MyoFascial Facts & Fallacies
This is a Response I made to an article posted at IgnitePhysio on Fascia and its proposed properties:
http://www.ignitephysio.ca/underrated-pain-contributor-fascia-may-culprit/#comment-98
Hello Doreen. Here are some comments on Fascia:
I totally agree that the sensory inputs and bio-chemical actions from fascia are probably vast and diverse, contributing greatly to information being processed by CNS & brain. And yes, they were greatly under-reported for way too long.
RE: "…dynamically adaptable and an important tissue in cell regulation…." Agreed there. Fascia, for example, has an amazing ability to stay soft with slow penetration from an outside force or object, yet instantly harden with fast penetration. It is also amazingly flexible (i.e., bend-able) and resilient without losing integrity.
RE: "…Because of this, a pull on one corner of the connective tissue framework exerts a pull throughout the structure…" Here, I would agree that a component of a tensegrity unit can affect other components, even at a distance. I call those "structurally transmitted forces (or strains if pathological)." EXAMPLE, an over-shortened abdominal wall will pull the rib cage down, flatten the lumbar spine, lever the cervical spine forward, causing forward neck & head posture. Then, the neck muscles, anterior & posterior, have to increase tension to A.) hold the head up against gravity and B.) stabilize against the downward force of the AB muscles on the upper front line of the torso. (Structural homeostasis as one muscle or muscle group contracting causes an opposing group to generate opposing force.)
I also agree the heavy innervation of fascia can contribute greatly to neurologically transmitted effects to near & distant parts of the body.
RE: the Sweater Illustration: While I have very high regard to Deane Juhan's work in his excellent book, *Job's Body,* that is one detail I think is not exactly correct or useful. And nearly ALL the fascia people rely on this visualization of the sweater. It's a nice idea. Yet Deane also reports, in the very same book, why fascia cannot be a primary source of postural distortion or imbalance. He describes how under anesthesia, people with significant postural distortion will lose those distortions while under, yet when they return to consciousness, so do the postural imbalances. Therefore, since anesthesia works by inhibiting MOTOR nerves, and the motor nerves act on muscle fibers and NOT fascia (fascia being primarily sensory), then it is primarily neuro-muscular forces producing postural distortions, not fascial forces. (I'll get back to this sweater thing in a moment.)
And, as referenced in your footnote regarding Robert Schleip's work and contractile fibers, if you read other research, he says he worked with people under anesthesia, attempting to change their fascia with manual therapy. He admits that the shape of fascia can-NOT be changed with anywhere near normal forces. He said the point at which fascia changes shape is just before it reaches breaking point, and you are NOT going to achieve that with therapeutic levels of manual pressure or stretching.
And, Schleip reported on the discovery of "contractile fibers" within fascia. Well, turns out in further research these stray contractile fibers are VERY few in number, they usually only show up after an injury to an area, and they are smooth muscle fibers, which do not generate near the pulling power of skeletal muscle fibers. According to the research I've read, the fibers Schleip speaks of are theorized to develop in order to hold damaged tissue together to facilitate tissue healing. But generate structural forces within the muscle or throughout whole body? Not very likely.
This means that while fascia is extremely bend-able and resilient, it is NOT stretch-able, nor is it contractile in any way like the actin-myosin units are. What IS remarkable about fascia is how bend-able it is, yet its very high resistance to extensibility (changing of length without distortion) is what allows it to transmit the actin-myosin generated forces through the facial sheaths, which become the tendons, which become the periosteum, by which they deliver the muscular force to the bones. (I think that ability is just remarkable that fascia can be & do that, by-the-way. I find it quite interesting that some people fervently need to add more properties to fascia beyond what it already does.)
Now, if fascia was NOT resistant to stretch, huge amounts of muscular force would be lost by way of force dispersion when the fascia "stretches," which it does not do much of, for very good reasons. Research over many years, available in many physiology textbooks, puts the maximum stretch-ability of fascia-related components at a maximum of 4 to 7 %, depending on who you read. (I did see 10% somewhere once, but only once.) This probably contributes to the "shock-absorber" effect. Yet muscle fibers can change length up to 150%.
What makes a bone or joint move from internal forces is the synergistic effect of the deeper Musculo-AND-Fascial units whose individual, unique properties, working together, generate contractile force (actin-myosin cells) and deliver that force to the bones (fascial sheaths, tendons, periosteum), as a harmonious, cooperative unit. No duplication of function necessary, that I can see.
RE: "…Other characteristics of myofascial pain include pain that is dull, aching, and often deep…." As long as we remember that the word "myofascia" is interpreted as muscle AND fascia working together (NOT just the fascia located around the muscles), then yes. But as Tom Myers acknowledges very early in his book, too many people think of myofascia as JUST the fascia. Of course, Tom occasionally gives the impression he too focuses on JUST the fascia, which might be a contradiction or misunderstanding, but he at least openly acknowledges the need for, in practice & function if not scientific study, treating muscle and fascia as integrated, synergistic units, not discreet, independent actors in the landscape of the body.
Talking about fascia independently is great for examining its unique characteristics and properties, but not so good when discussing how fascia actually works as a member of a highly integrated & synergistic system, the Pycho-Neuro-Musculo-Fascial-Skeletal system.
RE: Anatomy Trains: Myofascial Meridians and "myofascial continuities" … I like Tom's book a lot. It is very interesting, and there is a lot of good information in it. However, some of his fascial trains I find very UN-useful. For Example, MOST of the people I work with, using Tom's terminology, are shortened up on the FRONT line from the pubic bone UP to the neck & skull. But they are shortened up on the BACK line from the upper, posterior ridge of the pelvis down the posterior portion of the legs.
The VAST majority of Clients I see (as well as therapists who were students in my training programs) present with a posterior tilted or neutral pelvis. (True anterior tilt with excess lordosis is exceedingly rare.) This means MOST of my structural work revolves around assisting the Client in Relaxing & Lengthening the abdominal wall and the hip extensors, which posteriorly tilt the pelvis. If I was following strictly with the Anatomy Trains model, I'd be doing the abdominal wall and hip FLEXORS, or hip Extensors and posterior low-back muscles. But I find either of those contra-indicated in most cases in the early stages of therapy. (There are, of course, exceptions, but my example is the majority of people I and most of the therapists I've ever worked with see, including physical therapists.)
Now, I'm not saying working with the entire front line or entire back line is not warranted in some or even many cases. It depends a lot on what patient or client population you see much of. All I'm saying is the most common postural misalignment in many patient populations is what I've described above.
RE: "…I could feel a definite connection of a shortened fascial line…" Now, my question is, HOW does one feel the difference between the muscle and the fascia in the tissue? How does one observe a "shortening of the fascial line" independently of the muscle fibers encased within the fascial sheaths? They are so intimately interwoven with each other, how can you observe or feel, let along treat them, as independent entities? After 30 years of practicing hands-on therapy and stretching therapy, I've not developed that level of sensitivity to feel or see a difference between muscle fibers and their casings in any practical way. (When speaking of myofascia, fascia is the casing or sheaths of the muscle fibers.)
The hardness we feel in these tissues is in my view generated by actin-myosin cells shortening, increasing internal pressure within each cell. Being water filled, the increased hydrostatic pressure presses outward against the fascial sheaths, in turn creating the hardness of the tissue. It is not one or the other, but BOTH muscle and fascia working together producing that hardened feel of the tissue. If fascia were truly extensible (stretchable) it would disperse that hydrostatic pressure, dramatically decreasing the ability of the muscle to deliver force to the tendon and bone.
And HOW does a fascial line "shorten" without the actin-myosin action of muscle fibers? The pro-fascia advocates are correct in pointing out many things fascia does that previously went unnoticed. HOWEVER, they have bent over backwards trying to prove that fascia can, in and of itself, "shorten" or "contract" sufficiently to cause significant postural distortion.
Any "contraction" of fascia, apart from it's synergistic actions with muscle fiber, is probably due to dehydration, and to the slight hardening effect generated by the action of colloidal molecules that increase the density of the tissue when too much force is exerted too fast on said tissue. There is also, possibly, the hypothesized piezo-electric effect that might have some hardening or tensing action on fascia. Yet with next to or NO motor innervation, and no significant presence of contractile fibers, there is, so far, no evidence that fascia can relax or contract to any great degree on its own.
So, getting back to "…a pull on one corner of the connective tissue framework exerts a pull throughout the structure,…" Yes, but that is not from the structure being distorted through the fascial system BY ITSELF, but by the Synergistic Effect of musculo-fascial properties & forces acting together on bones & joints, sometimes in series and delivering forces several body segments away. But the physiology of fascia, in and of itself, cannot deliver a STRUCTURAL pull at a distance without the muscular force being transmitted through the bones. But again, neurological transmissions are a whole other story.
I'd like to discuss adhesions and scarring, but this has gotten long enough.
Bottom LIne here is I have for many years been mystified as to why the amazing beauty of the system of Fascia & Muscle working together as a synergist, harmonious whole is down-played by the pro-fascia advocates? For some reason, they have an attachment to the idea of fascia doing almost EVERYTHING, and throwing out the magnificent Division of Labor — i.e., unique anatomical & physiological properties & functions — created by nature itself in muscles & fascia.
I think a lot of that is emotional attachment to the ideas of the Founders, Ida Rolf, John Barnes, and others. In Ida's case, she was in turn very influenced by Andrew Taylor Still and Alfred Korzybski, both great thinkers & innovators. But I think, once the unique properties of fascia were highlighted and brought to the forefront, the focus on fascia was over-emphasized at the expense of muscles. In the book, **Ida Rolf Talks About Rolfing & Physical Reality,** Ida is quoted as saying way back when that (approximate quote) "everyone is talking about muscles, and no one's talking about fascia." … Today, the situation is reversed.
Thanks for Reading,
David Scott Lynn (DSL*)
* DSL: Your Hi-Touch Uplink to the Inner-Net*
Inner-Net: Your Psycho-Neuro-Musulo-Fascial System
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