The Importance of Fascia
For the last 10 years I have been learning and developing my knowledge of this forgottensubstance. Fascia is found throughout the body and gives us structure, shape and form. The steak eaters among you will recognise the “clingﬁlm” like layers that surround the steak can be seenthroughout the meat, the “marbling” that the butcher gets so excited about. Dig a little deeper andpull a few muscle ﬁbres apart and it will unveil fascia in between each individual ﬁbre.
As we learn our anatomy from traditional text books, many of the superﬁcial layers of fascia havebeen removed in order that we can see the “interesting” stuff underneath. As such, as a youngPhysiotherapist, the importance and abundance of the material passed me by.
Working at the English Institue of Sport and being introduced to the use of Graston Techniquetools, my interest was kindled and I have developed my thoughts and understanding since then.
My original understanding of Fascia was that it was quite a passive structure. I knew it was strongbut I did not think it had any innervation or the ability to change its form.
A fantastic piece of ﬁlm by Dr Guimberteau – “Strolling under the skin”, beautifully demonstrates how this gel like substance is able to adapt to any force applied to it – pull, push or twist, it canmorph into any shape.
It is also an important statistic to realise that 80% of the proprioception cells in the body are withinthe Fascia. Proprioception is the mechanism that constantly feeds back to the brain, to know wherewe are in space.
From what might apear the simple skill of sitting upright to the very complicated skill of walking andrunning there is a massive feedback loop from the body to the brain to increase tension anddecrease tension in the appropriate structures, a) to keep our inherantly unstable skeleton uprightand b) to allow and monitor smooth, co-ordinated movement between all the limbs.
Infact further research is demonstrating that the brain may not be required in this loop. In order tomaintain stability in a relatively simple task such as taking a step forward, the changes need tohappen so quickly that a message from the leg to brain and back again would be too slow and as such the Fascia is able to change and adapt by communicating with itself. This would explain why 80% of the proprioceptive cells sit within the Fascial web.
The Fascial web also deﬁnes our form, our posture. As well as instant change it adapts slowly over a long period of time to respond to the repeated force that it undergoes. Our posture is both partly inherited from your parents DNA, but much is learned through repeated movement patterns. It is ultimately the fascia that decides. Hence, when you try to touch your toes and the Physio / Doctor says you have tight hamstrings, we create an image of “muscle” tightness. However, we shouldhave an image of Fascial tightness, that has responded to repeated load to teach the fascia to beshort and tight. If we accept this restrictiion is primarily fascial it instantly questions how do wechange that length. To me this explains why in this area of high tech medicine we still do not knowhow to do stretching. Many studies have reached the same inconclusive summary, probably because it was looking at how to stretch muscle.
This is supported by histroical evidence that exercise forms like yoga, TaiChi and Pilates areeffective in changing mobility and posture. It works at a low level but recognises combinations ofnormal movementns that gently, and more importantly, repeatedly organise the body at a fasciallevel to allow freedom of movement.
My approach to treatment has been very inﬂuenced by my better understanding of Fascia. In many ways it makes Physiotherapy very simple. By anaylising the way the body moves it is possible torecognise where areas are restricted or weak and therefore compromises optimal movement.
I then use my hands and Graston tools to try to release areas of tension. This is combined withmovement, often in the gym in front of a mirror to reinforce and feel what correct movemnt looks and feels like. It is very important that patients learn and feel what this movemnet is like.
Home exercises are avital part of a treatment package but it is equally important that the patient feels and understands any changes we are trying to acheive.
Working with teams allows you to work closely with athletes on a regular basis. This highlights theimprotance of maintenance. The team environment means that you are able to work in the gym with athletes to try to identify faulty movement patterns and correct them before they causeproblems. For people who are training regularly this can become a vital part of their conditioning.
Recognising good patterns of movement and being able to feel when it is correct, allows athletes/patients do take control and ultimately manage their own risks and weaknesses.
To me that is the basis of what modern Physiotherapy should look like and be based upon.
Thank you for reading.