WHAT'S NEW IN FASCIA RESEARCH?
On occasion I take a few minutes, head over to PubMed, comb through the latest research on any given topic, and then give you a synopsis of what's relevant as far as solving chronic conditions (pain included) is concerned. Today I'm doing that with FASCIA. Let's get right down to business and see what the experts have to say about Fascia over the course of the past few months.
- When I treat people with FACE OR SKULL PAIN, they have often been written off as "crazy". Although there are any number of reasons for this (remember, Fascia does not image with standard medical testing -- HERE), much of it has to do with the way they so often describe their problem. Invariably, they will use adjectives such as "crinkling or rustling leaves," "the sound of wadding paper into a ball," "a constant, low grade, Rice Krispies crackling, with each and every movement," or like Brenda described YESTERDAY, "eyebrows so tight on my face you couldn't pull them away." I have talked about these sounds before (HERE), but it's not so much the sounds people hear that I am interested in, as much as what's causing them. Last month's issue of Anatomical Record published a study pertaining to this topic called The Mobility of the Human Face: More than Just the Musculature, whose authors concluded, "The human face has the greatest mobility and facial display repertoire among all primates. However, the variables that account for this are not clear. Humans and other anthropoids have remarkably similar mimetic musculature. This suggests that differences among the mimetic muscles alone may not account for the increased mobility and facial display repertoire seen in humans. This study was undertaken to clarify the morphological underpinnings of the increased mobility and display repertoire of the human face by investigating the Superficial Musculo-Aponeurotic System, a connective tissue layer enclosing the mimetic musculature located between the skin and deep fascia / periosteum. This connective tissue layer may be a factor in the increased facial mobility and facial display repertoire..." For the record, the PERIOSTEUM is the membranous layer of Fascia that covers bones, while APONEUROSES are flattened tendon-like structures virtually indistinguishable from Fascia.
- A study from last September's issue of Anatomy and Cell Biology (Histological and Biochemical Study of the Superficial Abdominal Fascia and its Implication in Obesity) provides us with a primer on Fascia. "The superficial fascia is formed of collagen fibers, loosely packed and mixed with abundant elastic fibers and adipose tissue. The collagen fibers have great tensile strength. It can resist considerable tensile forces without significant increase in their length and at the same time they are pliable and can bend easily. Elastic fibers run singly, branch and anastomose [run together and connect with] with other fibers. They are usually thinner than collagen fibers. Elastic fibers stretch easily with perfect recoil. These fibers are numerous in membranes that stretch periodically. Superficial fascia covering the anterior abdominal wall has high proportions of elastic fibers. In abdominal obesity, fat cells lie between various layers of multilayered abdominal fascia." What does this mean to the average American, considering that about 70% of us are overweight or obese? Only that the more ABDOMINAL OBESITY you have, the greater the chance of stretching your Fascia past the point of no return (HERE). By the way, this study pertained to PLASTIC SURGERY, which I have numerous times seen mess people up in severe and debilitating ways.
- In a very cool study on CANCER as it relates to Fascia and bodywork, November's Cancer Research (Connecting Tissues and Issues: How Research in Fascia Biology Can Impact Integrative Oncology) dealt with similar subject matter to what DR. INGBER of Harvard has been talking about for years (not to mention DR A.T. STILL) --- the fact that health of your Fascia plays a huge role in your overall health. "Complementary and integrative treatments, such as massage, acupuncture, and yoga, are used by increasing numbers of cancer patients to manage symptoms and improve their quality of life. In addition, such treatments may have other important and currently overlooked benefits by reducing tissue stiffness and improving mobility. Recent advances in cancer biology are underscoring the importance of connective tissue in the local tumor environment. Inflammation and fibrosis are well-recognized contributors to cancer, and connective tissue stiffness is emerging as a driving factor in tumor growth. Physical-based therapies have been shown to reduce connective tissue inflammation and fibrosis and thus may have direct beneficial effects on cancer spreading and metastasis." Wow, that doesn't sound like any cancer doctors I know (HERE)! And this from a mainstream journal. If you are interested in the relationship between INFLAMMATION & FIBROSIS, just click the link.
- Last October's issue of Manual Therapy (Mechanical Deformation of Posterior Thoracolumbar Fascia After Myofascial Release in Healthy Men: A Study of Dynamic Ultrasound Imaging) showed that after receiving bodywork on their low backs, "The primary finding included a decrease in the stiffness index of the Posterior Thoracolumbar Fascia and a greater difference in deformation of the Posterior Thoracolumbar Fascia between 50% and 100% maximum voluntary contraction." How big was the difference in the "stiffness" of the THORACOLUMBAR FASCIA from pre-bodywork to post-bodywork? Almost a quarter. One more interesting fact in this study; since MRI does not do a good job of imaging Fascia (excepting maybe the PF), the authors used advanced ultrasound technology as seen in the thoracolumbar link (click for a side-by-side comparison of five second videos --- healthy Fascia -vs- damaged Fascia).
- November's issue of the Journal of Sports Sciences (Is Remote Stretching Based on Myofascial Chains as Effective as Local Exercise? A Randomised-Controlled Trial) actually talked about "myofascial chains" (ANATOMY TRAINS) in regards to stretching distant tissues to get local effects. What do I mean? "Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM)... ....both lower limb stretches and cervical spine stretches increased cervical ROM compared to the control group in all movement planes and at all measurements. Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in program design." What does this tell me? It tells me that a good stretching protocol will address the whole body --- not just the spot you hurt. Can anyone say YOGA?
- Next month's issue of Insights into Imaging carried a study (Imaging of Plantar Fascia Disorders: Findings on Plain Radiography, Ultrasound and Magnetic Resonance Imaging) that showed that the most common imaging finding for PLANTAR FASCCITIS is a "thickening," which has been referred to elsewhere in the scientific literature as "DENSIFICATION". I bring this up only because some people want to split hairs and say that densification is different from FIBROSIS or SCAR TISSUE FORMATION. Call it whatever you want, the October issue of the Journal of Bodywork and Movement Therapies (Long-Term Impact of Ankle Sprains on Postural Control and Fascial Densification) addressed this issue in a study where, "20 young, healthy subjects with a history of significant (Grades 2, 3) lateral ankle sprains and 20 controls with no history of ankle sprains were recruited to cross-sectional case-control study. The ankle sprain study group -vs- the control group exhibited significant differences... significantly high prevalence of fascial densification for the talus internal rotation, talus retromotion, talus lateral and pes external rotation. There are long term effects of an ankle sprain on postural control and on the sensitivity and movability of the fascia in the calf and foot." As a person who suffered for the better part of a decade after roaching my ankle several times playing basketball (at least two Grade III's, with two avulsion fractures), I can attest to this both personally and professionally. HERE is our ankle sprain page, as well as our page on LIGAMENT INJURIES. Thanks to Dr. Michael Miller, I also learned the importance of using a drop-table to work through and mobilize each joint in the foot / ankle, through all their different ranges of motion.
- The October issue of the Chinese Journal of Gastrointestinal Surgery carried a fascinating study called The Third Component in Surgical Anatomy and its Impacts. The first two components of surgery were described by the authors as the organs and their blood vascular supply respectively. Guess what the third component was? That's right; Fascia. "The third component is omitted by surgeons for many years. The omitted reasons are failed recognition and unknown function. Re-understanding of the third component in surgical or local anatomy will make some changes in the local anatomy, tumor pathology, oncology surgery and operations.... Many aspects will change with surgical developments, especially with the membrane anatomy, the third component." Holy Toledo! I've been saying for two decades that far too many doctors think of Fascia merely as the 'stuff' that has to be removed in order to get to the goodies --- the organs, muscles, bones, etc (HERE), not fully comprehending the magnitude of what happens when FASCIA GETS INJURED and people subsequently develop FASCIAL ADHESIONS.
- I happen to be the guy who has been talking about RIB TISSUE PAIN (not to be confused with RIB SUBLUXATION) for the better part of the past twenty years. Why is it such a big deal? Only because anything wrong with your ribs will literally make you think you are dying (I have seen untold numbers of people air-evac'd because someone confused their rib pain with a heart attack). A study in last month's issue of Cureus (The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery) helped shed some additional light on this issue. Although the study was aimed at surgeons, this ligament lies underneath the THORACOLUMBAR FASCIA, and is described as a, "constant structure of the thoracolumbar junction." The authors also said it was a potential factor in 12th Rib Syndrome. One more reason I always pay close attention to the TL spine when adjusting patients (I thank Dr. Jim Teachworth for that one).
- A study of last month's issue of the Journal of Craniofascial Surgery looked at what the study itself was named for --- the Anatomy of the Platysma Muscle. Although the PLATYSMA MUSCLE is, as it's name implies, a muscle; in many ways it actually acts more like Fascia. "The aim of this paper was to review the anatomy the platysma systematically." But unlike injured Fascia that tends to thicken or "densify," "The most common aging-related change of the platysma was shortening, followed by thinning." When you start to grasp the relationship of FHP to any number of pain syndromes, including CHRONIC NECK PAIN and HEADACHES, you start to see why a "shortened" Platysma is such a huge deal. If you'll take a moment to click the first link in this bullet, you can take a look at pics of this muscle you've probably never heard of, and see why it's incredibly important as far as people with WHIPLASH are concerned. Not as important as the SCM maybe, but important nonetheless.
- The November issue of the European Journal of Histochemistry (Hormone Receptor Expression in Human Fascial Tissue) talked about the ways that hormones affect Fascia --- especially in women. That's right folks; as I've shown you before, when it comes to almost any sort of ill health, including injuries to the Fascia, women are much more likely to take it on the chin than men --- and this study could shed some light on this part of the puzzle. Here are some of the cherry-picked findings from this study. "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 [pain receptors] could come from hormonal factors such as estrogen and relaxin [the hormone that causes pregnant women's ligaments to loosen], that are involved in extracellular matrix and collagen remodeling and thus contribute to functions of myofascial tissue. We can assume that the two sex hormone receptors analyzed are expressed in all the human fascial districts examined and in fascial fibroblasts.... 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 [pain receptors]." Although systemic inflammation is bad news, local inflammation (THIS POST explains the difference between the two) supplies the growth factors needed to stimulate FIBROBLASTIC ACTIVITY. Thus, in the same way that too much estrogen causes something called ESTROGEN DOMINANCE --- extremely common here in America --- too little estrogen can lead to problems as well. "It is well known that relaxin is a multifunctional factor which contributes to collagen tissue remodeling by inhibiting fibrosis and inflammatory activities and that a longer duration of estrogen deficiency is associated with increased fibrosis. In this respect, estrogen inhibits fibrosis, reducing TGFβ expression, connective tissue growth factor production and function, matrix metalloproteinases 2 and 9 expression and activity, the conversion of fibroblasts to myofibroblasts and the production of collagens I and III. All these factors are also important to define fascial remodeling and fascial tension. If fascial stiffness is increased, the nociceptors within the fascia could be sensitized causing the underlying muscles to be stiffer." By the way, metalloproteinase dysfunction is associated with abnormal scar formation and stretch marks (HERE).
If you have struggled with CHRONIC PAIN, the body's system of Fascia probably makes as much sense as anything you've heard. And if you like what you're hearing, feel free to show us some love on FACEBOOK, which actually helps you get this message into the hands of those you love and care most about.