Fascial Science - 'The Cinderella of Orthopedic Medicine'

From the International Fascia Research Congress...

About Fascia

Fascia is the soft tissue component of the connective tissue system that permeates the human
body. It forms a whole-body continuous three-dimensional matrix of structural support. Fascia
interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique
environment for body systems functioning. The scope of our definition of and interest in fascia
extends to all fibrous connective tissues, including aponeuroses, ligaments, tendons, retinaculae,
joint capsules, organ and vessel tunics, the epineurium, the meninges, the periostea, and all the
endomysial and intermuscular fibers of the myofasciae.
There is a substantial body of research on connective tissue generally focused on specialized
genetic and molecular aspects of the extracellular matrix. However, the study of fascia and its
function as an organ of support has been largely neglected and overlooked for many years. Since
fascia serves both global, generalized functions and local, specialized functions, it is a substrate
that crosses several scientific, medical, and therapeutic disciplines, both in conventional and
complementary/alternative modalities.
Among the different kinds of tissues that are involved in musculoskeletal dynamics, fascia has
received comparatively little scientific attention. Fascia, or dense fibrous connective tissues,
nevertheless potentially plays a major and still poorly understood role in joint stability, in general
movement coordination, as well as in back pain and many other pathologies. One reason why
fascia has not received adequate scientific attention in the past decades is that this tissue is so
pervasive and interconnected that it easily frustrates the common ambition of researchers to
divide it into a discrete number of subunits which can be classified and separately described. In
anatomic displays the fascia is generally removed, so the viewer can see the organs nerves and
vessels but fails to appreciate the fascia which connects, and separates, these structures.
Clinician Perspective on Fascia

There is increasing interest in certain therapeutic communities in the role that fascia plays in
musculoskeletal strain disorders such as low-back instability and postural strain patterns of all
types, fibromyalgia, pelvic pain, and respiratory dysfunction, chronic stress injures, as well as in
wound healing, trauma recovery and repair. The Fascia Research Congress seeks to present
recent findings that advance knowledge of biomechanical and adaptive properties of fascia that
may account for clinical observations in health and dysfunction.
The expanding worldwide scientific research on the human fascial tissues forms a body of
knowledge pertinent to a wide range of professionals engaged in conventional and CAM
modalities who serve individuals afflicted with specific pathologies or injuries of fascial
tissue. The latest research will further the mechanistic understanding of many manual therapies
and CAM modalities which contact, mechanically manipulate, penetrate, or otherwise involve
fascial tissues.

Andrew Taylor Still, MD

"I know of no part of the body that equals the fascia as a hunting ground."
"All... nerves go to and terminate in that great system, the fascia."
"This connecting substance must be free at all parts to receive and discharge all fluids, and use
them in sustaining animal life, and eject all impurities, that health may not be impaired by dead
and poisonous fluids."
"By its action we live and by its failure we die."
"The soul of man, with all the streams of pure living water, seems to dwell in the fascia of his
body."

The fascia/tendon/ligament system, or the Qi substrate

August 15, 2008 by richard
Flip through any human biology book and you should see that a human body is made up of
different subsystems: the skin, the muscle, the skeletal, the blood circulation, the nervous system.
If it is a medical book, it would even have the lymphatic system overlaid.
What most books miss the most is the most important subsystem for the internal martial artists:
the fascia system. What is the fascia? Imagine a system where it connects to the muscles, the
bones, the tendons, the ligaments, and serve as webbing surrounding all the internal organs. In
other words, the connective tissues that connect to all other systems. The Chinese word for it is
membrane, suggesting its nature.
The acupuncture meridians, unsurprisingly, map to the fascial pathways, and unsurprisingly, the
abdominal area is a nexus of fascia materials. The kicker? Take a look at a book on fascia
anatomy book (*), and compare the major fascia systems with for example, Chen Xins famous
drawing of the silk reeling spiral Qi lines.
Make you think. Doesnt it?
Then consider the fact that to most people, fascia is not even on their radar screens. If they pay
any attention at all to the connective tissues, its to avoid injury. Very few training exercise is
specific to this area. No wonder most people do not get internal martial arts.
Among other documents, the Yangs 40 Chapters makes it clear that Qi travels in the fascia,
tendons, ligaments connective tissues, hence the heading of this blog entry, the Qi Substrate.
(*) Anatomy Trains, by Meyer is a good one.

the "theory" (on Theory page): "The Acupuncture System and The Liquid Crystalline
Collagen Fibres of the Connective Tissues" by Mae-Wan Ho, director of Institute of Science
in Society (ISIS at www.i-sis.org). Her assembly of research material, some of it her own,
virtually creates the scientific support infrastructure for the Fascia Memory Theory. Her interests
include conductivity, resonance or 'coherence', and healing via cellular alignment. Here's a series
of excerpts from "The Acupuncture System and The Liquid Crystalline Collagen Fibres of the
Connective Tissues":
"According to Becker (1990), the DC body field is not located in the nervous sytem
itself, but in "perineural" tissues such as the glial cells in the brain and spinal cord, and
the schwann cells encasing the peripheral nerves. This hypothesis would seem to conflict
with the suggestion that the DC body field is correlated with the acupuncture system.
...Also, an electrodynamical field can be detected in all early embryos and in plants and
animals which do not have neural or perineural tissues (Burr and Northrup, 1935). It is
likely that the DC field is functionally interconnected with the nervous system, and yet
exists, to a large degree, outside the nervous system. In fact, it is widely recognized that
under a variety of conditions, the speed of communication in our body is much faster than
can be accounted for by the known speed of nerve conduction (see Ho, 1997a), and nerves
simply do not reach all parts of our body. ...we recently discovered that the living
continuum is liquid crystalline, with all the properties that make liquid crystals ideal for
intercommunication (Ho et al, 1996; Ho, 1997a). [various important lead-up points &
references skipped]... Liquid crystals typically undergo rapid changes in orientation or
phase transitions when exposed to electric (and magnetic) fields - which is why they are
widely used in display screens. They also respond to changes in temperature, hydration,
shear forces and pressure. Biological liquid crystals carry static electric charges and are
therefore also influenced by pH, salt concentration and dielectric constant of the solvent
(Collings, 1990; Knight and Feng, 1993). [various important lead-up points & references
skipped] ...It is already widely recognized that all the major constituents of living
organisms may be liquid crystalline (Collings, 1990) - lipids of cellular membranes, DNA,
possibly all proteins, especially cytoskeletal proteins, muscle proteins, and proteins in the
connective tissues such as collagens and proteoglycans (Bouligand, 1972; Giraud-Guille,
1992; Knight and Feng, 1993). Recent nuclear magnetic resonance (nmr) studies of muscles
in living human subjects provide evidence of their "liquid-crystalline-like" structure (Kreis
and Boesch, 1994). [various important lead-up points & references skipped] ...Hardy
suggested in 1927 that molecular orientation may be important for living protoplasm, and
Peters, two years later, made the explicit link between molecular orientation and liquid
crystals. Needham, indeed, proposed that organisms actually are liquid crystalline. But
direct evidence for that has only recently been provided by Ho and coworkers ( Ho and
Lawrence, 1993; Ho and Saunders, 1994; Ho et al, 1996). who successfully imaged live
organisms using an interference colour technique that amplifies weak birefringences typical
of biological liquid crystals."
The noted references have been put below in the section, "References from Mae Won
Ho".

- Tissue level: Fascia is densely innervated by mechanoreceptors which are responsive to manual
pressure. Stimulation of these sensory receptors has been shown to lead to a lowering of
sympathetic tonus as well as a change in local tissue viscosity (Schleip, 2003a, 2003b). Schleip
et al. (2005) suggest that fascia may be able to actively contract and relax in a smooth musclelike manner and consequently influence musculoskeletal dynamics. The ability of fascia to
smoothly glide and move on other tissues can be compromised, producing restrictions, and
suggesting therapeutic possibilities (Fourie, 2008).
- Muscular level: Fascia is involved in force transmission from one tissue to another, which can
explain how the body functions, and how manual methods can be used to influence distant
tissues (Rijkelijkhuizen et al., 2005).
In many bodywork books, myofascial release techniques are claimed to be able to alter the
density, tonus, viscosity or arrangement of fascia through the application of manual pressure or
stretching (Barnes, 1990). This is elucidating the tissue release that is felt by therapists hand.
Chaudhry et al. (2008) presented a mathematical model for the deformation of fascia, their
calculations reveal that the palpable sensations of tissue release that are often reported by manual
therapists cannot be due to deformations produced in the firm tissues, for example, plantar fascia
and fascia lata. Studies have also shown that either much stronger forces or longer durations
would be required for a permanent viscoelastic deformation of fascia (Schleip, 2003a). Fascia
nevertheless is densely innervated by mechanoreceptors which are responsive to manual
pressure. They hypothesized that palpable tissue release is more likely the result of reflexive
changes in the tissue tonus. The mechanical forces generated by therapists may stimulate fascial
mechanoreceptors which may, in turn, trigger tonus changes in connected skeletal muscle fibers.
Schleip (2003a, 2003b) presented a comprehensive review on the neurobiology of fascia and
provide a theory on how myofascial release works. Fascia and the autonomic nervous system
appear to be intimately connected. Fascia is densely innervated by mechanoreceptors which are
responsive to manual pressure. Myofascial manipulation involves a stimulation of intrafascial
mechanoreceptors which are then processed by the central nervous system and autonomic
nervous system. The response of the central nervous system changes the tonus of some related
striated muscle fibers. The autonomic nervous system response includes an altered global muscle
tonus, a change in local vasodilatation and tissue viscosity, and a lowered tonus of intrafascial
smooth muscle cells.

A review by Cottingham (1995) showed that Alexander technique and Rolfing treatments can
alter the neural control of movement in the direction of sub-cortical and spinal levels, away from
the conscious cortical influence. These studies indicate that certain body procedures lead to the
inhibition of conscious control over habitual movements, allowing the more unconscious,
spinal and subcortical levels of movement patterns to dominate.