What is the fascia?

Structure and Functions

There are three layers of fascia: the superficial fascia, the deep fascia, and the visceral fascia. The superficial fascia, also known as the subcutaneous tissue, is a layer of adipose or fatty tissue that lies under the skin. The deep fascia is a layer of dense, fibrous tissue that lies under the superficial fascia, surrounding and penetrating the muscles, bones, nerves, body organs, and blood vessels. The deep fascia has extensions that stretch from the tendons that attach muscles to bone and lie in broad, flat sheets, called an aponeurosis. The deep fascia is so strong that it is rarely damaged, even in traumatic injuries. The visceral fascia surrounds the body organs, suspends them, and wraps them in a protective layer of connective tissue.

The superficial fascia has the capability of stretching to accommodate pregnancy and weight gain. Usually, it slowly reverts to its normal tension level after pregnancy or weight loss. The visceral fascia lacks the elastic properties of the superficial fascia, since its role is to protect the body organs. It provides for limited movement of the organs within their cavities, while not constricting the organs. The deep fascia contains many sensory receptors that are able to report pain and changes in body movement, in pressure and vibration within the body, in the chemicals produced by the body, and in body temperature.

The deep fascia contracts during the response to a threat, known as the “fight or flight” reflex. This increased tension increases the strength of it. The deep fascia relaxes at times when the body is stressed beyond what it can tolerate and when the body is put in a relaxing position. If the tension on the deep fascia persists, then it responds by adding collagen and other proteins, which bind to the existing proteins. While this increases the strength of the body, it can restrict the structures that it is supposed to protect. Hormones produced by the body can relax the deep fascia. For example, parasympathetic nervous system hormones can trigger its relaxation.

Disorders and Diseases

Due to the presence of fascia throughout the body, many conditions can be caused by its disorders. Some examples are adhesions, carpal tunnel syndrome, compartment syndrome, fibromyalgia, hernia, Marfan syndrome, meningitis, mixed connective tissue disease, myofascial pain syndrome, necrotizing fasciitis, pericardial effusion, plantar fasciitis, pleural effusion, polyarteritis nodosa, rheumatoid arthritis, scleroderma, and tendinitis.

Common conditions that affect the fascia are carpal tunnel syndrome, inguinal hernia, plantar fasciitis (heel spur), rheumatoid arthritis, and tendonitis. Carpal tunnel syndrome affects a small opening through the wrist into the hand. The median nerve and the carpal ligament pass through this opening. Narrowing of the opening pinches these structures and causes pain and numbness in the hand. The treatment includes physical therapy, wrist splints, and possibly surgery. An inguinal hernia is the protrusion of part of the bowel through an opening in the fascia. It protrudes through the openings in the abdominal aponeurosis for the two saphenous veins. Inguinal hernias are treated by surgery to support the aponeurosis in the area of these openings.

Plantar fasciitis is caused by chronic inflammation of the fascia that supports the arch of the foot, leading to calcification on the bottom of the heel. This condition is treated with orthotics or surgery. Rheumatoid arthritis is an autoimmune condition that affects symmetric joints in the body and causes chronic inflammation of the synovial membranes in the joints, leading to joint damage. Many medications are available to treat rheumatoid arthritis, but they suppress the immune response of the body and so have risks. Tendinitis is inflammation of a tendon, often as a result of injury or repetitive use, such as tennis elbow. This condition is treated with corticosteroid injections into the joint, the application of ice or heat, and rest.

Perspective and Prospects

The importance of the fascia has been embraced by practitioners other than doctors of traditional medicine. The fascia forms the basis for therapies such as Rolfing, massage, chiropractic, physical therapy, osteopathy, yoga, and Tai Chi Chuan. In the late 1800s, Sweden’s Pehr Henrik Ling, with his associates, wrote of the relationship of mind and body. His therapy was aimed at improving the mental status of a person by improving their ability to move their body. In 1984, Raymond Nimmo wrote of the importance of treating the fascia, as well as trigger points in the body.

Ida P. Rolf (1896–1979) was a notable pioneer in the understanding of the importance of the body fascia. Rolf felt that the fascia had been largely ignored by the medical community and developed a technique centered on structural integrity and the importance of gravity. Structural integrity deals with the property of the fascia that causes it to adapt to changes in the body, even when the change puts the body off balance, out of alignment, or causes pain. Rolf devoted much of her life to treating those disabled who had not responded to medical treatment. Her therapy is called Rolfing.

Medical doctors specializing in exercise physiology, neurology, and orthopedics are becoming more cognizant of the role of the fascia in the body. However, chiropractors continue to hold the primary role in dealing with problems of the fascia that do not respond to medical treatment. In 2007, the first International Fascia Research Congress was held in Boston, Massachusetts.

Bibliography

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