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Dr. Cathy A. Kim, MD, APC

Sitting and Fascial Plasticity | Ep. 8

Sitting and Fascial Plasticity

Sitting and Fascial Plasticity | Ep. 8

In this video, learn how you can remodel your thigh fascia and promote elasticity by changing your mechanics of sitting. This is my functional medicine approach to proper sitting. Watch the video or read the transcript below to learn more.


Hi, I’m Dr. Cathy Kim, Body Function Specialist and Functional Medicine doctor.  My goal is to help you understand how our modern lifestyle is causing us inflammation and inflexibility, and what changes you can make to help heal yourself.  

In the last video, I explained the hidden role that stiff thigh fascia can play in causing back pain. Today, I want to demonstrate how you can start developing more flexibility in your fascia by altering one of your most fundamental daily movements, sitting.

Years ago, we were taught that our brains were fixed structures. Fortunately, modern research has proven that brain plasticity exists. This neuroplasticity is possible in motor, cognitive and even emotional health. Amazingly, this rewiring has no age limit. 

Two excellent books on these subjects are: The Brain’s Way of Healing, by Dr. Norman Doidge, and Mindsight, by Dr. Daniel Siegel. Both authors bring the research findings to life with great story-telling and clear writing style.

Apparently, brain plasticity has always existed, but our limited imagination held us back from learning how to nurture it.

Fortunately, we are already recognizing that fascial plasticity exists, and I have helped many patients with complex pain, and other chronic problems such as recurrent UTI, TMJ disorder, and vertigo by restoring healthy fascial function.

Elasticizing vs. Stiffening

We are all born with the ability to sit down without using a chair, watch any toddler squat on a beach or playground. Most of us lose this ability as we age, and we believe that only the very young or very flexible are capable of performing this action. But if this were true, how do entire populations in other parts of the world retain their ability to squat into advanced age?

A traditional squat requires a controlled descent because there is nothing to catch us. Our muscles and fascia must contract with strength to hold us up, while allowing increments of stretching to win out. This combination of contraction strength plus stretch helps us to develop elasticity in our tissue. 

As we lower, the heels stay flat, while the blue, black, and green muscle groups contract and stretch at the same time.  Even the pink back muscles become recruited for this elasticity challenge.  

Let’s contrast this with the mechanics of chair sitting.

Most of us begin to sit by first shifting our weight forward and then bending our knees so that our thigh muscles only have to stabilize us for the short descent to the chair.

Those with a swayback or lordosis contract their pink back muscles into an arch as they descend, while the green muscle group stretches mildly. In contrast to squatting, the pink back muscles never undergo elastic forces.  

Others, usually with a flat lower back, rotate their pelvis even more posteriorly as they lower, shortening the leg muscles and deep hip flexors while stretching the pink back muscle group. These biomechanics are challenging to imitate. 

If we perform more stabilizing than strength-stretch movements, then overall stiffening results and people will start to brace themselves with their hands to decrease pain.

Dominant Movement Patterns Determines Fascia Patterns 

Our movement and fascia have a “chicken or the egg” relationship. As our fascia adapts to our movement patterns, it acts as a placeholder, providing the shortened, stiffened platform that most efficiently serves the work of the muscles. By the time we have tight, shortened muscles and dense, inflexible fascia, the cycle of one reinforcing the other is well established. This is why I advocate for adding mindful movement to myofascial release work, otherwise, the same tension patterns return.

Let’s look at the mechanics of how most of us would squat. Unsurprisingly, we resort to chair-sitting mechanics, moving the knees and shifting our weight. For most people, the heels rise during the descent, and the final forms of the two squats look very different. 

What changes when we shift our weight forward? Pushing down on our heels activates all of our thigh muscles, as we can see in the blue muscle group. Similarly, the green muscle groups flex fully, enough to cause noticeable vertical movement. Using our heels promotes a robust muscle contraction which in turn helps to stretch the overlying fascia.

In contrast, when we push down on our toes, the leg muscle contraction is barely visible.

As we have switched to exclusive chair sitting, modern society seems to have lost a crucial opportunity to maintain elasticity in our powerful and influential thigh fascia.  

Fortunately, we can help our fascia remodel.

Three Rules of Movement

By incorporating Three Rules of Movement into our day-to-day mechanics, we can help revive its flexibility and make the most of our myofascial therapies.

Rule number 1: Use your heels to recruit more muscles!

Rule number 2:  Keep your knees back to increase your flexibility.

Rule number 3:  Hold your pee!  Kegel as you move to help out your back.

When you adopt the Three Rules, you will notice that your typical “bad areas” are not the same when you go for your myofascial massage or do your foam rolling. Your new movement patterns are modifying your fascia.  

These Movement Rules are definitely not a new concept. Yoga has had this figured out for centuries. For those of you who practice yoga, you may recognize this as Yoga Chair.

Yoga’s chair pose creates strength-stretch forces on the thigh, pelvis and the back when performed with accurate intention: weight in the heels, straight back, and knees held back in line with the ankles.

But yoga chair is often performed by leaning into joints to decrease muscle work: the back arches to lean into the discs and the thighs lean into the knee joints.  

Even though it is not as deep, the aligned pose is much more strenuous, because it requires strength-stretch forces to hold the joints in alignment.

Holding our joints at 90 or 180 degrees is an important concept for preserving myofascial elasticity, as we will see in my next video on the mechanics of standing.

As modern society reduces the diversity of daily movements to just walking and sitting, how we move becomes even more important. Imagine all of the strength-stretch opportunities we have every day, to sit at work, at meals, in the car, in the bathroom, even to get dressed!  When you incorporate these Rules of Movement into your muscle memory, you will develop deep core strength and flexibility that no hectic work schedule or long vacation can derail.  

I hope this video gives you some new perspective on how our fascia, muscles, and movement influence each other, especially in our legs. Please leave any questions or suggestions for future topics in the comments section. Thank you for watching.  

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Dr. Cathy Kim

Dr. Cathy Kim is a Board-Certified Family Medicine physician and Body Function Specialist. She practices in Camarillo, CA and specializes in complex cases.

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