Have you ever tried to watch a movie from the front row? Difficult isn’t it. Today’s Medical education, with its huge emphasis on technology, can be a lot like watching a movie from the front row.
Because the practice of medicine is predicated on dividing, subdividing, and dividing some more, it tends to give student doctors a “front row” perspective of anatomy and physiology. Think about it; we have kidney specialists (nephrologists), heart specialists (cardiologists), nerve specialists (neurologists), butt specialists (proctologists), muscle and joint specialists (orthopedists), stomach specialists (gastroenterologists) etc, etc, etc, etc, etc.
Unfortunately, this model is out of date. It fails miserably as far as advancing our understanding of the human body. It cannot explain how the whole organism is greater than the sum of its individual parts. What do I mean by this? For instance, Hydrogen (an explosive gas) + Oxygen (a flammable gas) = Water (H2O), a liquid — the foundation of all life — that is used to quench fire.
The problem with using OUTDATED MODELS that “reduce” and subdivide the human body into increasingly smaller parts is that you never really see the larger picture. The movie ends without the student doctor ever moving from the front row. And unless doctors are willing to step outside of “the box” of their formal educational model (something they are encouraged not to do), the “Big Picture” is rarely grasped.
Doctors use this same philosophy and thought process when trying to explain the musculoskeletal system. Fascia is one of the best examples that I can think of concerning this phenomenon. Doctors frequently miss the forest for the trees because the books they learned from (that were themselves written by other doctors trained with the same reductionist philosophy) show hundreds of pictures of individual muscles —- without ever showing or explaining the fascia.
Go to virtually any anatomy text book and take a look. The fascia is almost always removed so that we can see the really “important” stuff. But never forget that removed = ignored. And after all; if the medical text books are not talking about fascia, or showing us lots of pictures of fascia, and explaining how fascia works; exactly how important can it really be?
Because many of the pictures leave the fascia intact is the big reason that most of the anatomical drawings on my site come from Gray’s Anatomy. Henry Gray is still considered one of the greatest anatomists the world has ever seen.
fWHAT IS FASCIA?
Fasciae (plural) are the tough layers of fibrous, collagen-based connective tissues that permeate the human body. If you are a deer hunter, you have seen fascia and know what it is. It is the thin, white, cellophane-like, membrane that wraps itself tightly around the meat / muscles. Around here folks call it “Striffin” or “Silver Skin“. But there is far more to fascia than what is readily observed while butchering.
Fascia surrounds individual muscles, muscle bundles within individual muscles, groups of muscles, blood vessels, and nerves. It binds these structures together in much the same manner that plastic wrap is used to hold the contents of your Hoagie together. Fascia consists of several extremely thin layers, and is the tissue where the musculoskeletal system, circulatory system, and nervous system all converge. It extends from the top of the head to the tip of the toes, and like ligaments and tendons, contains closely packed bundles of wavy collagen fibers that line up in an organized and parallel fashion (PICTURES HERE). Subsequently, healthy fasciae are flexible tissues that are able to resist great tensile forces. Unhealthy fascia? We’ll get to that shortly.
Fascia forms a whole-body, continuous, 3-D matrix of structural support. Its connections extend to all fibrous (elastic) connective tissues, including APONEUROSIS, LIGAMENTS, TENDONS, RETINACULUM, joint capsules, organ and blood vessel sheaths, the epineurium (nerve sheaths), the meninges (spinal cord sheaths), the periosteum (sheath that surrounds bones), as well as the membranes that surround MUSCLES.
Among the different kinds of tissues that are involved in the body’s “elastic” framework (chiefly ligaments, tendons, muscles, etc); fascia has received the least scientific attention – probably because in most regions of the body it cannot be imaged with even the most technologically advanced imaging techniques such as MRI (hey, out of sight, out of mind). Nevertheless, fascia plays a major (albeit poorly understood) role in joint stability / instability, PROPRIOCEPTION, coordination, strength, joint motion, as well as pain syndromes of all kinds. It can even be involved in several disease processes.
Critical Functions of Healthy Fascia:
- It binds and holds muscles together compactly.
- It ensures proper alignment of the muscle fibers, blood vessels, nerves, and other tissues within the muscle itself.
- It transmits forces and loads evenly throughout the entire muscle.
- It creates a uniformly smooth surface that essentially “lubricates” the various surfaces that come in contact with each other during movement.
- It allows the muscle to change shape as they lengthen or shorten.
Collagen is the building block of all connective tissues. Some collagen-based connective tissues like bone and most cartilages, are part of your body’s load-bearing framework. Their purpose is to withstand compressive forces, while grossly maintaining the body’s shape.
On the other hand, you have the Elastic, Collagen-Based, Connective Tissues, whose chief job is to overcome the tensile forces that are constantly trying to pull joints apart whenever movement or muscle contraction takes place. These tissues don’t need to be able to bear heavy loads, but instead, must be able to stretch and elast (at least to a slight degree) while resisting tearing. Of these “elastic” collagen-based connective tissues, fascia is the most elastic.
As long as the individual collagen fibers that make up the fascia, are aligned in parallel fashion to each other, the tissue is stretchy and elastic (think about long hair that has been combed out. If you run a comb or brush through it, it glides — smoothly and unrestricted.) But what happens when fascia is injured?
When fascia is stretched beyond its normal load-bearing capacity, it begins to tear. Bear in mind that these tears are so microscopic that they never show up on an x-ray, and only on rare occasions will they show up on an MRI (possibly the Plantar Fascia on the bottom of the foot). Fascial tears can be caused by sports injuries, repetitive trauma, car wrecks, postural distortions, falls, child bearing, abuse, etc, etc, etc. Oftentimes people have no idea how they ended up with Fascial Injuries or adhesions.
Whenever a muscle is impacted (contact sports, falls, abuse, etc) or overused / injured (lifting weights, running, over-training, heavy or repetitive jobs, etc), collagen microfibers form in between adjacent layers of fascia to bind them together so that the muscles can heal. These microfibers are sort of like nature’s internal cast.
Unfortunately, they do not automatically go away after the area has healed, and they tend to accumulate over time. This means that over time, the elastic, collagen-based tissues (particularly muscles and fascia) get increasingly stiffer and less stretchy. If you are over the age of 35 or 40, you realize this all too well!
Think of the collagen found in fascia in terms of a Slinky. In normal collagen, there are waves. A slinky is no different. The coils of a slinky act like waves and give it the ability to elast and stretch in response to tensile forces. As long as the load is not too great to overcome the tissue’s tensile strength, it can spring back —- and things are peachy.
However, if the most elastic of the collagen-based tissue (fascia) is forced to bear more load than it can handle, tissue failure begins to occur. The tissue looses its ability to stretch and elast. Think of this as a slinky that has been stretched out to the point of failure. The material has not necessarily broken, but it has been stretched far enough that it is not going to “spring” back like it should. This leads to tangles, which is a whole other problem unto itself. We have all experienced a mangled Slinky before. This is just like a Fascial Adhesion!
UP CLOSE & PERSONAL
Bottom Line: If something causes fascia to exceed its normal tensile capacity, there will be a disruption or “micro-tearing” of individual collagen fibers. This in turn leads to fascial “scarring” and adhesion / restriction.
Think of fascial scarring in another way. Put both of your hands flat on a table in front of you, and slide the fingers of one hand back and forth between the fingers of the other. This is similar to the way fascia works, and is what gives all of the elastic connective tissues including fascia, ligaments, tendons, etc, an incredible amount of stretchiness and flexibility. Normally functioning fascial membranes are not only arranged in a very organized and parallel manner, but if you were to look at them on edge, they are flat and smooth —- like a piece of paper.
Once fascia is injured (stretched, pulled, torn, etc.), the microscopic fibers become disrupted and deranged. Instead of fibers running parallel to each other in an organized fashion with their normal degree of elasticity / flexibility, the fibers now run every possible direction in all three dimensions and have an extremely diminished amount of organization and elasticity. Interlock the fingers from one hand with the fingers from the other, only now do it with the fingers pointed in all directions. Now try to slide the hands back and forth. See the difference in flexibility?
Also notice that when the fingers are interlocked randomly, they will no longer lay flat on the table. Facial adhesions act the same way. When fascia is injured, individual fibers run every which direction, in all three dimensions. This means that the fascial membranes no longer lay flat like a piece of paper. Instead, they are more like a wadded up or crumpled piece of paper. Unfortunately, injured fascia frequently heals in this tangled, twisted, and wadded-up manner.
We can also think of this fascial scarring and adhesion in terms of hair. Remember our example of well-manicured hair that a comb or brush glides through easily? Now think of the exact opposite. Think of a hair tangle. What happens to hair that is not well taken care of, or was slept on wet? Instead of the individual hair follicles lying parallel to each other in a neat and orderly fashion, they become tangled with the individual hair fibers running in every conceivable direction. The result is a tangled mess —— a ball of hair that takes forever just get a comb or brush through it. “Hair balls” can be so restrictive that just trying to get a comb through it, pulls and causes great pain. This is even more true with fascia. Most people are unaware that……..
FASCIA IS THOUGHT TO BE THE SINGLE MOST PAIN-SENSITIVE TISSUE IN THE ENTIRE BODY
When the organization of the parallel collagen fibers of fascia are disrupted by injury, a host of really bad things begin to happen. The first thing that occurs is restriction of joint motion. Understand that if you have tissue restriction, you will automatically have some degree of loss of normal joint motion in the corresponding area(s) of the body. Also understand that loss of normal joint motion virtually assures you that sooner or later there will be pain —- even if you are not yet experiencing pain. Unfortunately, pain is not the worst thing that is caused by loss of normal joint motion. That would be degeneration.
Loss of, or abnormal joint motion, is the known cause of localized joint degeneration. When I speak of “LOCALIZED JOINT DEGENERATION“, I am talking about things like calcium deposits, bone spurring, and loss of articular cartilage or disc height. Degeneration is a great example of a “vicious cycle“: Loss of joint motion causes joint degeneration —– and joint degeneration causes loss of normal joint motion. Repeat. As this cycle spins around and around, it causes pain.
STOP! Think for just a moment. Pain is frequently nothing more than a by-product of the vicious cycle. This is why pain pills and other similar measures (drugs), mask symptoms of Chronic Pain (ineffectively, I might add) without ever addressing its underlying cause (and some of the most popular musculo-skeletal drugs add to the degenerative effect). In many cases of Chronic Pain, the underlying cause is subluxation, fascial restriction, and microscopic scar tissue.
Think for a moment how problematic this whole scenario is. Fascia is the single most pain-sensitive tissue in the body —— yet it does not image well with even the most advanced imaging technologies such as MRI! What does this mean? Those of you who have dealt with Chronic Pain long enough, know exactly what it means!
It means that when you go visit various doctors (orthopedists, pain specialists, neurologists, etc) they run all sorts of tests, and then look at you as though you are crazy. Or maybe they look at you like you’re a drug seeker, or trying to get Social Security Disability. Or maybe they just chalk it up to hard work and too many sports. Or maybe they just tell you that you have “arthritis” or “fibromyalgia” just to get you out of their office. Or maybe they used that old and trusted standby, “After all Mrs. Smith, you just aren’t as young as you used to be.”
Whatever the case, the result is almost always the same. A blank stare and the recommendation for more pills —- or maybe even corticosteroid injections. The latest medical “treatment” for Chronic Pain involves putting people on SSRI’s (anti-depression drugs) while trying to convince them that their Chronic Pain is the result of depression; when just the opposite has been proven to be closer to the truth. (Clinical Depression has not been shown to cause Chronic Pain, but Chronic Pain can cause Depression).
Oh, and how about your doctor kick you a few more times while you are down. Scientific studies have repeatedly shown that beyond the wide array of side-effects to the kidney, liver, and heart; both NSAIDS, and cortico-steroids actually deteriorate collagen-based tissues —– severely and rapidly. This is why doctors will ration the amount of cortisone you can have, even if it helps your pain.
The Journal of Bone and Joint Surgery published a study over a decade ago that said if a person has more than one cortico-steroid injection in the same joint, over the course of their lifetime, their chance of developing premature deterioration of the affected joint is 100%. Gulp!
EFFECTIVELY TREATING FASCIAL ADHESIONS
The question always comes up, “If fascia cannot be imaged with advanced techniques such as MRI, how in the world does a hillbilly chiropractor from the rural Ozark region of southern Missouri image it?” Plainly stated; I don’t. I examine the areas that I believe to be affected by Fascial Adhesion (10 years of experience has helped me know what to look for), and I start treating. Every year I get more proficient at knowing what to look for, finding it, and fixing it. What am I using to fix it? Glad you asked.
I use something that I call I.I.R.E.C-B.C.T. (Instrument Induced Remodeling of the Elastic, Collagen-Based Connective Tissues). In the office, I simply call it “Tissue Remodeling”.
Because our “Tissue Remodeling Treatment” consists of actually breaking the Fascial Adhesions and subsequent tissue restrictions that cause so many symptoms, there is often some bruising associated with the technique. Microscopic scarring is dense, inelastic, random, and unorganized tissue —– not what anyone really wants. If you have been paying attention, you are aware that scar tissue is not exactly an “optimum” situation. Nonetheless, scars (even the microscopic kind) are living tissue with a blood supply.
This means that when I “break” the adhesion, I also break the blood supply. There will be some internal leaking of red blood cells from the scar’s capillary bed into the surrounding tissue. Please don’t panic. In plain English, this means that you will have a bruise. When I break Fascial Adhesions, it is not uncommon that this bruising can be really really (really)ugly. Don’t worry — it really is OK. See our BRUISING & PICTURES PAGE. You can also visit our VIDEO TESTIMONIAL PAGE as well.
Fascia is the fabric that it woven throughout every part of our body to hold us together. Perpetually disregarded by the medical community as “unimportant” (hey, after all it does not show up on MRI’s), fascia is beginning to take its rightful place at the forefront of both cutting-edge medical research and cutting-edge treatment (particularly in the field of Sports Injuries). It should! Fascia is arguably the most prevalent tissue in the body.
Other than the nerve system, is there another body system that connects the distant parts of the body together in such an intimate manner? I say no! Fascia covers the body from the top of the head (Epicranial Aponeurosis) to the bottom of the feet (Plantar Fascia), and everything in between.
When there is a tightening or restriction of the fascia in one place, it can cause pain and dysfunction in distant and seemingly unrelated locations. And the kicker is that problems in the fasciae not only cause pain, they cause the nerve system to misfire (see our PROPRIOCEPTION & DEGENERATION PAGE). As you can imagine, the problems associated with a misfiring nerve system are many and potentially severe.
also be aware that what is true about fascia is true about the other Elastic, Collagen-Based Connective Tissues as well. Yes, ligaments are injured and respond to treatment in an almost identical manner as fascia. We also know from medical research that an almost identical tissue model can be applied for the treatment and healing process of tendons as well. This is good news because tendon problems are a leading reason for musculo-skeletal doctor visits —- and Chronic Pain.