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Dr. Cathy A. Kim, MD, APC

What is Fascia?

Fascia - Dr. Cathy A. Kim, MD, APC

What is Fascia?

For centuries, this answer was straightforward.  Fascia was only seen as ribbons and sheets of “soft” tissue that connected and encased the “important” body structures:  muscles, bones, organs, as well as nerves and vessels.

Since the millennium, understanding of fascia has shifted from viewing it as external and extraneous, to recognizing it as crucial to the functioning of our body as an integrated whole. 

Since the International Fascia Research Congress (FRC) first convened in 2007, committees of professional organizations of manual therapists, anatomists, chiropractors, osteopaths, and other researchers have begun meeting to define fascia.  While they readily agree that fascia is a continuum of collagenous tissue that functions together as a system, this inherent diversity complicates their quest for consensus about its physical and functional boundaries.  

Fascia 2.0:  Updating Fascia’s Profile:  

1) Fascia can Remodel . . . in reverse. 

Stiffness, height loss, and degenerative joint disease have all been accepted as inevitable aspects of aging – fascia remodeling, but in a “declining” direction.

But with regular fascial “stretching” and modalities such as myofascial massage, our fascia possesses the plasticity to reverse its course and revive its elasticity and glide between its layers.

2) Fascia may include bone. 

The debate among the experts depends somewhat on the relative importance of “soft” vs. “continuum” in fascia’s technical definition. 

If “soft” is prioritized, then bone is clearly excluded as fascia, but, if “continuum” is emphasized, then bone could be included.  When the collagenous fibers of fascia attach to and penetrate into our  bones, at what point is the hard bone completely separate from these infiltrating fibers? 

Thomas Myers, bodyworker, researcher, and author of Anatomy Trains, recently demonstrated in one of his seminars what happened after human skeletal bones were soaked in acid to dissolve the rigid bone – what remained looked exactly like the original bones, but could be twisted and bent like a rubber toy!  If bone is part of our fascia, then promoting myofascial health earlier in life could have significant benefits for osteoporosis and hip fractures. 

3) Fascia includes Fluid.

In 2018, new technology allowed researchers to analyze living tissues and they accidentally discovered that fluid circulated between layers of fascial tissue, which distended and collapsed in response to fluid shifts.  This liquid system had also previously been described by French hand surgeon, Dr. Guimberteau, and Anatomy Trains author, Thomas Myers.

“Biotensegrity” models of the fascia system are usually made of elastic bands to reflect the linear tensional forces; but because these models don’t capture fascia’s ability to detect pressures within and between its layers, the term fascintegrity has been proposed.   

One implication of fluid fascia is in the formation of myofascial adhesion or trigger points.  When we move, myofascial tissue is shortening and elongating lengthwise, but fluids in the layers are also shifting as they are milked out of one area and drawn into another.  With too much sitting (or standing) and inflammatory diet, layers can start to stick together and may require massage of the fascia or other bodywork to mobilize.  

4) Fascia influences our Immune system.  

As cells circulate, their membranes flex as they move through the blood and lymph vessels, otherwise, they would get stuck and create blockages in narrowed or compressed areas.

Research has found that macrophages, a type of  immune cell, release inflammatory mediators when their membranes are deformed beyond a certain threshold.  

Autoimmune disease, cancer, and dementia are all linked to chronic metabolic inflammation and more people are learning about anti-inflammatory diets and supplements to mitigate and avoid these problems.  

Relating tight fascial tissue to immune system dysfunction may spark new research into the role that inflammation of fascia may play in these diseases, and even Long COVID. 

5) Fascia may influence our emotional state.   

Fascia is rich with sensory receptors for: proprioception (detecting where our bodies are in space), nociception (detecting pain) and interoception (awareness of body functioning).  

Research has found that fascia sends signals to areas of the brain involved in regulating emotions, such as the insular cortex.  This suggests that promoting healthy fascia and preventing its dysfunction may help maintain our mental health.  

6) Fascial function is quite complex.  

The entity of fascia may require quantum mechanics to explain the simultaneous interplay of physical tension, fluid pressures, vibrational waves, quantum particles, and electromagnetic fields in its system.  Grasping fascia’s quantum biology may help advance our understanding about how movement may be inseparable from our emotions and even consciousness.   

Understanding Fascia’s Influence 

As fascia’s status elevates toward becoming acknowledged as an organ, incorporating new knowledge about its role in our physiology will likely disrupt very established theories on many diseases, as well as offer new insights for the unsolved ones.  

Patients with Joint Hypermobility Syndromes (JHS) have been challenging rheumatologists for decades.  Dr. Rodney Grahame, a now-retired pediatric rheumatologist, published an opinion letter in 2008, asking his colleagues, “Why is hypermobility largely ignored by the rheumatology community at large, and, if it figures at all at major rheumatology meeting, why is it a fringe activity?” (2008, Nature, Hypermobility:  an important but often neglected area within rheumatology).   

JHS patients suffer with a lifelong evolving spectrum of medical problems including apraxia (poor proprioception), chronic musculoskeletal pain and premature stiffness, TMJ dysfunction, pelvic organ and floor dysfunction, gastrointestinal disorders, dysautonomia, and impaired immune function (e.g., autoimmune disease, MCAS).  

Thomas Kuhn, the author of The Structure of Scientific Revolutions wrote that a new paradigm provides “a new way of giving order to data now all assembled.”   With an enlightened view of fascia’s multi-dimensionality, it is possible to relate the suboptimal biomechanics of hypermobile patients to their dysfunctional fascia and ultimately dysfunctional physiology.  In today’s world of subdivided medical specialities and research, it’s easy to understand the barriers to treating the JHS population adequately. 

In my specialty practice, I help patients utilize anti-inflammatory lifestyle and healthy biomechanics to improve many chronic conditions that (unexpectedly) appear to be rooted in stiff fascia, including TMJ dysfunction, vertigo, urinary symptoms, dysmenorrhea, and pelvic pain.

As fascia research expands the paradigm of medical thinking, perhaps one day, movement therapy and fascial massage will be promoted and prescribed as validated mainstream anti-inflammatory therapies and the term “asymptomatic joint hypermobility” will be obsolete. 

~~~

References:

  1. Journal:  Benias P, Wells R, Sackey-Aboagye B, Klavan H, Reidy J, Buonocore D, et al.  Structure and Distribution of an Unrecognized Interstitium in Human Tissues.  Scientific Reports, 8:4947, 2018.
  2. Journal:  B Bordoni, JA Varacallo, B Morabito, and M Simonelli.  Biotensegrity or Fascintegrity?  Cureus, 11(6):e4819,  2019. 
  3. Journal:  B Bordoni and E. Zanier.  Clinical and Symptomatological Reflections:  The Fascial System.  J. Mulitidiscip Healthc, 7:401-411, 2014.  
  4. Journal:  B Bordoni and S. Simonelli.  The Awareness of the Fascial System.  Cureus, 10(10):e3397, 2018.
  5. Journal:  B Bordoni et al.  Emission of Biophotons and Adjustable Sounds by the Fascial System:  Review and Reflections for Manual Therapy.  J Evid Based Integr Med, 23:2515690X17750750, 2018.
  6. Journal:  B Bordoni and F Marelli.  Emotions in Motion:  Myofascial Interoception. Complement Med Res, 24:110-113, 2017.
  7. Journal:  B Bordoni et al.  Fascial Nomenclature:  Update 2022.  Cureus, June; 14(6): e25904, 2022.
  8. Journal:  B Bordoni, D Lintonbon, and B Morabito.  Meaning of the Solid and Liquid Fascia to Reconsider the Model of Biotensegrity. Cureus, Jul; 10(7): e2922, 2018.   
  9. Journal:  B Bordoni.   The Shape and Function of Solid Fascias Depend on the Presence of Liquid Fascias. Cureus, Feb; 12(2): e6939, 2020.
  10. Journal:  M Castori et al.  Towards a Re-Thinking of the Clinical Significance of Generalized Hypermobility, Joint Hypermobility Syndrome, and Ehlers-Danlos Syndrome,  hypermobility-type.  Am J Med Genet A, Mar, 164A ​​Mar;164A(3):588-90, 2014.  
  11. Journal.  R. Grahame.  Hypermobility:  an Important but often Neglected Area within Rheumatology.  Nat Clin Pract Rheumatol, Oct;4(10):522-4, 2008.
  12. Journal: JC Guimberteau et al. The Microvacuolar System: How Connective Tissue Sliding Works. J Hand Surg Eur, 35E: 8: 614-622, 2010.
  13. Book:  TS Kuhn. The Structure of Scientific Revolutions: Progress Through Revolutions. University of Chicago Press, Chicago, 1962.
  14. Book:  T. Myers.  Anatomy Trains, 3rd Edition.  Elsevier Ltd, 2014.
  15. Journal:  Pratt RL. Hyaluronan and the Fascial Frontier. Int J Mol Sci, 22(13):6845, 2021.  
  16. Journal:  R Schleip, S Adstrum, and G Hedley.  Letter to the Editor:  Regarding:  Update on Fascial Nomenclature – an additional proposal by John Sharkey Msc, Clinical Anatomist.  Journal of Bodywork & Movement Therapies, 23 (2019) 9-10.
  17. Journal:  J Sharkey. Letter to the Editor:  Regarding:  Update on fascial nomenclature – an additional proposal by John Sharkey Msc, Clinical Anatomist. Journal of Bodywork & Movement Therapies, 23 (2019) 6-8.  
  18. Book: C Stecco. Functional Atlas of the Human Fascial System. Elsevier, United Kingdom, 2015. 
  19. Journal: CW Yoon, Y. Pan, and Y. Wang. The Application of Mechanobiotechnology for Immuno-engineering and Cancer Immunotherapy. Front Cell Dev Biol, 10: 1064484, 2022.
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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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