Spine magazine in 1995 for the first time asked the question as to the pathomorphology of fascia in people with chronic mechanical back pain.1 Before this article, for the most part fascia was only described physiologically. Compared to people without chronic mechanical back pain, electron microscopy revealed inflammation or ischemia and degenerative changes within the thoracolumbar fascia. The two researchers reached the amazing conclusion that fascia "may be of relevance to back pain syndromes."
To clinicians dealing with fascia for many years, this conclusion had long since been taken for granted. Numerous articles and courses have been given over the years evaluating and treating this all-pervasive structure. John Barnes, PT,2 makes the bold statement that there is no such thing as a muscle, that it's the fascia that we are dealing with since you cannot separate muscle from fascia.
I agree with his reasoning. He states that muscles are meant to move individually and after an injury such as a quadriceps trauma, for example, there may be internal bleeding. The fascia may become "glued" together, causing muscles to work as a group rather than individually, thereby putting pressure on blood vessels and nerves. Chronically taut quadriceps fascia can be responsible for an anterior pelvis, resulting in a pelvic torsion and all the ensuing consequences.
The fascia which separate muscles also acts as an anchor which muscles can attach to and infiltrates muscles down to the cellular level. The epimysium, perimysium and endomysium are fascia. Cailliet states that each muscle spindle is enclosed within fascia that limits elongation.3 He further states that muscle bundles will only elongate to the extent that their fascial sheath will permit. It is fascial contracture that restricts muscular elongation and joint range of motion.
Fascia is the body's only continuum that hooks us together. It's the most widely distributed tissue of the body. It expresses lamination that tends to go in opposite directions. Fascia expresses mechanical changes such as soldifying and shortening. Fascia expresses biomechanical changes since fluid flows through it and the intercellular spaces affecting the nutrition of tissues. Fascia is related to the nervous system since it contains type C nociceptors and is the cause of entrapment syndromes throughout the body. Fascia surrounds the autonomic nervous system. Fascia is directly related to the vascular system where it may block arterial perfusion preventing normal oxygenation to the tissues, leading to pain (compartment syndrome, for example).
Fascial release can therefore reduce mechanical stresses which are caused by chronic poor posture, inflammation and injury; allow tissues to function more normally by restoring proper nutrition; reduce or eliminate nerve compression causing entrapment; restore normal circulation to tissues; and change the set in the spindles so muscles can work and relax more efficiently. The system is all-inclusive.
The November 1998 issue of Chiropractic Technique printed my article, "Genitofemoral Entrapment Using Integrative Fascial Release (IFR)."4 IFR combines the theories of several clinicians which points out a way of evaluating and treating the fascial system both locally and globally. IFR stresses evaluation and treatment of the fascia as a system rather than evaluating specific muscles.
References
- Bednar DA, Orr WF, Simon GT. Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain: a microscopic study. Spine 1995;20:1161-4.
- Barnes JF. Myofascial Seminars. 1-800-FASCIAL (1-800-327-2425).
- Cailliet R. Hand Pain and Impairment, 4th ed. Philadelphia, PA: F.A. Davis Company, 1994; p. 74.
- Hammer WI. Genitofemoral entrapment using integrative fascial release (IFR). Chiropractic Technique 1998;10(4):169-176.
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