in one part of the body may cause a cascade of ‘‘remote’’ effects in seemingly unrelated areas and organ systems.” (5) Dr. Langevin has been able to show acupuncture points and its meridians correspond to fascia planes. Acupuncture meridians are a complex network that cover the entire body. Various points also correspond to certain organs. The theory is by treating these points the corresponding organ is also treated. The new discoveries in fascia have further validated acupuncture theories. These theories have been around for thousands of years. Something I utilize everyday in my office with treating patients.
Speaking of the receptors in the fascia, Dr. Robert Schleip stated, “These hidden neurons are much smaller in diameter and are now commonly called interstitial muscle receptors. A better name would be interstitial myofascial tissue receptors since they also exist abundantly in fascia. According to the model of hypothalamic tuning states by Ernst Gellhorn, an increase in vagal tone does not only trigger changes in the autonomic nervous system and related inner organs, but also tends to activate the anterior lobe of the hypothalamus. Such a ‘trophotropic tuning’ of the hypothalamus the induces a lower overall muscle tonus, more quiet emotional activity, and an increase in synchronous cortical activity. This results in global neuromuscular, emotional, cortical, and endocrinal changes that are associated with deep and healthy relaxation.” (6) So not only are we affecting organs like the stomach and pancreas but also the brain. Everything works together. Every body system is interdependent with each other.
Another relation to endocrine and organs with fascia are something called Chapman’s Reflexes. These reflexes corresponded to different organs located all over the body. Dr. Frank Chapman originally postulated the idea in the early 1900s and thought it had to do with neurological connected points of lymphatic congestion. We have since learned that it is not accurate. But the breakthroughs in fascial research and thanks to Drs. William Devine, and Christian Fossum the link between the reflexes and the organs have been discovered. Again the interconnectedness of the body comes through. The fascia not only is a sensory organ involved in movement but also plays an integral role in the function of every organ and body system. It can be used to treat various issues, even issues distant in relation itself such as acupuncture points and Chapman’s reflexes. Furthermore, it is becoming more apparent in its role in the musculoskeletal system, movement, and chronic pain.
Jennifer Mayline Jing in her Master’s dissertation Fibromyalgia as an Inflammatory Disease: A look into the Increased Prevalence in Women, “Fibroblasts elicit excessive production of IL-6, which normally subsides after a few days and deactivates the inflammatory immune response. However, the production of estrogen interferes with the recall of IL-6, and triggers the female body to maintain a constant inflammatory state observed as FM.” She is illustrating one of many mechanisms that can cause FM. “One initiator of the increased pro-inflammatory cytokine levels in FM patients are fibroblasts, which are triggered by stress or injury to produce IL-6.” “Within fascia, this initiated inflammatory response increases the excitability of nearby free, unmyelinated nerve endings.” These nerve endings are “only excitable under inflammatory conditions.” These “transmit transmit noxious 22 signals throughout the body, and lead the protective inflammatory response to be abnormally perceived as pain. Inflammation of the fascia, as a result of IL-6 production by fibroblasts, is also a source of long-term activation of the dorsal horn neurons of the spinal cord. This phenomenon is known as central sensitization, and refers to overreaction of the central nervous system to painful stimuli as a result of constant input. While attributed to chronic pain conditions such as endometriosis and peripheral arterial disease, central sensitization in FM patients may occur spontaneously or as a result of active MTPs. Additionally, astrocytes and microglia cells within the fascia can be sensitized by the chronic inflammatory state and produce the exaggerated pain response characteristic of FM.” (7)
Chronic pain is a debilitating reality for many people. In addition to myofascial trigger points, myofascial adhesions or restrictions come into play. These restrictions can cause a tremendous amount of pain. Of course, these can lead to central sensitization creating a vicious cycle of pain. These restrictions are sometimes referred to as fibrosis, scar tissue, or densification. Nevertheless these restrictions can get worse over time especially if the inflammatory culprit has not been extinguished. The more severe cases could be due multiple injuries and poor movement over a period of time, food sensitivities, infection, hormonal imbalances, chronic stress, or environmental toxin. Inflammation will lead to more restrictions causing further degeneration. It is cyclical.
Location of the causative factor can be hard to determine because often times it is distant to where the pain is. I find this a lot in my practice. On a frozen shoulder case I found myself working on fascial restrictions in the opposite hip. Once a few restrictions were removed the pain decreased dramatically and the patient’s full range of motion was restored.
So what is the difference between a trigger point and a restriction? Are we splitting hairs? Are they the same thing? Maybe all of them need to be reclassified as myofascial restrictions, maybe something else entirely. What we call them is still evolving. Trigger points correspond to irritated spots of muscular tissue. Trigger points can be felt as tiny nodules or knots in a muscle. They are hyperirritable meaning they are painful. Drs. Travell and Simons defined them as, “hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.” You body intelligently shuts down the area of inflammation for healing and you compensate around the trigger point. But often times they can become chronic areas of injury leading to further irritation and compensations. Hence the reason I will lump trigger points, adhesions, and restrictions under the heading of myofascial restrictions especially since treatments are similar. Myofascial restrictions might not be palpable. But they are very tender to the touch.
Fascia is an incredibly interesting subject and at the center of what I do everyday. As you can tell your body is an ingenious design. By understanding the fascia a host of issues can be diagnosed and treated. What may seem like something in particular could be something else entirely. By addressing a painful spot in the foot someone’s shoulder pain can be decreased and resolved. Or by utilizing certain acupuncture points, an organ issue can be further understood in relation to the body. The body’s systems being interdependent must be approached holistically. It is joy to see this each day and help people recover from what seemed unrecoverable.