Take a yoga class and chances are you’ll hear your instructor mention the word fascia…in fact, you’re likely hearing it everywhere, from “myofascial treatments” at your favorite spa to celebrities touting the benefits of cupping.
But what is fascia—and what role does it play in your physical health?
Fascia refers to your internal webbing. Located roughly two millimeters below the surface of your skin, it’s made up of connective tissues such as elastic fibers, collagen, glycoproteins, and various other cells (including fibroblasts and fat cells). It stretches throughout your body, keeping your organs, bones, muscles, blood vessels, and nerves in their proper place, organizing your internal system and providing you with the capacity to both move and stay stable. It also plays a major role in your posture and determines where you are most likely to get injured, just as it influences your recovery time. As the author of Anatomy Trains and the leading expert on fascia, Thomas W. Myers says, “You would need a large shopping cart to purchase all the materials you would need to make a body, but connective tissue manages to build all of them—strings, wires, elastics, sheets, sacs, insulating material, bushings, struts, and springs—your connective tissue cells wrestle all of these from three simple elements: water, gels, and fibers.” In sum, fascia is vital to helping you move, perform, and heal.
How Fascia Work
Your “second skin,” as it’s also called, is connected to your muscles, tendons, organs, and ligaments at thousands of contact points throughout your body. Fascia’s fibrous connective tissues are tightly bound together, and can be slippery, wet, and like a robust rubber band inside of you, allowing your body to return to its original position after it’s been elongated, and letting you elongate in the first place. It applies tension and compression to the body material it shields and surrounds (like joints and organs), absorbs shock, and reduces friction from everyday movement. It’s also a superhighway of communication, sending information from your muscles to your organs to your bones, and balancing stressors and counter-stressors in the dance your body needs to be mobile, pliant, and strong.
What Can Go Wrong with Your Fascia—and How Does It Impact Pain?
Fascia is important for dozens of reasons, but one of the biggest of all is that it can be the source of chronic or acute soft-tissue pain.
When people have pain in their bodies, often the site of their pain is not the site of the problem. They may point to their lower back as the cause of their aches when it’s really an issue with their hamstring.
How can this be? Remember: Every bit of you is encased in fascia. Sensitive to all movement, this highly innervated internal matrix bucks the notion of isolation exercises and “chest and biceps” days. All movement—and lack thereof—affects it. It runs in “trains,” or lines, throughout the body, spanning from the bottom of your foot to the top of your head. Neck pain, then, could actually be due to a problem with your hip, or even your heel.
Trauma, disease, inactivity, and more can impact the suppleness and “smooth glide” of your fascia, causing it to “thicken and become sticky,” Harpreet Gujral, DNP and program director of integrative medicine at Sibley Memorial Hospital, told John Hopkins Medicine. When it “dries up” and constricts around muscles, it can decrease agility and cause painful adhesions, or knots, to develop.
What Can You Do to Keep Fascia Healthy?
Luckily, there’s plenty you can do to keep your fascia healthy.
* Fluid Movement. We tend to think we are supporting our muscles when we exercise, which in fact we are. But because each muscle is swathed in fascia—and because fascia hold the majority of your nerve fibers—fluid movements such as dance that engage multiple muscle groups or the majority of your body is one the savviest ways to keep your fascia well-oiled—and keep you able to perform effortless and painless movements. So pump it up at your aerobic dance lessons, Zumba classes, learn how to do the cha-cha or any other type of continuous movement, and enjoy knowing you are also supporting your fascial health.
* Yoga and Stretching. Stretching is often overlooked for more vigorous forms of activity or due to a dearth of time. This is a shame as stretching is one of the keys to maintaining the fitness of your fascia. Why? Because stretching takes the movement of your cells beyond their normal range, and it’s important for you to have full range of motion. At the same time, safe stretching is central to the health of your fascia—not too little, but also not too much. You want to activate it physiologically without over-activating it, which may create scarring and reduce mobility.
That being said, bear in mind that, genetically, we have different fascial tendencies. People who are naturally superflexible tend to have structurally different fascia tissue than people who tend to be stiff. These flexible types need more time to recover from intense exercise because their “mending cells” (the fibroblasts) work more slowly than those who are stiffer and have faster-moving fibroblasts. Knowing the type of fascia you have can help you create an exercise program that is best for your body. Naturally super-flexible people need more strength training, toning, and ballistic stretching (bouncing on a trampoline or jogging) than stretching. Those who tend to be stiff, on the other hand, need more stretching, which is what they will find in a yoga class.
Which brings us to my next point: Yoga’s myriad benefits are widely known, but much of the current research focuses on its effects on the nervous system and circulatory system. Emerging research, some of it helmed by the aforementioned Myers, is concentrating on the wonders yoga can have on your fascial system. Yoga helps to both stretch and ease your inner webbing, while lubricating it at the same time to maintain vibrancy. The lubricating material can change quickly when doing a stretch, and the fascia will ultimately change more permanently when yoga or consistent stretching is done over time.
Indeed, during my training as an Iyengar yoga teacher, I discovered that yoga’s ancient asanas (postures) tap into both the deep and superficial fascial lines of the body. By consistently doing asanas, the fascial lines are released, balanced, toned, and profoundly affected. Those who have chronic soft tissue pains, postural imbalances or stiffness would benefit tremendously by slowly and methodically starting a yoga or stretching practice that impacts on these fascial lines.
* Sleeping—and Rising the “Right” Way. Not just any sleep, but sleeping on a hard bed. Yes, hard. A soft bed may appear welcoming, but it makes it harder to get going in the morning because you’ve been “gelled up” in its cocoon. Also, your fascia become stiff when you don’t move all night long. When you sleep on a hard bed, you have a greater tendency to move during the night, and shifting positions hydrates your fascia. In addition, a good night’s sleep allows your connective tissue cells to do their job of knitting your fascial tissues back together.
When you rise, consider doing what’s known as “pandiculating.” You know when your cat or dog gets up from a long nap and does a big stretch? This is “pandiculation,” and both animals and humans do it. It stretches your body’s fascia and all the nerves that travel in it, literally waking up your sensory-motor system and preparing your body for movement, all while minimizing strain.
* Body Therapies. One of the reasons massages feel so fantastic is that when your massage therapist presses down on your tissue, she or he is pushing blood and fluid out of the area. Then, when the pressure is released, blood and fluid flood back into the area, including more fluid than before. This increases the “glide” of fascia and ultimately improves your range of motion.
Additionally, myofascial release, the body treatment I mentioned earlier, not only increases blood flow to the area being treated but, when done correctly, it can support smooth fascial planes from the tips of your toes to the crown of your head.
Rolfing, meanwhile, a form of deep-tissue fascial massage, supports the release and reorganization of fascia. Typically, a person receiving rolfing goes through a series of 10 sessions with a highly trained practitioner who will address the deep and superficial fascial lines in the body. These sessions have been known to resolve postural and structural imbalances that have plagued people throughout their lives.
Techniques to Release Fascial Adhesions
Learning about fascia, how it works, and its makeup has helped me to understand more clearly how some of the therapies I offer patients work to treat their chronic pain.
* Acupuncture involves the use of fine needles, which are inserted into acupuncture points along meridians (highways of energy, or Qi) in the body. It is not scientifically known how acupuncture works, but I believe part of its efficacy in decreasing pain is due to stimulating blood and fluid to the area where the needle has been inserted. Interestingly enough, in Traditional Chinese Medicine, pain is always associated with what is called “Stuck Qi,” and putting a needle into a painful area releases the Qi and allows for the free-flowing movement of Qi. My feeling is that this ancient technique “unkinks” fascia and allows it to return to its most optimal state.
* Cupping, also part of Traditional Chinese Medicine, is also used to break up stagnant Qi and decrease pain. The treatment utilizes sterile glass or ceramic cups that create a suction on the skin. The cups adhere to the skin either by applying heat to the inside of the cup before placing the cup on the skin, or by suction. The skin and fascia lift up and fascial adhesions break up when the cups are moved along the skin. Note that cupping can sometimes cause bruising of the skin and should only be done by a trained professional.
* Perineural Injection Treatment is a treatment that utilizes 5% dextrose (medical grade sugar) plus sodium bicarbonate in sterile water to treat stiffness and pain. Developed by New Zealand family physician Dr. John Lyftogt, the treatment is performed through small injections that are made along the peripheral nerves. (Your peripheral nervous system is a web of 43 motor and sensory nerves that link the brain and spinal cord to the body.) The dextrose in the solution is believed to block a particular receptor, known as Trpv-1, that releases proteins—or neuropeptides—that generate stiffness and pain. What remains under investigation is if the injected water also promotes the coveted “smooth glide” of fascia. I have seen patients who, within seconds of receiving perineural injections, felt “lighter, looser, and freer,” and the taut, painful, restricted movements in their neck had suddenly diminished.
* Prolozone Therapy utilizes a prolotherapy solution of dextrose, sodium bicarbonate, and procaine (an anesthetic) that is injected into trigger points, where there are fascial adhesions, or joints followed by ozone (a gas that carries extra oxygen). When the ozone gas is injected, it immediately converts to oxygen and water. The oxygen then stimulates the cells to produce more energy, or ATP, and increases growth factors. The water, originally thought to just be an inert byproduct, may also contribute to the smooth glide of fascia. I have witnessed countless patients—as well as myself—experience terrific fascial changes post-Prolozone injections that rolfing and other deep tissue therapies couldn’t touch.
* Foam rolling is a self-treatment in which you use a foam roller to apply pressure to your fascia, thereby urging it to release tension, re-establish the integrity of the tissue, and encourage flexibility.
If movement seems to be a recurrent theme here, that’s because it’s essential to keeping your fascia healthy and gliding. Ultimately, tending to your fascia can change your chronic body-pain patterns, improve your posture, and give you freedom of movement—keeping you healthy and gliding. Through life, that is.
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