What is a Fascia: Connective tissue has conquered science and the fitness scene. Some even consider it a new sense organ. What role does it play in the body and what role does it play in future therapies.
Sometimes he fetched the corpses from the cemetery in the dark of night or cut them straight from the gallows in order to smuggle them into the city. With stories like these, Andreas Vesalius wanted to develop the reputation of an adventurer who is passionate about his research.
In 1539 he even dissected all those executed in the Venetian city of Padua, at whose famous university he was teaching surgery and anatomy at the time.
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He was certain of fame: later he published the mammoth seven-volume work De humani corporis Fabrica on the structure of the human body. It is now considered fundamental to modern anatomy. Unlike famous colleagues of his time, Vesalius is said not to have simply opened dead bodies to remove organs, for example. Rather, he exposed the corpses layer by layer.
In spite of this meticulous approach, a large tissue structure, as we know it today, which is equipped with sensors and which is even involved in movements, did not receive the immense attention it currently has.
Neither did it in the many other anatomy textbooks that followed into the late 20th century. The fascia was mentioned there but never was it examined so closely and brought into focus as much as it has just now.
Bad luck for medicine. But lucky for today’s researchers like Professor Carla Stecco. In 2015, almost half a millennium after her predecessor, the surgeon, anatomist, and movement scientist, also from the University of Padua, published the first atlas of the human fascia system. In it, she describes, illustrates, and maps the previously neglected tissue.
What is a Fascia?
Fascia is connective tissue. They envelop the muscle fibers, fiber bundles, and entire muscles and embed organs, for example as pericardium. For a long time they were viewed as a kind of white skin that surgeons cut through or cut off in order to get to the actual object of treatment in the event of an injury or illness; nothing more than packaging or separating layer.
Skeletal muscle (red) with muscle fibers and bundles, as well as connective tissue (white) fascia
For some years now, however, more and more experts have seen it more comprehensive or, in keeping with the zeitgeist, more holistic: namely as a three-dimensional network of soft, collagen-containing, loose, and dense fibrous connective tissue that runs through the body as a system from the toes to the back of the head. And connects organs, skin, and bones.
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In an expanded definition, some researchers also include tendon plates, joint capsules, ligaments, and tendons. For example in a consensus statement 2018 in the British Journal of Sports Medicine.
The Function of The Connective Tissue
For many, fascia is no longer just a passive covering, but rather a system that reacts actively to mechanical and biochemical influences – which could even cause pain if its function is disturbed.
Can this system be left out in medicine? It would be like ignoring the nervous system or the blood circulation, says Stecco: “In the beginning, everyone still thought I was crazy.” “My father was a physiotherapist and one of the first to use manual fascia therapy.”
The orthopedic surgeon’s focus was not on the knife and the dissecting table, but on the therapy table and palpation – but only when she was unable to help a patient with acute pain in the lower back. Stecco found no obvious cause for his complaints such as tension or a pinched nerve. Only manual fascia therapy finally helped.
It has an external effect on the fabric with pressure and sliding techniques. Stecco was still dissatisfied. She had no scientific explanation for her treatment success: “I wanted to understand how fascia work.
A Source of Pain?
One, if not the most important, finding of the fascia system is that it contains nerve fibers. In an average body, it should contain around 100 million mostly sensory nerve endings, estimates Professor Martin Grunwald from the haptics research laboratory at the University of Leipzig.
Because there are almost as many sensory cells as there are in the skin, some scientists like Dr. Robert Schleip therefore even of the fascia system as a separate sensory organ: “The question is: Which sensory stimuli are conveyed?”
Tissue research in the laboratory: the human biologist Dr. Robert Schleip examines fascia under the microscope
This could, for example, be the perception of one’s own body, such as whether the head is tilted to one side. Schleip worked for years as a manual body therapist, then studied human biology and conducted research as director of the Fascia Research Group at the University of Ulm. In the meantime, he has switched to conservative and rehabilitative orthopedics at the Technical University of Munich.
For example, the large back fascia, also called lumbodorsal fascia, occupies experts like him. Ultimately, it connects the shoulder blades and hip joints and is thus at least indirectly involved in many movements. Could it be a cause of the widespread unspecific back pain?
In tissue studies, researchers found pain-sensitive nerve endings in this fascia. Its structure was also changed in patients with chronic pain. Previously, the results of a US study had shown reduced transverse elasticity. It was published in BMC Musculoskeletal Disorders magazine. An overview study from 2017 names tissue adhesions as a possible explanation for this. They could have arisen because the tissue was previously inflamed or injured.
Another explanation would be that hyaluronic acid, a type of lubricant, became more viscous between the fascia layers due to a lack of exercise. Critics consider this an unproven idea.
The summarized results suggested that the large back fascia is a potential pain generator, so the conclusion of the authors around Schleip and Stecco. It is not clear whether the changed tissue is really causing the pain or is only occurring at the same time. There is a need for further research – this is often the conclusion of fascia studies.
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Because it is not uncommon for results and connections to be more indicative than proof. In addition, some of them come from animal experiments, were obtained with cell samples in the laboratory, or – this has not changed in 500 years of modern anatomy – obtained in studies on cadavers.
The extent to which this can be transferred to living people must then also be examined more closely.
A Slightly Different Muscle?
Can fasciae transfer forces similar to muscles during movements or through treatment by a therapist and thus be stressed? Can you train them specifically?
In fact, fasciae can contract in the test tube under certain conditions. However, the effect in the body is very unlikely and also not biomechanically relevant, said Falk Mörl in a 2016 conference contribution. However, he did not deal with the topic as a fascia researcher, but as biomechanics.
In addition, due to the different definitions, it is often not clear what is actually meant by fascia: The very high tensile strength and little stretchable patellar tendon on the knee, for example, transfers a multiple of the force compared to the very soft and elastic fascia tissue.
“Mechanically, this means that fasciae cannot transmit any decisive forces during physiological movements,” Mörl notes in the critical discussion, “Do we have to train our fasciae?”.
Regardless of this, fascia training is a megatrend. There is hardly a fitness or yoga studio that can do without a course for fit fibers, and the hard foam roll has also found its way into many living rooms.
How Effective is Fascia Training?
In his essay, Mörl criticizes the hype: “Many of the training effectiveness mechanisms currently in the media have not been researched and are largely based on speculation.” He considers statements by experts such as Schleip that fascia training can optimize performance and keep the body in shape as excessive and untenable.
Schleip, in turn, notes that fascia training is often equated with exercises on the hard foam roller. However, it actually means primarily elastic training with springy, swinging exercises, and jumps that are intended to stretch, compress and thereby strengthen the tissue.
He emphasizes, however, “that fascia training should never replace endurance and muscle training, but complement it”. The most sensible is movement training that includes the fascia. Basically, almost any kind of movement is good for the body. And thus for the fascia.
The Prospect of New Therapy Options
Dr. Jan Wilke at the Goethe University in Frankfurt. He has shown that muscle stretching in the calf and thigh muscles also makes the cervical spine more flexible at the same time.
The measured effect could confirm the assumption that fasciae in connection with muscles do transfer forces: Corresponding chains, called myofascial, should run between the legs and trunk, for example.
According to a review by Jan Wilke and a colleague, there is so far weak evidence for specific therapeutic methods. So it has not yet been proven whether targeted fascia therapy actually alleviates symptoms.
Carla Stecco, who is currently investigating receptors for female sex hormones, is also thinking of future therapies. These docking points are also found in fascia and could help to make the connective tissue more elastic and softer – important for pregnancy. In addition, according to Stecco, this could enable the development of targeted pain relievers for patients.
Nevertheless: Stecco does not want to portray fascia as the missing link in the understanding of numerous biological processes, as a potential solution for all possible medical problems, as Mörl criticizes. “In today’s medicine, we often no longer see the whole picture,” she points out, however. Findings of fascia could therefore very well contribute to an understanding of how structures in the body communicate with one another.
Perhaps one day one will think about today’s fascia research what historians say about Andreas Vesalius’ contribution to ancient anatomy: no revolution.
Training With The Role
To relieve tension and relieve pain, so-called fascia training with hard foam rollers has been the trend for a few years. Experts consider it speculative to reduce the resulting positive effects solely on the fascia.
Because when you roll, not only the fascia tissue but also muscle fibers and skin are stretched. This activates various organ systems such as the skin and its receptors, stimulates the metabolism and bone formation, stimulates the nervous system, and also affects the perception and processing of pain.
