IMPLICATIONS OF FASCIA'S ABILITY TO CONTRACT
Although it's not a totally new concept (I've spoken of it on several occasions --- HERE, HERE, and HERE), a brand new study shed even more light on fascia's ability to act as a contractile tissue. DR. ROBERT SCHLEIP led a team of 10 researchers from Europe and Australia that published a study on this topic (Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation) in this month's issue of Frontiers in Physiology.
Despite the recent work on this subject (not to mention the fact that physiologists are well aware of its ability to transmit mechanical forces), FASCIA is still largely believed to be "inert" --- a tissue of biomechanical importance, but "only serving a passive role". Take a look at this, however. For the better part of three decades, studies --- numerous studies --- have shown that certain types of connective tissues can, in similar fashion to muscles (but on a much smaller scale) contract.....
"In contrast to this common assumption there have been sporadic indications of a more active role of fascia due to an inherent ability to actively contract. These indications include the reported phenomenon of 'ligament contraction' of human lumbar fascia in response to repeated isometric strain application in vitro (Yahia et al., 1993), the documented presence of interspersed cells with smooth muscle-like appearance in the human fascia cruris (Staubesand and Li, 1996; Staubesand et al., 1997; Bhattacharya et al., 2010), and the clinical experience of seemingly animated fascial tonus changes in response to fascia manipulation treatments frequently reported by manual therapists (Minasny, 2009) and acupuncturists (Langevin et al., 2001)."
While these authors spoke of the tissue shortening and constricture that occurs in FIBROTIC PROCESSES and microscopic "SCAR TISSUE," the sort of contractile ability (contractility) we are going to discuss today is not only that which is functionally pathological, but that which is considered normal. While we will certainly deal with the former, please realize that depending on context, fascial 'contraction' is a normal part of the physiological process of FASCIA BIOMECHANICS. How did these scientists prove this once and for all?
The researchers took tissue slides of fascia from human cadavers that had no known pathologies, from the right FASCIA LATA, PLANTAR FASCIA, and the THORACOLUMBAR FASCIA lateral to L3 for comparisons. The thoracolumbar fascia was then dissected out of 40 rats and hooked up to sensitive force-measuring devices in baths of a type of Ringer's solution to see what would happen (contraction or not) when exposed to certain chemical stimulus added to the bath.
"Our immunohistochemical plus mechanographic findings and related force calculations suggest... active cellular contractility of fascial tissues may be able to impact musculoskeletal dynamics. Our findings suggest that, due to the contractile behavior of inherent myofibroblasts, human lumbar fascia may be able to change its stiffness in a time frame of minutes to hours and thereby possibly affect motoneuronal coordination."
That was a mouthful, but allow me to break it down for you. It's known that MYOFIBROBLASTS (a special kind of FIBROBLAST --- cells that create both COLLAGEN and the EXTRACELLULAR MATRIX) have contractile properties. These authors discovered that when the thoracolumbar fascia is exposed to certain types of inflammatory mediators (although there were many, TGF-BETA was the most important of these, while caffeine was the most well known), it "contracts". Where are myofibroblasts found in the greatest numbers? Not surprisingly, the thoracolumbar fascia (see earlier link). This is one more reason that the "disc" model of low back pain, while certainly not going away entirely, is slowly but surely being relegated to second fiddle (HERE). Some of the features of thoracolumbar-induced low back pain include....
Listen to the author's final conclusions....
"Our findings question the common clear distinction between active tissues and passive tissues in musculoskeletal dynamics. While the contraction forces observed in our study do not support a significant contribution of active fascial contractility in time frames of seconds (as are frequently considered, e.g., for locomotor dynamics), they suggest that active changes of fascial stiffness might play contributory roles to the motoneuronal coordination aspect of low back stability and other musculoskeletal parameters when viewed in a time-window of several minutes and longer. As some chronic disorders develop asymptomatically over a large time frame and are characterized by increased tissue stiffness, the potential contribution of fascial MFB activity merits further investigation."
This last sentence is critical to grasp --- that chronic disorders can, and frequently do, develop slowly and asymptomatically over time. Until they are no longer asymptomatic. This is part of what leads people into the world of CHRONIC PAIN and even CENTRAL SENSITIZATION. It's also why taking care of your body biomechanically and living an anti-inflammatory lifestyle are of such importance.
Fortunately for you, I have provided a NICE LIST of things you can be doing to help accomplish this --- or at least start the process. How else do you really expect to get better? WITH DRUGS? And as always, if you appreciate what we're doing here, be sure and spread the wealth by sharing this with the people you love and value most (just like, share, or follow on FACEBOOK!).
CHRONIC, NON-SPECIFIC BACK PAIN...
When looking at a lateral view of the spine, the first thing we notice is the curves. The (normal) forward curve in the neck and low back is known as "lordosis" or "lordotic," while the mid-back curve runs the opposite way and is known as "kyphotic" or "kyphosis". What do these curves do? For starters they allow normal movement, both segmentally and sectionally (HERE). Proper curves also create a spring-like function that allows the spine to act as a sort of shock absorber; particularly important if you work on CONCRETE or other hard surfaces.
Without proper curves your spine would take a pounding of epic proportions. The curves work to distribute weight and force as well as transferring muscle energy to where it's needed. As you might imagine from looking at the picture; when spinal mechanics are off, the end result is that there is abnormal distribution of forces to spinal discs --- or maybe more accurately, to parts of the disc where said force should not be. Allow me to give you an example.
While discs will often herniate some degree laterally, they virtually always herniate backwards (posterior), meaning that herniated discs --- mostly from the low back or neck --- have the potential to be pushed or squeezed into the spinal cord or spinal nerve roots that come from the cord. What does this have to do with maintaining normal lordotic curves?
These normal curves put an axial pressure on the backs of the discs (as opposed to the fronts of the discs). As you can see from the picture above, this squeezes down on the posterior aspect of the disc, while opening up the anterior or front of the disc and pushing it forward. This natural "wedging" of these discs makes it extremely difficult for the disc's jelly center (the nucleus pulposis) to herniate (because without a horrific trauma the disc will not herniate forward), and explains why you will sometimes see this spinal position referred to as "closed-packed". However......
Imagine what would happen to the low back or neck if there were either no curves, or even worse, a REVERSE CURVE. Now, instead of the discs having the "open" portion of their wedge to the front, the open part of the disc faces the back. This is what happens to your lumbar spine if you bend forward and touch your toes. No big deal. That is, no big deal until you start loading the spine. Imagine, however, bending forward and lifting something, while not consciously maintaining the normal curve in your back.
Not only are you opening the disc in the back, but the heavier the object you are lifting (or the more overweight you are), the more pressure you are exerting on the front of the spinal column and discs, as opposed to them carrying this force on the posterior parts of the spinal column (the facet joints). This pressure literally squeezes the disc backwards like squeezing a tube of toothpaste. When there is too much force, or more likely, too many years of poor lifting mechanics, the ligamentous fibers of the disc (the annulus fibroses) that hold the jelly-like nucleus in place begin to separate and tear. The result is that you are now in a position where disc herniations are not only possible, but increasingly probable (HERE is a basic video of what this looks like).
Let's add one more variable to this situation. Let's do some situps. After all, everyone knows that situps are good for your back because strong abdominal muscles promote strong discs ---don't they? Enter Stuart McGill. Decades ago, McGill was the lone voice in the wilderness, warning that situps were not only not good for your back, but were arguably one of the single worst things you could do to your spine. His research has shown why situps are one of the best ways to cause spinal problems, including herniated discs (HERE).
In a recent interview with Dr. William Morgan (A Conversation with the Preeminent Lumbar Spine Researcher: Stuart McGill, PhD); after discussing overuse of spinal imaging, McGill made this statement concerning what's arguably the single most common spinal finding on radiologist's reports DJD or DDD (degenerative joint disease . degenerative disc disease). "When they [radiologists] use the term degenerative disc disease, I put that in the same category as nonspecific back pain. It's a garbage term." Interesting because that is essentially what I said in THIS 2012 POST.
In the PORTION OF THE VIDEO INTERVIEW titled Mechanics of Injury For Lumbar Disk Herniations and Extrusions, those of you suffering low back pain will find some interesting tidbits as far as what put you there, as well as pointing you in the right direction to a solution. The biggest disappointment concerning this video was that two of the chief drivers of chronic back and neck pain were not really addressed; the first being SYSTEMIC INFLAMMATION, the other being micoscopic fibrosis or adhesion of the FASCIA, or more specifically, the thoracolumbar fascia (HERE, HERE, HERE, HERE, HERE, HERE, HERE, HERE, or HERE) --- a factor that increasing numbers of experts are saying is responsible for the majority (as much as 70%) of chronic back pain. I would argue that if you add these two modes of thinking to the knowledge and protocols created by McGill, your results will be better yet. Allow me to explain.
What do we know about back pain?
- We know that back pain is the world's number one leading cause of disability (HERE).
- We know that back pain and disc herniations are both considered "inflammatory" (HERE or HERE).
- We know that back pain is associated with increased potential of developing chronic neurological disorders and diseases (HERE).
- We know that in our sit-too-much society, both LOWER CROSSED SYNDROME and UPPER CROSSED SYNDROME are epidemics that are dramatically increasing in both numbers and severity.
- We know that there is an intimate relationship between chronic pain, chronic illness, adhesed fascia, inflammation, and fibrosis / scar tissue (HERE, HERE, HERE or HERE).
- We know that SCIATICA is often caused by VERY SPECIFIC FASCIAL ADHESIONS as opposed to disc herniations.
- We know that adjustments are helpful for many cases of spine-related pain (HERE). We also know that in many cases, these same adjustments don't hold very well (HERE).
Although I could have taken this list further, it helps explain why even though one cannot ignore the biomechanical aspects of back and neck pain, it's critical to realize there are other factors at play; particularly the chemical factors we refer to as "INFLAMMATION" --- a factor known to put people into a true CONUNDRUM.
If you are interested in shedding systemic inflammation and starting the process of RESOLVING YOUR BACK PAIN, be sure and take a look at THIS POST. It will at least provide a few ideas as far as creating your own personalized EXIT STRATEGY is concerned. Also, be sure to like, share or follow on FACEBOOK if you appreciated this post because it's still a great way to reach the people you love and value most.
THE LATEST IN FASCIA RESEARCH
HIGHLIGHTS OF THE FASCIA CONGRESS
Fascia is made up of FIBROBLASTS (collagen-secreting cells), MYOFIBROBLASTS (cells that give fascia the ability to contract), telocytes (extremely long fibers that give fascia the ability TO CONNECT YOUR BODY AS A WHOLE, aiding in it's ability to act as A SECOND NERVOUS SYSTEM), fasciacytes (cells that secret the gel-like HYALURONIC ACID), along with numerous other components, including the new lymphatic circulatory system called the INTERSTITIUM. These channels have already been shown to be important in LYMPHEDEMA / LIPEDEMA, the spread of CANCER, in wound healing, in HOMEOSTASIS, as well as their ability to "remove pathogens". When the authors made the statement, "Interstitial fluid flow is essential for a properly functioning immune system," I couldn't help but thinking about one of the many incredible benefits of OUR BACKYARD TRAMPOLINE!
Also talked about were THE VARIOUS TYPES OF PAIN, with mention being made to the premises underlying DR. CHAN GUNN'S WORK --- showing that when exposed to the chemicals that make up the immune system mediators we collectively refer to as "INFLAMMATION," nerves within the tissue can become hyper-sensitized, leading to problems like HYPERALGIA / ALLODYNIA, which are both characteristics of an all-too-common phenomenon known as CENTRAL SENSITIZATION (the worst kind of chronic pain).
The same research team also showed how SPONTANEOUS DISC HERNIATIONS are related to both muscular atrophy and FATTY INFILTRATION of the low back muscles and THORACOLUMBAR FASCIA, mostly the result of unbridled inflammation coupled with lack of exercise (or maybe I should say, lack of the right kinds of exercise). This section of the study also mentioned treating pain by focusing on "improving sleep, depression/stress and negative affect." Interestingly, I just showed you how light is being successfully used to address to all of these (HERE). As far as exercise, they suggested starting "gently" (especially those of you struggling with FIBROMYALGIA or similar). Maybe this explains why I've become such a huge fan of WBV and use it myself almost every day.
What I found amazing, but not surprising was that when looking at the actual causes of back pain, disc-related pain accounted for less than 5% of all back pain. OSTEOPOROSIS accounted for even less, and DEGENERATIVE ARTHRITIS accounted for only about one in ten cases. What was the major culprit in most back pain? "By far the biggest source of low back pain from what Dr. Willard has found in the literature is myofascial-ligamentous pain, which seems to contribute to about 70% of cases."
Again we see the importance of the THORACOLUMBAR FASCIA (or HERE, HERE, HERE, or HERE) as well the reasons it's important to grasp concepts like UPPER CROSSED and LOWER CROSSED syndromes. And while there was little detail provided, fascia's relationship to WHIPLASH INJURIES was also discussed, as was the importance of PROPER BIOMECHANICS on preventing musculoskeletal injuries, particularly to tendons.
Along these same lines, there were biomechanical discussions about the fact that one of PLANTAR FASCIITIS' chief characteristics is that the fascia "THICKENS" --- something they now believe is likewise happening to the Tensor Fascia Lata muscle in people (mostly runners and jumpers) with ITB problems. The authors also discussed the relationship between weak feet and PF, suggesting that in societies where no one wears shoes, the population has better arches --- still another reason to start a "GROUNDING PROTOCOL" (not to mention it's benefits your proprioception --- one of fascia's primary functions --- HERE or HERE).
One last thing I must mention before winding down is the relationship of fascia to hormones, particularly FEMALE HORMONES. Dr. Carla Stecco of Italy is one of the world's leading experts on this relationship between FASCIA AND HORMONES, and had this to say.....
"Another finding important to facial tissue composition is that fascial fibroblasts contain sex hormone receptors, which can affect collagen expression. Dr. Stecco's team has focused so far on female hormones and found receptors for estrogen, relaxin, and estradiol. These sex hormones, in particular estradiol, stimulate secretion of collagen type 3, which is elastic and organized more like a web; they also seem to decrease secretion of collagen type 1, which produces large bundles of strong collagen fibers to create stiffer and stronger fascia. In addition, fibrillin (a glycoprotein secreted by fibroblasts) was found to increase expression during the peri-ovulatory phase and pregnancy, making fascia more elastic. Increased elasticity in response to sex hormones makes the fascia of the trunk more adaptable to change of volume during pregnancy, and it is valuable to understand the biochemical mechanisms by which these changes occur. Looking at postmenopausal women, Dr. Stecco's lab found decreased expression of sex hormone receptors, making fasciae less receptive to hormonal input and more likely to develop and maintain stiffness."
Because fascia is often at the root of any number of PAIN SYNDROMES, what kind of research is being done to help suffering humanity with problems that may very well be fascia-related? Because "endocannabinoid receptors have been recently identified in fascial fibroblasts," there is a great deal of work being done trying to influence the INFLAMMATION / FIBROSIS / SCAR TISSUE CONUNDRUM using CBD and similar. There is also research into using specific enzymes that break down hyaluron to lessen "FASCIAL DENSIFICATION" (something we seem to be doing a pretty good job of her in our clinic --- HERE).
"Clearly, much progress has been made and is being made in this direction. In the meantime, there are many scientifically validated options immediately available to reduce pathology and pain and improve wellness, including manual therapy and exercise."
Although I would never for even a moment call it comprehensive, at least on some level MY INFLAMMATION-REDUCING PROTOCOL addresses each and every one of the points brought up in this post. If you are looking for more posts on fascia, HERE THEY ARE (or HERE if you want them organized), just follow the links. And if you enjoyed today's post, don't forget to like, share or follow on FACEBOOK as it's still one of the best ways to reach the people you love and value most. After all, there are growing numbers of researchers touting fascia as both the beginning and the end of all disease and chronic pain processes (HERE).
CHRONIC BACK PAIN AND FASCIAL ADHESIONS OF THE THORACOLUMBAR SPINE
MIGHT THERE BE A SOLUTION FOR YOU?
"The diagnosis of chronic low back pain is a scourge of society that does not take into account the pathoanatomical cause of pain. Low back pain is one of the most challenging conditions to treat, as it is a symptom of an underlying disorder. Low back pain is incredibly frustrating for clinicians to treat, as over 100 conditions can result in back pain. It is one of the most prevalent musculoskeletal disorders in developed countries, affecting up to 85% of the adult chronic pain population. Also, a precise pathoanatomical diagnosis cannot be determined in up to 85% of patients with low back pain, so treatment is based on the classic step-wise approach. For those unfortunate patients who do not respond, chronic pain management is advised to mitigate the effects of the pain on patient function with an attempt to approximate as close to a normal lifestyle as possible."
Think about what's being said for a moment because it flies in the face of everything the average person is led to believe about back pain. First, despite what you've been told (and just as I've shown you before --- HERE), it's virtually impossible to look at an orthopedic test --- any orthopedic test, including MRI --- and determine with any degree of certainty whether or not the findings on said test are in any way related to your pain. Secondly, whether we are talking about MRI or modern digital x-rays, telling people their pain is due to "degeneration" (arthritis, osteoarthritis, degenerative arthritis, DJD, DDD, etc, etc, etc) is USUALLY LESS THAN ACCURATE, with the same being true of most visible disc herniations as well (HERE). Thirdly, when the authors say that over 100 conditions are related back pain, they are grossly UNDER-EMPHASIZING THIS ASPECT. And lastly, we've known for years that chronic low back pain is the single biggest cause of disability in the developed world (HERE).
The patient in this case study was a geriatric male (age 65), with a history of spinal fracture from a football injury over fifty years prior, which was followed a few years later by a rugby injury. He ended up in a rigid, full-torso brace for three months, eventually having his lower back FUSED several years later. This individual had all the usual signs and symptoms associated with his injury and subsequent treatment; severe degeneration, disc herniations, SCIATIC-LIKE SYMPTOMS, as well as a shuffling gait (see 'under-emphasizing' link above). He had tried therapy (THIS WAS HIS RESULT), TRIGGER POINT INJECTIONS (they did not work either), and was not interested in a life lived on "THE BIG FIVE". Eventually, a PRP INJECTION was tried.
Although I am certainly not against Platelet-Rich Plasma injections (they are unarguably much safer than CORTICOSTEROIDS), I'm biased because even though I have seen numerous patients get incredible results from stem cell injections, I have yet to see a patient who had good results from PRP. What I really want you to listen to, however, is the cherry-picked description of what PRP does, according to the study's author.
"Platelet-rich plasma is thought to work through the release of growth factors in areas of tissue damage. The alpha-granules in platelets contain many growth factors that are responsible for the initiation and maintenance of the healing response. The growth factors that are released include platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factor (VEGF), and fibroblast growth factor (FGF). The fibrin matrix that forms also has an additional stimulatory effect on healing by trapping platelets and providing an initial matrix for fibroblast migration."
Forget PRP for a moment. What I want you to grasp here is that if you look at two of my past posts on what it takes to stimulate fibroblastic activity (HERE and HERE), you'll find each and every one of the features from the paragraph above, as well as many others. How is it being done without drugs, stem cells, or PRP? It's being done via intense body work (HERE & HERE).
And while it's true that "intense" means that my patients occasionally look like THIS (emphasis on "occasionally"), my goal is always to use the MINIMALLY EFFECTIVE DOSE when treating. What's kind of cool for my patients here in the OZARKS OF RURAL SOUTHERN MISSOURI is that I've been talking about this relationship --- the relationship between BRUISING and healing (fibroblastic activity) --- for the BETTER PART OF TWO DECADES! What's doubly cool is that we haven't even gotten to the best part of this case history yet --- CS. The authors went on to talk about CENTRAL SENSITIZATION, saying........
"Central sensitization is the amplification of neural signaling within the central nervous system that causes pain hypersensitivity not only at the site of pain but in the spinal cord and brain as well. It is thought to be the primary reason chronic back pain is virtually impossible to treat. It is possible that there is bi-directional neurological input that is responsible for the development and maintenance of central sensitization. In this case, it is possible that nociceptive input in the periphery resulted in the development of central sensitization. Once this nociceptive input was removed, the phenomenon of central sensitization also resolved. This suggests that the identification of the original pain generator remains important in patients with a long history of chronic low back pain and that additional attention should be focused towards the thoracolumbar fascia, as full resolution of their pain complaint may still be possible."
I must admit that when I read this, I almost fell out of my chair. Why? Because mainstream medicine's concept of Central Sensitization is that chronic nociceptive inputs (PAIN, INFLAMMATION, etc) in the periphery can create abnormal brain activity that can cause pain to play on a loop in the brain, even though the original injury is 'healed'. In regards to what THIS AUTHOR is saying, one of two things must be true. Either, contrary to popular belief, these abnormal brain loops can be broken (FUNCTIONAL NEUROLOGISTS know this is often possible), or, even though people are being told they are 'healed' (such as insurance companies do all the time with WHIPLASH PATIENTS), the reality is that they could very well be carrying the same CHRONIC INJURY they've carried for decades ---- the point of my post titled CENTRAL SENSITIZATION AND TISSUE REMODELING!
Not only have I shown my readers many studies related to the thoracolumbar fascia (HERE, HERE, and HERE are a few), but I've shown you what it takes to start addressing it in the earlier-mentioned manner (HERE). I've also shown you how thoracolumbar adhesions are responsible for sciatica (HERE) as well as the technology that this doctor used to image his patient's thoracolumbar fascia (HERE). I've even shown you how research continues to show how spinal surgery frequently fouls up the function of the thoracolumbar fascia (HERE). On top of it all, I'm constantly providing you ideas to help you start addressing your own back problems (HERE and HERE are two examples of many).
Although I would never for a moment try and convince you that fasical adhesions of the thoracolumbar spine are the only cause of back pain, they are a major reason for all the reasons I've listed HERE. What about CASE HISTORIES / TESTIMONIALS from patients with problems of the thoracolumbar fascia that were treated without PRP? Allow me to show you two unsolicited emails (HERE and HERE) as well as an amazing one-minute video of a patient from California who suffered with low back pain for over two decades before finding a solution in tiny Mountain View, Missouri (HERE). And because fascia is found all over the body (HERE ARE ALL MY POSTS ON FASCIA), the exact same concepts frequently work for people with chronic neck pain as well (HERE).
As an extra boon for many of you, remember that tissue remodeling is only a small part of my protocol for helping people start the process of taking their lives back, albeit an important one. While it certainly won't provide the solution for everyone; on this first day of 2019, my generic protocol is yours, completely free of charge (HERE). Just remember to like, share or follow on FACEBOOK since it's a good way to reach a lot of people, most particularly the people you love and care about most.
IS DR. STEPHEN LEVIN CORRECT?
IS BONE REALLY FASCIA?
"The definition of fascia keeps expanding and what is now considered fascia includes all the muscles except the cells encased within epimysium and perimysium, the nerve devoid of its neural component, the gut devoid of its digestive cells, and the organs (kidney, heart, liver, etc.) devoid of their specialized organ cells. In fact, anything that encapsulates or connects anything to anything else in the body with the exception of skin, bone, cartilage, the inside of cells, and anything that takes a compression load, is considered fascia. (It is obscure to me just what the basis is for excluding the body’s firmer structures). More simply defined, fascia seems to be that which is not parenchyma (the functional tissue of an organ as distinguished from the connective and supportive tissue)."
My first thought was hold on --- if everything is fascia, then nothing is fascia. However, after reading the article in its entirety and then watching his video explaining how "BONE IS A SPECIALIZED CONDENSATION OF CALCIUM SALTS WITHIN THE FASCIA," I was more convinced. Especially after he addressed this topic in the context of the 'continuum' (I'll get there in a moment). Levin went on to describe the entire thing as being like "a doorway connecting rooms in an apartment," showing how the PERIOSTEUM (the ultra-thin cellophane-like membrane that covers bones) is continuous with all of these tissues, fascia TENDONS, MUSCLES, and bones, although it may have different names according to where its found (EPIMYSIUM / PERIMYSIUM, etc). Dr. Levin went on to explain that when you add it all together, bone is not quite what we think it is.
"Bone is not a crystalline column of calcium, it is a stiffly starched shirt very much dependent on the structure of its fabric for both form and function. The underlying structure of the bone is the same soft collagenous connective tissue network that composes the rest of the fascial organ. The calcium crystals manufactured by the bone’s parenchyma do not become part of the bone’s parenchyma (its inner workings), or a product to be excreted or used elsewhere in the body; they become part of the fascia support system of the bone organ. However, the calcium crystals do not dictate the layout of the boney apartment, they are stiffeners that strengthen the collagenous weight-bearing walls."
Back to the continuum: Once we start to see how fascia penetrates virtually every tissue imaginable, as well as surrounding and invaginating most (many would argue all) organs, we get a better picture of why ultra-smart people have been calling fascia a SECOND NERVOUS SYSTEM for decades as well as intimately (and causally) linking it to all pain, sickness, and disease (HERE). Honestly, this paper is super cool and short enough to read in five minutes, which I suggest you do. Allow me to use this concept to show you a consequence of this aspect of fascia going haywire.
One of the things we know is that when fascia is injured or exposed to SYSTEMIC INFLAMMATION, it becomes fibrotic and THICKENS or DENSIFIES (Dr. Stecco's word). We see this not only in virtually all injuries, but we see it in numerous disease processes including cancer (HERE). In fact, it's an important enough phenomenon that fibrosis (the medical word for thickened scar-like tissue) is the #1 cause of death on the planet (HERE). The same thickening that's characteristic of fascia is likewise characteristic of bone.
Publishing in the August 2005 issue of Nature Materials (Sacrificial Bonds and Hidden Length Dissipate Energy as Mineralized Fibrils Separate During Bone Fracture), a team of 11 researchers from the physics department at University of California, Santa Barbara showed just how right Levin really is. A press release (Fundamental Discovery About the Fracture of Human Bone: It's All in the 'Glue) that was published in a university publication (The Current) revealed that unhealthy bone undergoes continual fractures at the molecular level, leading to a (you guessed it) thickening of the bone; even though said bone may be significantly weaker.
A certain amount of thickening (whether bone or soft tissue) can be a good thing. For instance, in response to the mechanical loads and forces of athletic endeavors or hard labor, the goal is to achieve muscle hypertrophy along with some connective tissue thickening. However, once we understand the work of the renowned German surgeon, who, in the mid 1800's, figured out that bone grows / thickens / becomes more dense in response to mechanical forces put on it (even if said forces are 'bad' such as what might be seen in altered biomechanics), we can begin to grasp how big this concept really is. His name was put on his theory, which eventually became known as WOLFF'S LAW. The work of Dr. Julian Wolff should help you understand why I'm a huge fan of WEIGHTLIFTING, explosive exercises such as SPRINTS, REBOUNDING / TRAMPOLINING, or stretching / exercising on a simple and inexpensive WBV MACHINE.
Here's what's doubly cool about all of this. If you will focus on reducing whole-body inflammation (I've left you a few pointers HERE), the end result is not only stronger bones and connective tissues, but better overall health as well as the likelihood of diminished pain ---- this is often times the case even for those struggling with CENTRAL SENSITIZATION. If you found today's post interesting or beneficial in any way, be sure and spread the wealth by liking, sharing, or following us on FACEBOOK.
AN EXPERT REVIEW AND SYNOPSIS OF MYOFASCIAL PAIN SYNDROMES
What's just as interesting as calling trigger points a source of pain is that he referred to them a "source of functional limitation". In other words, these creatures (TP's) are not only painful, they have the potential to alter the way you go about your normal day-to-day life. Bordoni went on to talk about the various theories on why people get Trigger Points. Here are some of the takeaways (trying to simplify some of this for my readers).
- Trigger points are more prone to be found in red muscle (aerobic, slow twitch, postural) that white muscle (anaerobic, fast twitch, explosive movements).
- Constant (repeated) microtrauma is a problem --- probably one of the reasons that the consensus is that REPETITIVE INJURIES are usually harder to deal with than acute trauma.
- This constant microtrauma to red fibers causes an increased need for cellular OXYGEN, which depletes cellular energy (ATP) and causes increased sensitivity to pain.
- In this environment, numerous chemicals, compounds, and elements (including the biomarkers we refer to collectively as "INFLAMMATION,") causes both tissue STIFFNESS AND DENSITY, as well as the heightened pain sensitivity and low threshold to meet said sensitivity we saw in the previous bullet. When this process happens in the central nervous system it's known as CENTRAL SENSITIZATION. As the famed neurologist and acupuncturist (he's considered the father of modern dry needling techniques) Chan Gunn said, this can make fibrotic tissue over 1,000 times more sensitive to pain than normal tissue (HERE).
- Thanks to the above-mentioned CS, as well as similar phenomenon occurring in the peripheral nervous system, areas of the nervous system begin firing on their own, sometimes almost perpetually, with an end result that there is "a constant local contraction of the muscle fibers". Mind you, I am not saying that the entire muscle is contracting, but instead, due to the fact that when an individual muscle fiber contracts it contracts at 100%, the individual fibers under the control of a specific nerve can be hyper-stimulated and contract until they finally run out of ATP. The end result is that once this occurs, many people will get a short period of TP relief until the body replenishes it's stores of cellular energy to start contracting again.
- As the vicious cycle spins faster and faster, not only is there an increase in pain, but the FIBROBLASTS actually start converting to myofibroblasts, which dramatically changes the dynamics of the fascia. In fact, Bordoni theorizes that the fascia, which acts as A SECOND NERVOUS SYSTEM, has the potential to itself start sending "looped" messages that play over and over again, causing further "spontaneous presence of local muscle contraction."
- There is also an alteration of the hyaluronan or hyaluronic acid (HA) that, like most everything else seen in fascia, also thickens, becoming more viscous, creating a scenario where the various layers of fascia do not slide on each other (IT LOOKS LIKE THIS). This seems to cause stretching of the nerve tissue in the fascia, creating still another reason for it "becoming constantly activated".
- If you throw altered BLOOD PRESSURE into this whole mess, the smallest blood vessels (the capillaries) become ischemic, starving their corresponding muscles for O2. In a nation where we learned just last week that our COLLECTIVE BMI (body mass index) went up yet again, it's just another nail in the proverbial coffin.
- Because the internal environment of a trigger point is hypoxic (low oxygen), it's also acidic. For those of you who suffer from any sort of digestive issue, I suggest you read about the inverse relationship between the stomach and the body as far as acidity / alkalinity is concerned (HERE).
- The end result is that there are several positive feedback loops (viscous cycles) that set themselves up, causing a release of neurotransmitters that stimulate contraction, based largely on inflammation, hypoxia, acidity, and the muscle contraction itself, "surging the sending of painful information to the nervous system."
- Trigger points, if biopsied, contain cells, tissues, and biochemical markers that are different than normal surrounding tissues. Not surprisingly, the tissues are themselves thickened (sometimes researchers refer to this as "DENSIFICATION").
One of the theories that Bordoni specifically mentioned has to do with altered neurological function of the nervous system as it relates to the SKIN. "The concept of altered electrical activity of the skin and the afferents [sensory nerves] coming from the TPs could explain the altered emotional state in patients with the myofascial syndrome (anxiety and depression)." Interesting, considering ANXIETY and DEPRESSION are both considered to be "inflammatory" diseases (HERE).
Furthermore, we saw confirmation of previous studies that various parts of the brains of people in chronic pain, and especially chronic myofascial pain, actually shrink and atrophy. In fact, I've seen studies showing that this phenomenon can be so severe that over time, brain scans of those who have lived with chronic pain become almost indistinguishable from people with neurodegenerative diseases such as ALZHEIMER'S (HERE).
Although the books by TRAVELL & SIMONS were mentioned (Janet Travell was JFK'S PERSONAL PHYSICIAN), what I found most interesting was the lack of consensus as to what can be used to effectively image and / or destroy these creatures ("Currently, the causes of the presence of TPs are only speculative, as well as the correct evaluative and therapeutic approach."). As far as treatment, Bordoni mentioned every single one of my 'BIG FIVE,' as well as "lidocaine patches, BOTOX, POSTURE-CONTROL EXERCISES, NUTRITION, THERAPY, CHIROPRACTIC ADJUSTMENTS [actually, he mentioned "Osteopathic Manipulation"], ultrasound, STRETCHING, DRY NEEDLING, YOGA, ACUPUNCTURE" and a number of others. What wasn't mentioned was, at least in my mind, even more interesting than what was. Namely, any sort of bodywork, massage therapy, rolfing, TISSUE REMODELING, etc.
The paper's theme was that the drugs are not going to be very helpful and can actually cause a myriad of SIDE EFFECTS. It seems that Bordoni would agree that A SYSTEMIC APPROACH to trigger points has the potential to be much more effective than simply attacking these beasts in a purely local fashion. If you appreciated today's post, be sure to share it with others. FACEBOOK is still an effective way to reach the people you love and care about most!
AWARENESS OF THE FASCIAL SYSTEM
"It was as if some ghostly bridge across the city of Geneva, Switzerland, had permitted two photons of light nearly seven miles apart to respond simultaneously to a stimulus applied to just one of them. Since there was no way for the photons to communicate with each other, ''classical'' physics would predict that their independent choices would bear no relationship to each other. But when the paths of the two photons were properly adjusted and the results compared, the independent decisions by the paired photons always matched, even though there was no physical way for them to communicate with each other. Entangled particles are identical entities that share common origins and properties, and remain in instantaneous touch with each other, no matter how wide the gap between them [in this case 7 miles]. Albert Einstein sneered at the very possibility of such a thing, calling it ''spooky action at a distance.'' Scientists still (somewhat shamefacedly) speak of the ''magic'' of ''quantum weirdness.'' And yet all experiments in recent years have shown that Einstein was wrong and that action at a distance is real."
Italian researchers, DR. BRUNO BORDONI and Dr. Marta Simonelli, recently published a short but well-bibbed paper in the journal, Cureus, titled The Awareness of the Fascial System. The gist of the treatise was that "Each cell communicates with the other cells by sending and receiving signals; this concept is a part of quantum physics and it is known as quantum entanglement... A fascial cell has not only memory but also the awareness of the mechanometabolic information it feels, and it has the anticipatory predisposition in preparing itself for alteration of its natural environment." Why is this such a big deal? Because these authors state (and I would agree), "Cellular behaviour and the inclusion of quantum physics background are hardly being considered to find out what happens between the operator and the patient during a manual physical contact." This may account for fascia being described as the root of all sickness and disease (HERE).
One of the first things the authors did was to describe FASCIA in terms of "salutogenic homeostasis". HOMEOSTASIS describes your body in perfect metabolic balance. Salutogenic homeostasis is a term that instead depicts an approach focused on specific things that support health and well being as opposed to focusing on things that disrupt health and cause disease. The next factor mentioned was something called INTEROCEPTON. Related to PROPRIOCEPTION --- the body's ability to perceive it's spatial and positional relationship to the external world --- interoception refers to the body's ability to sense what's going on in its internal environment. Listen to how a team of Belgian, German, and Australian researchers described the phenomenon in 2016's On the Origin of Interoception (Frontiers in Psychology).
"Over the course of a century, the meaning of interoception has changed from the restrictive to the inclusive. In its inclusive sense, it bears relevance to every individual via its link to emotion, decision making, time-perception, health, pain, and various other areas of life. While the label for the perception of the body state changes over time, the need for an overarching concept remains. Many aspects can make any particular interoceptive sensation unique and distinct from any other interoceptive sensation. This can range from the sense of agency, to the physical cause of a sensation, the ontogenetic origin, the efferent [motor] innervation, and afferent [sensory] pathways of the tissue involved amongst others. In its overarching meaning, interoception primarily is a product of the central nervous system, a construct based on an integration of various sources, not per se including afferent information."
Just last year Bordoni wrote a paper on this specific topic in Complementary Medicine Research that was titled Emotions in Motion; Myofascial Interoception, which stated, "What is still missing [from most therapeutic approaches] is the awareness that the body is also emotion. The myofascial continuum is able to stimulate the areas of the brain that deal with the emotional state, and manual treatment activates the interoceptive system." In today's paper, Bordoni described how this occurs. "The [fascial] continuum constantly transmits and receives mechanometabolic information that can influence the shape and function of the entire body. These afferent [sensory] / efferent [motor] impulses come from the fascia and the tissues that are not considered as part of the fascia in a bi-univocal mode."
This is why, as I have shown my readers repeatedly, fascia has the ability to act as a SECOND NERVOUS SYSTEM. In fact, because of the massive volume and type of information that fascia conveys, I have heard some experts argue that MECHANOTRANSDUCTION could allow fascia to accurately be described the body's primary mode of communication, with the nervous system coming in second place (and the GUT'S ENTERIC SYSTEM likely coming in third). Much of this is due to something known as RAIN (Rapid Adaptability of the Internal Network) made possible by the fluid portion of fascia (HERE).
"The nervous system does not regulate the morphological features of the fascial system. The latter is a holobiont, an asymptotic behaviour between the mechanical environment inside and outside the cell and the modification of the environment itself. A non-movement syntropic is based on a heuristic basis: the maximum configuration of the order and at the same time maximum differentiation with the aim to have access to all information. Tissues use a stigmergic communication through a stochastic process to achieve optimal adaptation strategies; tissues change their characteristics and the means of transmission of external information inward. It is not only about a tissue, but it is, in fact, an awareness. The article discusses the fascial cellular response modality to mechanical stimuli and the possible influence on the fascial tissue by a manual palpation during a manual treatment, in terms of quantum physics and physiology."
In other words, the shape and configuration of fascia is something it does based on it's mechanical environment, for the express purpose of optimizing both it's physical properties and optimizing its ability to pass information throughout the body. One action, leads to another, which leads to another, resulting in a type of communication that innately creates amazingly complicated structures, and at least at times, does so seemingly spontaneously. Thus, the whole is far greater than the sum of its individual parts, and is at least part of what makes studying fascia in cadavers and in vitro (outside of the living organism in a petri dish or test tube) so difficult and inaccurate.
So; not only are tissues and cells are aware of other tissues and cells via traditional means such as that can be explained purely via mechanical, electrical or biomagnetic means, but Bordoni argues that they are likely aware of each other in a manner similar to the "entanglement" seen in Dr. Nicolas Gisin's twin-photon experiment at the University of Geneva. This is the astounding beauty and mystery of quantum mechanics, with the end result, as Bordoni states through the title of his paper, that fascia is "aware".
Despite a host of factors that Bordoni and Simonelli could not prove or were not certain of (mostly specific quantum mechanisms that physicists still do not understand even though they can observe them), they said, "What we know for sure is that manual approaches to tissues can alter the cellular behaviour of the fascial system." That, folks, is why bodyworkers do what they do, and why I feel I have a PRETTY GOOD HANDLE ON WHAT IT TAKES to help people living with chronic pain start the process of taking their life back. Just before invoking EPIGENETICS, Bordoni spoke of this awareness in terms of tissue memory.
"Mechanical events suffered by the fascial holobiont are actively maintained in its memory, with the aim of being already predisposed to a new action of the same stressors. A fascial cell has not only memory, but also has the awareness of the mechanometabolic information it feels, and it has the anticipatory predisposition in preparing itself for alteration of its natural intra- and extracellular milieu. A cellular genome can monitor itself in response to mechano-metabolic stimuli, obtaining information not only from the extracellular matrix (ECM) but also from other cells and tissues."
The paper that Bordoni cited for the first part of this paragraph was a 2014 paper (Does Fascia Hold Memories?) by a fellow Italian osteopath named Paolo Tozzi, that was published in the Journal of Bodywork and Movement Therapies. In this paper, Paolo made the case that what we essentially refer to as "memory" is based on quantum physics and contained in water, chemicals, the fascial structure (TENSEGRITY), the neurofascia, the ECM, microtubules, FIBROBLASTS, and others, even though we don't have a good grasp on how it actually works. Dr. Paolo ended with this fascinating "hypothesis" that is right in line with the quantum physics that Bordoni has been talking about.
"There is increasing evidence that organisms may communicate between cells and tissues by electromagnetic radiations, phonons and photons. Biophotons are believed to be emitted from a coherent photon field within the living system that may work as an energy (and possibly as a memory) storage field. It appears then that the body matrix, as a continuous physical and energetic system, is capable of conducting message units in the form of electrons, vibrations, protons, photons, phonons. It is therefore an informational network that distributes regulatory signals throughout the body, coordinating cellular and extracellular activities involved in growth, morphogenesis and regeneration. A yet more interesting possibility is that the liquid crystalline continuum may function as a quantum holographic medium, recording the interference patterns of local activities interacting with a globally coherent field. Holographic memory is distributed globally and yet can be accessed and recovered locally. Possibly during bodywork, the interaction of vibrational, biomagnetic and bioelectric fields between therapist and client may allow an exchange of information about the history and the present status of the living matrix. The information encoded in cell and tissue structure and activity may be read holographically, by tuning to the appropriate frequencies. This may even lead to a recall of past traumas and of an array of related sensations. The result may be the restoration, balancing, and tuning of resonant vibratory circuits."
Bordoni went on to talk about parts of the cell that are responsible for carrying both electric and non-electric messaging; the CELL MEMBRANE, the cytoskeleton, and the microtubules. Cell membranes are polarized, meaning they conduct electric charges. When tissue undergoes deformation, whether the deformation is in the form of an injury, like say a WHIPLASH, or the subsequent treatment thereof (HERE) it is polarized / depolarized, creating a messaging system that can, in certain cases, travel at speeds of almost 400 feet per second --- just a bit longer than a football field with both endzones. Thanks to the liquid portion of fascia and the fact that fascia is literally what connects you to every other part of you, fascia-based messaging can travel at the speed of sound in water ---- over 5,000 feet per second or about 12 times faster than the very fastest electrical messages (something I talked about HERE). Dr. B talked about another type of messaging system that can take hours. Here is what he said about fascial messaging as it relates to tissue memory.
"Cell deformation by intrinsic forces could give rise to very fast or extremely slow messages. We can assume that palpation can create mechanical stresses that continue over time. Cells are deformed following vectors, as the shape of the man's footprinted in the sand. Cellular morphology affects the extracellular matrix shape, influencing how the mechanometabolic resulting message will be transported: slow, fast or conditioning its direction. Probably this kind of "mirror" behaviour would allow the cell to better respond to stress solicitation, improving its adaptation. The cytoskeleton plays an important role for cell conformational memory."
The end result of the tissue messaging and tissue memory is that, "the cell can change its morphology [shape, form, structure, pattern, size, etc] in real time. The DNA adapts itself to cellular morphological changes, increasing the transcription of genes activated by specific regions of DNA which are sensitive to the flow of electromagnetic energy: electromagnetic response elements or EMRE. The deformation of the cellular structures also activates the transcription of other genes, which are specific to a mechanical stimulus." What does this mean in English? It means that even though I don't really know jack about quantum physics or the biochemical minutiae of fascia, I can use general principles of TISSUE DEFORMATION to get THESE SORTS OF AMAZING RESULTS on a day-to-day basis. In fact, THIS METHOD USUALLY WORKS SO WELL that when it doesn't, it leaves me perplexed, wondering what I missed or failed to account for.
If you want to see what it may take to start the process of successfully addressing some of the most commonly-seen underlying causes of pain and disease (fortunately, they are usually the same), HERE is the post for you to browse. And if today's post resonated with you, be sure and make sure it makes the rounds on FACEBOOK, as it's still the easiest way I know to reach the people you love and care about most.
TORN OR ADHESED FASCIA
WHAT IN THE WORLD DOES IT LOOK LIKE?
Because fascia does not image with standard technology (HERE), struggling patients are frequently treated as though their problem / pain doesn't exist --- as if IT'S ALL IN THEIR HEAD. It's also common to be treated as a drug seeker, especially in the environment surrounding our ever-present OPIOID EPIDEMIC. The result is patients who live in despair, often times being told their pain is the result of DEPRESSION, when the opposite is far more likely to be true. What's exciting is that for many of you reading today's post, there is hope. There may actually be a way to start breaking out of the prison of HELPLESSNESS / HOPELESSNESS and STRESS your pain has confined you to.
Today I want to show you a picture of a FASCIAL ADHESION that's caused several years of CHRONIC PAIN (9 on a scale of 10) in a woman who had tried everything under the sun in an attempt to not only treat, but simply figure out what was wrong with her. The problem started several years ago as the result of OVER-VIGOROUS STRETCHING, which caused a "popping" sound, intense pain, and later, hardness in her lower abdomen (yes, soft tissues will often pop when they TEAR OR BREAK).
Although over the course of her ordeal she was given a myriad of ever-changing diagnosis (including CUTANEOUS NERVE ENTRAPMENT(S)), she was eventually told she had INTRA-ABDOMINAL ADHESIONS, ultimately ending up having them surgically removed (she'd had several past abdominal surgeries, including more than one vertical C-section, which were, excepting an appendicitis surgery, decades old), which helped a great deal with the feeling of hardness and internal abdominal pain. Unfortunately, the severe pain above her right lilac crest (the bone you put your hands on when you put your hands on your hips) was still there, only worse.
I tested and found areas of restriction, and in her case decided to work my way in towards the epicenter of her pain instead of working my way out (part of my reasoning was that she had extremely tight HIP FLEXORS and a great deal of pain in her upper buttock / hip / lower back --- I did not find much adhesion in her THORACOLUMBAR FASCIA). Since sitting was what reproduced the most pain (sitting was never pain-free for her), I would work on an area, then have her walk around a bit. I would then have her sit for a little while to see if her pain had changed (I call this BULLSEYING).
Before I ever got to the epicenter (the four arrows), her pain upon sitting had reduced substantially. As I worked my way in, I found two quarter-sized areas of ADHESED FASCIA which were obviously TETHERING HER substantially. Upon breaking them, her pain diminished even further. right next to these I found THE TEAR ITSELF (click for a pic of a different patient), which ran ran almost from her navel to her spine (you can visually see some of it in the picture above).
After working on this area, the patient could not reproduce pain. I gave her the proper stretching protocol and she and her husband started their journey home, with her riding in the back of a van so that she could stretch and pull the HAIRBALL-LIKE tissues apart before the broken adhesion could re-adhese. For the record, her husband was in the room with us for the entirety, the towel on her hind end was tucked into her underwear, and even though it's cut off in the pic, she was wearing a bra that had been pushed up, with a towel stuffed underneath.
I am not completely sure whether or not these results will hold up for her but SHE WILL KNOW AFTER THIS ONE TREATMENT whether or not that's the case. Not surprisingly, however, when a patient leaves my clinic unable to reproduce the pain that has been turning their life upside down, it's a hopeful sign. Will she have to return for more treatment? I have no idea. Regardless, we found her problem, allowed her to visualize it (important because IF IT BLEEDS, WE CAN KILL IT), and began the process of breaking down the SCAR TISSUE and FIBROSIS. If she does have to return, her next visit will be much shorter and easier (I spent an enjoyable hour and a half with she and her husband, learning the history of the area they hail from). And no; not everyone I treat has this kind of scar tissue, or for that matter, any significant scar tissue at all.
The scheduling slots for the OUT OF STATE & INTERNATIONAL PATIENTS I treat are, for the most part, reserved for Tuesday and Thursday mornings so that I can spend whatever time may be needed to address whatever we happen to find. While I cannot guarantee a "cure," browse through a few of the hundreds of PATIENT TESTIMONIALS on our site, some in the form of letters or emails, and others in the form of videos that we mainly do in-house (although on occasion someone sends me something they shot on their phone). Quite a few of these testimonials are from long-distance patients, but the majority are from the folks I treat right here locally (Springfield, Mountain Home, Rolla, and Poplar Bluff are all only an hour and a half away).
Also be aware that my average patient is not going to leave the office looking like this. Many patients simply need the right CHIROPRACTIC ADJUSTMENT to resolve their problem(s). However, if you are not holding your adjustments like you feel you should be (HERE), it's a common sign that there may be invisible scar tissue and adhesion present. For those who may be wondering, HERE is what a typical "First Visit" will look like for a local patient. It costs nothing to talk to me to see if I think I can help.
Because you must never forget how intimately inflammation is related to scar tissue (HERE), and that there are things you can be doing to address your level of systemic inflammation (HERE) ---- or that adhesed fascia is believed by a growing number of experts to be THE ROOT OF ALL PHYSICAL AILMENT --- it might behoove some of you to click the links in this paragraph. Finally, if you are one of the folks enjoying the mountains of free, relevant, and cutting-edge health-related information found on my site, be sure and spread the wealth. One of the best and easiest ways to reach those you love and care about most is by liking, sharing, or following on FACEBOOK.
FASCIA & SPORTS INJURIES
WHAT DOES THE LATEST RESEARCH HAVE TO SAY?
The paper starts with these words, "Molecular crosstalk between extracellular matrix (ECM) molecules and cellular components is an important determinant of fascial tissue physiology and pathophysiology." The ECM (extracellular matrix) is the liquid portion of fascia. What's interesting is that sound / vibration travels much faster in water than it does in air (3,300 mph -vs- 767 mph) making the fascial web an ideal "SECOND NERVOUS SYSTEM" due to the fact that fascia connects every part of you to every other part of you. Not to mention it's a prime example of a phenomenon known as MECHANOTRANSDUCTION --- the ability to convert mechanical stimulus to biochemical signals readily understood by the brain, nervous system, and receptors in various organs and tissues of the body.
"Strong alterations of the local ECM microenvironments are necessary to allow cellular adaptation and rebuilding of fascial tissues. All factors influencing cell or ECM behaviour can result in changes in the structure and homeostasis of tissues and organs."
HOMEOSTASIS is the state your body should be in, the state where everything works and flows in harmony. If you want to rebuild fascia, you will have to push your body's ability to adapt to the limit. Although there are many ways to push the body's tissues (KETTLEBELL SWINGS would be an example), when it comes to dealing with hardcore FASCIAL ADHESIONS it's critical to actually "BREAK" the adhesion. Although different practitioners go about this in different ways, in my clinic I incite fibroblastic activity via something I call Tissue Remodeling (HERE & HERE). "In fascial tissues such as tendons, acute and chronic loading stimulates collagen remodelling." What does it mean to "load" tissues?
In terms of physics, connective tissues are meant to resist shearing or pulling forces (these tissues must be elastic like fascia), or they must resist compressive forces (these must be more rigid like bone). "The mechanical properties of fascial tissues can be modified by several factors, including a change in... crosslinks and molecular organization... and the contractile activity of myofibroblast cells." In English this means that SCAR TISSUE can have issues with its organization. If the tissue is structurally random and heavily crosslinked, it begins to take on characteristics that are more bone-like, losing elasticity in the process (look for my upcoming article about bone as fascia). My goal is to find these areas and "UNTETHER" them (see 'break' link above). Beyond the obvious --- that fascial adhesions have the ability to cause pain --- why does it make sense to actually address mechanical problems mechanically as opposed to chemically (drugs)?
"Myofascial tissue that is stiffer or more compliant than normal has been shown to influence the magnitude of intermuscular force transmission and, arguably, may have a significant effect on muscle mechanics."
The authors went on to reveal why, helping explain why things like MUSCLE RELAXERS or other BIG-FIVE DRUGS are not helpful in the long run because they cannot successfully address biomechanical issues such as fibrosis and densification (I'll discuss it momentarily). "Physiological ageing is a highly individual process characterized by a progressive degeneration of tissues and organ systems. Age-related alterations in fascial tissues include densification (alterations of loose connective tissue) and fibrosis (alterations of collagen fibrous bundles). Functionally, these pathological changes can modify the mechanical properties of fascial tissues and skeletal muscle, thereby contributing to pain-related and age-related reductions in muscle force or range of motion."
Although I addressed AGE-RELATED CHANGES IN FASCIA yesterday, what's critical to remember is that this "aging" process (degenerative process) is not solely reliant on a person's chronological age. It has much to do --- maybe even arguably more to do --- with how well a person takes care of themselves, i.e. how much systemic inflammation they are generating or exposing themselves to. "Although early inflammation after tissue damage due to physical exercise or injury is crucial for tissue remodelling and adaptation.... limiting the magnitude of inflammation might be beneficial for tissue regeneration and gains in muscle mass and strength, depending on the nature of the injury and in elderly people." Here is where things really start to get interesting.
"Excessive or prolonged loading or direct trauma to fascial tissues initiates micro and macro changes necessary for tissue repair. These effects may also contribute to pathological changes that modify tissue function and mechanics, leading to compromised function of the healthy tissue. Effects may become systemic, and thus not limited to the injured/loaded tissues."
In other words, it essentially takes controlled trauma of varying degrees to both break down the old injury and create the local inflammation needed for the repair process. The train, however, starts going off the rails once the inflammatory process moves from local to systemic (more on that process can be found on my COLLAGEN SUPER PAGE). The authors go on to talk about the fact that this systemic inflammation has the ability to generate the scar tissue that the medical community refers to as "FIBROSIS". If you follow my site you are already aware that the endgame of inflammatory processes are fibrotic changes to tissues and organs.
"An acute inflammatory response is typically short-lived and reversible and involves the release of a range of molecules, including proinflammatory cytokines from injured cells and macrophages, along with other substances that sensitize nociceptive afferents and promote immune cell infiltration. If loading is prolonged or repetitive, persistent inflammation may develop leading to the prolonged presence of macrophages and cytotoxic levels of cytokines in and around tissues, ultimately resulting in ongoing tissue damage. Some tissue cytokines are fibrogenic and can promote fibrosis via excessive fibroblast proliferation and collagen matrix deposition."
Inflammation will cause sensory nerves (afferents) to become much more pain sensitive. How much more? When scar tissue itself becomes sensitized due to exposure to inflammatory mediators, the result is incredible pain sensitivity, which DR. CHAN GUNN describes as potentially being over 1,000 times more pain-sensitive than normal tissue. This is part of the scenario that sets up the unholy brain-based 'loop' of chronic pain known in the medical community as CENTRAL SENSITIZATION, where damaged tissue itself is no longer generating pain, but instead, the brain has become the pain generation. But it gets worse. Once tissues and organs start to experience the process of inflammation infiltration, they start to undergo fatty infiltration as well --- the process by which muscles and other connective tissues turn to fat (HERE). And if this weren't bad enough, the ECM-based fibrosis and "DENSIFICATION" that occurs right along with, is actually the world's #1 leading cause of death (HERE). Bottom line, if you have not been taking INFLAMMATION seriously, you must change your thought process if you hope to have any chance of reversing these physiological aberrations.
What did these authors say was good for reversing the processes above --- particularly in cases where it was not yet severe? How about some STRETCHING and RESISTANCE TRAINING; things I've dealt with on my site at length. I have always said that if you are unsure whether or not your pain is centralized, try a Tissue Remodeling treatment and see if it helps (HERE). Moving forward, the paper discussed what it takes to IMAGE FASCIA. While MRI can be used for certain tissues like the PF, the authors spoke at length about DIAGNOSTIC ULTRASOUND. From there they went on to the topic we are all waiting eagerly for --- treatment. In other words, are there other forms of treatment that may successfully help a person address adhesed fascia?
The authors stated that in all but rare cases, surgery for fascia is out, as are the medical community's number one treatment theme; NSAIDS and CORTICOSTEROIDS. Why? Because they "may impair regeneration and diminish tissue adaptation." There were warnings issued against FLUOROQUINOLONE ANTIBIOTICS as well, along with a limited endorsement of PRP INJECTIONS. FOAM ROLLING was mentioned as were several types of body work, including MYOFASCIAL TRIGGER POINT THERAPY. And while CHIROPRACTIC CARE was not mentioned, OSTEOPATHY was (not surprising considering the study was done in Europe). They also warned about the effects of certain drugs on fascia, speaking specifically about ESTROGEN / HRT. "While estrogen replacement in elderly, postmenopausal women impairs collagen synthesis in response to exercise.... Oral contraceptives have an overall depressing effect on collagen synthesis."
People are thinking and talking about fascia more than ever. While that's certainly cool, the fact that more people than ever are beginning to grasp the importance of lessening and controlling their inflammatory load is, at least in my mind, an even bigger deal. What I have done is put together a post (no charge to you) to help you in this endeavor. While I am not claiming to be a "cure all," I would suggest that for the vast majority of you it will provide a starting point or launching pad as far as addressing systemic inflammation; a first step in the process of taking your life back (HERE). If you appreciate this sort of work, be sure to like, share or follow on FACEBOOK as it's a great way to reach the people you love and care about most.
AGING, INFLAMMATION, FASCIAL THICKENING, AND DEGENERATIVE CHANGES SUCH AS OSTEOARTHRITIS AND LOSS OF FLEXIBILITYRead Now
THE RELATIONSHIP BETWEEN AGING, INFLAMMATION, LOSS OF FLEXIBILITY, DEGENERATION, AND FASCIA THICKENING
"The morphology of the connective tissue may play an important role in locomotor mechanics. Recent research has revealed an association between increased fascia thickness and reduced joint flexibility in patients with chronic pain. The present study aimed to examine the relationship of both factors in healthy individuals, additionally testing the hypothesis that older subjects display a higher fascia thickness. Young [average age 22] and old [average age 69] healthy females were recruited for a quasi-experimental, cross-sectional trial. All participants underwent standardized ultrasound-based thickness measurements of the deep fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of fascia thickness and variable associations (i.e. fascia thickness and flexibility) were detected. Older participants showed higher thickness in the lumbar spine. Correlations of both body mass and fascia thickness, as well as flexibility and fascia thickness were found. Age-related changes in fascia thickness may be a contributing factor of restrictions in joint range of motion."
There are significant numbers of takeaways from this abstract.
- Firstly, we see that fascia can be imaged. Although I've shown you this in the past (HERE), it is neither widely known nor widely utilized here in America; probably because most physicians do not know what to make of the technology or how to interpret the tests yet (and also because it's not typically paid for by insurance companies in this capacity, unless maybe when trying to see TENDINOSIS).
- Secondly; although the changes in fascia thickness were "systematic," the brunt was found in the THORACOLUMBAR FASCIA (where the seven second videos in the first link from the previous bullet come from). Once you begin to understand what this MAGNIFICENT TISSUE really does and how it works to transfer forces from lower extremities to upper extremities and vise versa, you can start to see why when it becomes dysfunctional, the consequences can be numerous and potentially severe.
- Thirdly, when these authors speak of "age-related changes," one of the biggest we need to be aware of is that everything else being equal, older people have more inflammation than younger people. Makes sense once you realize that INFLAMMATION is the collective name of a group of immune system compounds released in response to damaged tissue. While small amounts of inflammation are needed for the normal healing process, too much of a good thing becomes a bad thing --- in this case a very bad thing. What do I mean? For starters, we know that inflammation itself causes a thickening of the fascia that the Steccos have referred to in previous research as "DENSIFICATION". We also know that the 'Cascade of Death' looks almost identical for virtually all disease processes; inflammation ------> fibrosis (scar tissue) ------> degeneration -------> premature death (HERE). Note that when I talk about degeneration in this context, I am not simply talking about musculoskeletal degeneration, but degeneration of organ systems as well.
- Fourthly, it shouldn't come as a surprise that in this study, thickening of the fascia was also related to "body mass". Think about what we already know. Although the numbers are somewhat less in Europe, 70% of the American population is either OVERWEIGHT OR OBESE, with another 7-10% appearing that way via their blood labs (MONW). Not shockingly, weighing too much is considered an "INFLAMMATORY DISEASE" along with a myriad of others from the same family (DIABETES or METABOLIC SYNDROME / PREDIABETES for example). Thus, between their age and weight, huge numbers of suffering geriatric patients already have two strikes against them --- most of the time before they ever realize the third strike is on the way to the plate and they haven't even stepped into the batter's box. Throw in the fact that the single most important factor in health (GUT HEALTH) is also known to decline during the aging process (HERE), creating even greater potential for suffering (or A REASON TO PARTY if you are a drug company).
- Fifthly; although it was not mentioned here, it's not news that "thickening" is seen in any number of other disease processes, CANCER INCLUDED. Also not mentioned here, once you grasp just how inflammatory junk carbs and sugar really are, it's not a shock that SUGAR WOULD BE CANCER'S PRIME FOOD CHOICE.
After putting it all together, the question then becomes; what are you going to do about it? Are you going to continue to live your life in the same old rut, putting on five pounds or so every year or two, while getting increasingly sedentary? Do you feel you may be TOO ADDICTED TO YOUR JUNK FOOD or SODA to take the plunge and actually do something about it? Are you scared of failing? Are you worried that you CAN'T AFFORD IT?
Fortunately, I address each and every one of these issues and many others in my post titled SOLUTIONS FOR CHRONIC PAIN AND CHRONIC ILLNESS: FORTUNATELY THEY ARE THE SAME. No matter what age you are, it's time to get down to the business of taking your life back, because as much as you wish it could be true; while your doctor can keep you loaded up on DANGEROUS DRUGS, he/she can't do this for you. If you are enjoying our site, be sure and spread the wealth by liking, sharing, or following on FACEBOOK. After all it's a great way to reach the people you love and care about most!
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration