FASCIA AS AN ENDOCRINE ORGAN
"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. 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. Connective tissue may be a key missing link needed to improve cross-system integration in both biomedical science and medicine." Connective Tissue: A Body-Wide Signaling Network? Medical Hypotheses, June 2006
The endocrine system consists of hormones, the parts of your brain that originate the signals to create said hormones (most frequently the HYPOTHALAMUS and / or PITUITARY), as well as the actual glands where they are manufactured. Fascia and other connective tissues (BONE, LIGAMENTS, TENDONS, and even though it's not a connective tissue, MUSCLE) are far more than simple structural entities. Furthermore, when it comes to scarred or fibrotic Fascia (there are MANY WAYS that fibrosis or scarring can occur); I've shown you that it is different than normal tissue in almost every conceivable way (HERE).
Think about why this is a big deal for a moment. Given that fascia is the most abundant connective tissue in the body, ask yourself how fascia could be the suspected cause of all disease and pain (HERE) if it were not intimately related to the endocrine system? Speaking of the endocrine system, let's talk for just a moment about the neuroendocrine system. If we cruise over to PubMed and search the term "neuroendocrine," we come up with over 140,000 studies --- not a misprint. But we shouldn't be surprised once we begin to grasp the intimate relationship between neurology and endocrinology. The best example of this is to look at the HPA-Axis.
With the HPA-AXIS, the Hypothalamus (brain) sends out hormones that act on the Pituitary Gland (brain), which in turn releases hormones that travel all over the body to effector sites. In other words, you can't really understand neurology and brain function without understanding endocrinology, and you can really understand endocrinology without having a handle on neurology --- they are intertwined to the point they cannot be separated. And while this is nothing new, neither is the fact that these hormones have effects on connective tissues such as ligaments, tendons, and fascia.
For instance, an article from a 1921 issue of the Journal of the American Medical Association was talking about treating cancer by radiating it with x-ray and exposing the body to toxic chemicals that could stunt it or even kill it, went on to talk about a scientist who, "demonstrated the special relationship between the thymus and connective tissues. He even included connective tissues in the endocrine system. Its close connections to this system is apparent in its dependence on the different phases of development of the thyroid....." Rather vague, but I find it amazing that a century ago there was an ongoing discussion concerning this relationship. Fast forward into the 21st century and what do we see? Some pretty amazing stuff.
Bruno Chikly is a French psychologist and licensed massage therapist. He also happens to be an MD as well as a DO (osteopath). For quite some time he has been one of the foremost experts on the lymphatic system and lymphedema (related to, but not the same as a problem affecting one in ten adult American women, LIPIDEMA), authoring the book that's widely considered to be the definitive text on the subject (Silent Waves: Theory and Practice of Lymph Drainage Therapy: With Applications for Lymphedema, Chronic Pain, and Inflammation). Last year, his team of three researchers published a well-bibbed study (76 sources) in the Journal of the American Osteopathic Association called Primo Vascular System: A Unique Biological System Shifting a Medical Paradigm. Here is the abstract....
"The primo vascular system has a specific anatomical and immunohistochemical signature that sets it apart from the arteriovenous and lymphatic systems. With immune and endocrine functions, the primo vascular system has been found to play a large role in biological processes, including tissue regeneration, inflammation, and cancer metastases. Although scientifically confirmed in 2002, the original discovery was made in the early 1960s by Bong-Han Kim, a North Korean scientist. It would take nearly 40 years after that discovery for scientists to revisit Kim’s research to confirm the early findings. The presence of primo vessels in and around blood and lymph vessels, nerves, viscera, and fascia, as well as in the brain and spinal cord, reveals a common link that could potentially open novel possibilities of integration with cranial, lymphatic, visceral, and fascial approaches in manual medicine."
Why is this important to know? A couple reasons. Firstly, how often are scientists / anatomists able to find a new body system today? Amazing! It's kind of like exploring. In the days of Christopher Columbus, Ferdinand Magellan, and Lewis & Clark, everything was being "discovered" because it was all new and unexplored. Discoveries of this magnitude do not occur today because everything was discovered long ago. The same thing is true in anatomy.
Secondly, it provides yet another potential endocrine avenue. Follow along. "Endocrine Functions: Neurotransmitter Pathway. The PVS has also been described as an endocrine organ that transports hormones. Catecholamines (eg, adrenalin, noradrenalin) have been identified in the primo fluid in vessels on the organ surfaces.... Primo vessels are ubiquitous channels for transporting fluid with immune and endocrine functions. The PVS could reasonably link tissue functions across systems. If the anatomy and pathophysiology of the PVS, in particular their roles in inflammation, endocrinology, and oncology, are confirmed, our understanding of human body systems and of medicine in general will shift." Although some might say this is wishful thinking (or at least a great leap), it seems to me that the evidence from study after study continues to mount, pointing to the fact that even though we might not completely understand what's going on when it comes to bodywork or CHIROPRACTIC, there is often a much bigger effect than we could have ever imagined (HERE or HERE) --- or comprehend.
Thus, when we see a tissue like fascia that has obvious NEUROLOGICAL, PROPRIOCEPTIVE, and lymphatic properties, it certainly begins to make more sense that there are increasing numbers of brilliant physicians and researchers who either believe fascia is the chief factor in all sickness, pain, and disease (HERE), or at the very least, is a significant contributing factor. Enter DR. HELENE LANGEVIN whom I talked a bit about just the other day (see link).
Dr. Langevin, an endocrinologist / neurologist at Harvard and the University of Vermont, is the person who discovered that in 80% of the cases, acupuncture points correspond to fascial planes --- a fact later verified by the STECCOS (Italian MD's) and Tom Meyers with his ANATOMY TRAINS AS MYOFASCIAL MERIDIANS studies. What this means in English is that there is evidence pointing to the fact that fascia has the ability to act not only as a separate neurological system, but quite possibly as a separate endocrine system as well.
Back in 2003, Dr. Robert Schleip was already talking about this a study that was published in the Journal of Bodywork and Movement Therapies (Fascial Plasticity–A New Neurobiological Explanation). Dr. 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 then 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." Interesting, considering what we know about the hypertonic quality of TRIGGER POINTS, as well as how DRY NEEDLING has been shown to unwind these tissues. But the effect is even deeper than that.
A group of a dozen Chinese physicians and researchers published a similar study in a 2010 issue of the Journal of Acupuncture and Meridian Studies called Possible Applications for Fascial Anatomy and Fasciaology in Traditional Chinese Medicine in which they stated, "Research using medical imaging instruments such as computed tomography and magnetic resonance imaging has led to the proposal that the fascial network distributed over the human body is the anatomical basis for the acupoints and meridians of traditional Chinese medicine. Stimulated stem cells in the supporting-storing system differentiate to functional cells in the functional system, and therefore, provide a cell supplement for this system. This may be one of the mechanisms for traditional Chinese medicine therapy. The result is a mobilization of the body's reserves of stem cells and a regulation of the endocrine system." So, even though this does not show direct endocrine system control, it does show that fascia is helping to regulate that system.
One of the single coolest studies on this topic was published in a 2014 issue of the same journal as above called Neurobiological Mechanisms of Acupuncture for Some Common Illnesses. Tons of great stuff here, but under the section on "Neuroendocrine Effect," the authors concluded that, "One of the better studied clinical applications of acupuncture involving neuroendocrine effect is the polycystic ovary syndrome (PCOS), a disease of reproductive-age women associated with anovulation and infertility. The endocrine characteristic of PCOS is a hypothalamic pituitary dysfunction associated with elevated levels of the luteinizing hormone (LH) and androgen. It has also been hypothesized that PCOS is associated with increased sympathetic activity and increased beta-endorphin production. Electroacupuncture decreases the sympathetic tone and decreases the release of LH by the pituitary gland. In addition, stimulation at same spinal segments as ovaries decreases sympathetic activity at the ovaries and release of androgen." This, folks, provides at least part of the NEUROLOGICAL BASIS for the CRAZY MIRACLES seen in so many "alternative" clinics. To better understand the link between PCOS and SYMPATHETIC DOMINANCE, just click the links. Let me give you a few other examples of similar phenomenon.
- A lecture put on by Drs. Devine and Fossum on something known as "Chapman's Reflexes" helped shed further light on this topic. In the early 1900's, Dr. Frank Chapman discovered a number of diagnostic points that he described as, "Nerve Ganglion-Formed Contractions within the fascia as localized neurolymphatic congested points, secondary to visceral dysfunction, usually deep to the skin and subcutaneous tissue, most often in deep fascia." Various studies have not only shown this to be essentially accurate, but these authors make the point with peer review that the fouling of this system is not only related to virtually every sort of disease process one could imagine (can anyone say ANDREW TAYLOR STILL?), but that it is also related to CENTRAL SENSITIZATION (Chronic "learned" Pain). This is a super cool paper that helps pull a lot of things together from the acupuncture, osteopathic, and chiropractic fields, as well as MYOFASCIAL TRIGGER POINTS. As for the endocrine aspect, the authors talk about it a great deal, essentially linking SYMPATHETIC HYPERTONICITY with organ and endocrine dysfunction.
- Earlier this decade a type of cell was discovered in numerous organs and tissues called a telocyte. A group of five Polish physicians / researchers published a study (Electron Microscopy of Human Fascia Lata: Focus on Telocytes) in the October 2015 issue of the Journal of Cellular and Moleculer Medicine in which they concluded, "From the histological point of view, fascia lata is a dense connective tissue. Although extracellular matrix is certainly the most predominant fascia’s feature, there are also several cell populations encountered within this structure. Aside from telocytes, we have found fibroblasts, mast cells and cells with features of myofibroblastic differentiation. This is the first time it has been shown that telocytes exist in human fascia. One can speculate that fascia lata telocytes likewise telocytes in other organs may be involved in regeneration, homeostasis and intracellular signalling." Just remember that when the discussion turns to intracellular signalling, we are typically talking about either INFLAMMATORY MEDIATORS or hormones of some sort.
- Just last year, writing for the European Journal of Histochemistry (Hormone Receptor Expression in Human Fascial Tissue) a group of seven Italian researchers concluded that (completely cherry-picked as are most quotes I use due to restraints on time and space), "It is well known that sex hormones affect the connective tissues, above all the ligaments. Many epidemiologic, clinical, and experimental findings point to sex differences in myofascial pain in view of the fact that adult women tend to have more myofascial problems with respect to men. It is possible that one of the stimuli to sensitization of fascial nociceptors could come from hormonal factors such as estrogen and relaxin, that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue. Our results are the first demonstrating that the fibroblasts located within different districts of the muscular fasciae express sex hormone receptors and can help to explain the link between hormonal factors and myofascial pain. It is known, in fact, that estrogen and relaxin play a key role in extracellular matrix remodeling by inhibiting fibrosis and inflammatory activities, both important factors affecting fascial stiffness and sensitization of fascial nociceptors." While this is not fascia creating hormones, it is becoming clear that an increasing number of hormones affects said fascia. And for those of you who are not sure what FIBROSIS is, I left you the link.
- Board certified orthopedist and the chiropractic professions foremost expert on connective tissues, Warren Hammer, was discussing a study from back in 1999 when he wrote in a 2012 issue of Dynamic Chiropractic (Can the Body Use Fascia as a Method of Communication?), "In addition to the soluble factors such as hormones, cytokines or growth factors, cells also receive signals from the surrounding extracellular matrix (ECM) macromolecules. 'The activity of connective tissue cells is modulated by a number of factors present in their environment (soft-tissue methods?). Moreover, they may degrade the ECM proteins and liberate peptides, which may by themselves constitute new signals for the surrounding cells. Therefore, an actual regulation loop exists in connective tissue, constituted by peptides generated by ECM degradation and connective tissue cells.'" In case you need more info on the ECM, follow the link. We know there is signalling taking place, we are not yet 100% sure of the mechanisms
"Fibroblasts elicit excessive production of IL-6 [an inflammatory marker], 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 fibromyalgia. One initiator of the increased pro-inflammatory cytokine levels in fibromyalgia 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 nerve endings... only excitable under inflammatory conditions. These transmit noxious 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. Central sensitizaton in fibromyalgia patients may occur spontaneously or as a result of active trigger points. Additionally, astrocytes and microglia cells within the fascia can be sensitized by the chronic inflammatory state and produce the exaggerated pain response characteristic of fibromyalgia. The increase in IL-6 and resultant fascial inflammation directly affects the regulation of the stress-induced HPA-axis." Jennifer Mayline Jing from her 2013 Master's Dissertation at Ohio State University (Fibromyalgia as an Inflammatory Disease: A Look into the Increased Prevalence in Women)
"Fascial mechanoreceptors are not only intricately interwoven with the autonomic nervous system, but they are also vital to communication within the endocrine system. For example, many of the sensory neurons of the enteric brain are mechanoreceptors, which, if activated, trigger, among other responses, important neuroendocrine changes. These include a change in the production of serotonin --- an important cortical neurotransmitter --- as well as other neuropeptides, such as the substance hista- mine, which increases inflammatory processes. Obviously, fascia are not the passive players we often envision them to be." Dr. Robert Schleip from his 2003 paper, Fascia as a Sensory Organ
Bottom line part one; we can debate the merits (or lack thereof as naysayers like to argue) of referring to fascia as a true endocrine organ. What we cannot do, however, is deny that this connective tissue --- the most abundant in the body --- acts as a signaling system neurologically, chemically, and even hormonally. Both facets of the neuroendocrine system are based on communication within the body; neuro being electrochemical, while endocrine is mostly chemical. Bottom line part two, by reading between the lines, we can see in these quotes above that not only is it important for you to deal with your adhesed or restricted fascia or connective tissues, it is absolutely critical for you to deal with your SYSTEMIC INFLAMMATION as well. As Jing essentially showed us, the result of not doing so promotes a tendency to fire up your GLIAL CELLS, driving you toward CHRONIC PAIN in the form of something called CENTRAL SENSITIZATION.
For a generic template on what it takes to deal with systemic inflammation, it's your lucky day as I have provided it to you free of charge. While many of you reading this might require extensive bodywork or a "FUNCTIONAL MEDICINE" approach, THIS SIMPLE PROTOCOL will at least get most of you thinking and heading in the right direction.
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