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Key points:
¢ Fascia is a connective tissue that runs like a three dimensional web through the whole body
¢ Osteopaths think it can have an important role in musculo-skeletal problems and health, although its importance is not widely recognised..
Fascia is a tissue (other tissues are muscle nerve, bone, for example) that extends through the whole body. It is a type connective tissue
Fascia is a very important part of the body., although it is often overlooked by health care practitioners who are not osteopaths. It provides structural support and protection..
Fascia is thin, but very fibrous and strong. Anyone who has skinned chicken breasts or trimmed meat has encountered fascia, the whitish coloured thin sheets of tissue between the skin and muscle of the meat. Microscopically, fascia is composed of collagen and elastin. The collagen is arranged in tiny micro-tubules. Fascia is fairly inelastic (not stretchy), so will transmit pulls from one part of the body to another. Fascial connections can sometimes offer an explanation for some bewildering clinical presentations where one are of the body can effect another without there being any known muscle, nerve, or vascular connection.
Fascia forms a continuous network throughout the body and envelops all the organs. It has been said the body is like a geodisic dome, where altering the shape in one area inevitably changes the shape of the whole, and that the forces are transmitted in the geodisic along its struts and in the body alonf the fascia.
There are three layers – from the superficial fascia directly under the skin to the with subserous fascia, deep inside the body
The top layer of fascia is superficial fascia, directly under the skin. It serves as a strong layer of connective tissue between the skin and muscles underneath and is mixed with varying amounts of fat, depending on where it is on the body. The skull and hands have a particularly noticeable layer of superficial fascia which connects the skin to the tissues and bone underneath it. By wriggling your scalp, you can see that superficial fascia is strong but flexible, keeping the skin firmly anchored while allowing its owner to move freely.
Underneath the superficial fascia lies deep fascia, a much more densely packed and strong layer of fascia. It forms and connects tendons, ligaments, aponeuroses, retinacula , joint capsuls and intermuscular septa. It envelopes bone, as periosteum nd endosteum, cartilage, as perchondrium, and blood vessels, as the tunica externa. It covers,divides and protects muscles and nerves.Some areas of deep fascia display particular anatomical arrangements that reflect a more specialised role, eg the plantar fascia of the sole, the thoracolumbar fascia of the back, the anterior cervical fascia at the front of the neck
Deep fascia has few blood bessels, but many sensory nerves that can signal pain, movement, pressure ,chemical changes, and temperature changes. Deep fascia is able to respond to sensory input by contracting; by relaxing; or by adding, reducing, or changing its composition through the process of fascial remodeling. How deep fascia contracts is still not well understood, but appears to involve the myofibroblasts - fascial cells that are created from fibroblasts as a response to mechanical stress.
Deep fascia can also relax rapidly in response to sudden muscular overload or rapid movements in response the stimulation of Golgi tendon organs and Pacinian corpuscles. It can also relax slowly as some mechanoreceptors respond to changes over longer timescales. Ruffini endings respond to regular stretching and to slow sustained pressure. They also contribute to full-body relaxation by inhibiting sympathetic activity which slows down heart rate and respiration.
Like mechanoreceptors, chemoreceptors in deep fascia also have the ability to promote fascial relaxation. Certain chemicals, including hormones can influence the composition of the ligaments. in the menstrual cycle where hormones are secreted to create changes in the uterine and pelvic floor fascia. The hormones are not site-specific, however, and chemoreceptors in other ligaments of the body can be receptive to them as well.
Deep fascia can create tight knots or connective adhesions which act as trigger points which can cause pain If a patient is diagnosed with a condition like myofascial pain syndrome, myofascial means “fascia related to the muscles," Fascial restrictions range from a mild decrease in joint motion range to severe fascial binding of muscles, nerves and blood vessels, as in tibial compartment syndrome. of the leg.
The subserous or visceral fascia lies between deep fascia and major organs of the body..Visceral fascia is less extensible than superficial fascia. but more flexible than deep fascia It suspends the organs within their cavities and wraps them in layers of connective tissue membranes.. If it is too lax, it contributes to organ ptosis yet if it is too tight it restricts proper organ motility.Each of the organs is covered in a double layer of fascia – parietal and visceral . The organs have specialized names for their visceral fasciae. In the brain, they are known as meninges,: in the heart they are known as pericaria ; in the lungs, they are known as pleura ; and in the abdomen, they are known as peritnea Like deep fascia, subserous fascia can also form fibrous knots and adhesions.
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.
There is increasing interest 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.
Recent scientific research in the field of the human fasciae has resulted in several significant findings. In 2009 the first international conference on Research in Fascia is taking place 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.
Among the papers to be presented are:
The presence of contractile cells (myofibroblasts) within the fascial fabric. Clinicians are interested in their role in creating contractile tonus in the fascial fabric, how they form, how they are activated, and their influence on passive muscle tonus.
Biomechanical properties of fascial tissues: creep, relaxation, hysteresis, effect of sustained spinal flexion on lumbar tissues, strain induced hydration changes, myofascial manipulation and fascial viscoelastic deformation.
Mechanotransduction between the cytoskeletal structure within the cell and the extracellular matrix, and its implications for health and disease. Forms of mechanical signaling within the fascial matrix, such as the tugging in the collagen matrix created by twisting acupuncture needles
How fascia is innervated, and how proprioception and pain are created, detected and modulated by the spinal cord and the rest of the nervous system.
Recent ffindings and significant hypotheses in the realms of biochemistry and biomechanics of fascial deformation and reformation.
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