Fascial Structure As However, Fascia Is a Fibrous Connective Tissue Whose Importance Has Long Been Neglected

www.amtamassage.org/mtj 73 - body mechanics body by Joseph E. Muscolino E. Joseph by standing of the structure and function of superficial and deep fascia throughout the body yields standing of the structure and function of superficial and deep fascia throughout important implications for manual and movement therapies. fascial structure as However, Fascia is a fibrous connective tissue whose importance has long been neglected. important to our body of research has expanded, it is now understood that fascia is critically be long before the structure and function of the musculoskeletal system. Indeed, it might not . An under the term musculoskeletal system is replaced by the term myofascioskeletal system 74 mtj/massage therapy journal spring 2012 body mechanics 2010 mtj. 1 For ofmuscularfascia, moreonthestructure seethebodymechanics column“reversing anatomy: from musclestomyofascial meridians”intheSummer forces. forces, buttoalsocreate can functiontonotjust the production of the contractile protein actin, fascia to pullingforcesandtransitionintomyofibroblastsvia postures. Becausefibroblasticcellsoffasciacanadapt ing) forcesthat hold structuresin their appropriate tensegrity model: refers tothetensile(pull the body is provided by fascia via what is known as the throughout the body. Indeed, much of the stability of nature, fascia can mechanically transfer pulling forces structure ofthebodyaswell.Duetoitsstrongtensile the body. Itappearstoalsobeaprincipalfunctional Fascia iscertainlytheprincipalanatomicstructureof Fascial Web Function soft tissues. and therefore its pulling force, is exerted into adjacent updated: approximately30%ofamuscle’s attachments, simply attachesintobonesviaitstendonsneedstobe force. Itisclearthattheclassicmodelofamuscle and othersofttissues,causingalateraltransmissionof brous slipsthatattachlaterallytoadjacentmusculature fascial meridians(Figure1).Musclesalsosendoutfi- other, formingmyokineticchains,alsoknownasmyo oriented endtoareusuallycontinuousintoeach fibers ofthetendonscontiguousmusclesthatare planes, andothermuscles.Forexample,thesuperficial soft tissues,includingligaments,jointcapsules,fascial of amuscle melding oftheendomysia,perimysia,andepimysium its bonyattachmentsareactuallycontinuationsand tendons or aponeuroses of amuscle that connect it to sial sleevesthatcontainthemusclesthemselves.The sial sleevesthatcontainmusclefascicles,andepimy sleeves thatcontainindividualmusclefibers,perimy gral tothemusculatureitselfbyprovidingendomysial planes wraparoundmusculature.Fasciaisalsointe adipose (fat)tissue.Deeperwithinthebody, fascial where itcreatesahoneycombstructurethatcontains Superficially, itislocateddirectlybeneaththeskin Fascia islocatedsuperficiallyanddeepwithinthebody. responsible forthecohesivenessandunityofourbody. all tissues of the body. Simply put, it is fascia that is our body, providingapervasivewebthatinterconnects Fascia isaconnectivetissuethatwrapsandenvelops Fascial Web Structure bers andthereforefunctionsas amajorsensoryorganof Further, muscleshavefascialattachmentstoadjacent Fascia isembeddedwithpain andproprioceptivefi 1 . passively transfermechanical active mechanicalcontractile ------OFTEN ATTACH INTOEACH OTHER. FUNCTION, 2ED. ST. LOUIS, ELSEVIER /ILLUSTRATED BYJEANNIEROBERTSON FROM MUSCOLINOJE:KINESIOLOGY, THE SKELETAL SYSTEM AND MUSCLE

therapy. Available onlinenowatamtamassage.org onnumeroustechniquesrelatedtofascial information skills. Thecomprehensiveprogramoutlinesfundamental in theprofessionwhileadvancingtheirknowledgeand programaimstokeep massagetherapistscurrent part Fascial Therapy ContinuingEducationProgram.Thistwo- has youcovered withits is difficulttobreak. easily broken, abundle whereas asinglerodis through unitybecause represented strength symbolism ofthefasces of authority. The ancient Romansymbol an axe, andwas an was abundleofrodstied(bandaged)around derives fromtheLatinwordfasces,which fascism Theterm and connectsstructures. because like abandage, itwrapsaround bandage. origin, fascia, whichmeans share thesameLatinwordroot fasciaandfascism The terms fascial therapy? on education course in-depth continuing FIGURE 1.THEMORESUPERFICIALFIBERSOFMUSCLES

Looking foran Bone Fascial tissueissonamed AMTA

muscle A Tendon of muscle B Tendon of fibers Continuous

PART ONE PART

AMTA FASCIAL THERAPY CONTINUING EDUCATION PROGRAM EDUCATION CONTINUING THERAPY AMTAFASCIAL FUNDAMENTALS OF FASCIAL THERAPY: FASCIAL OF FUNDAMENTALS www.amtamassage.org/mtj 75 ------Epidermis Dermis bers Supercial retinacula cutis Fat Supercial fascial membrane Deep retinacula cutis bers Deep fascial membrane Hyaluronic acid layer Epimysium Muscle superficial fascia, we see that we fascia, superficial Examining the fibrous the Examining that runs parallel it is composed of a fibrous membrane this membrane is given differ to the skin. Even though example, for ent names in different regions of the body, fascia in fascia in the abdomen and cribriform Scarpa’s en the throughout continuous is it thigh, proximal the membrane tire body (Figure 3). The superficial fascial and passage is important because it provides channels vessels to ways for nerves and blood and lymphatic These neurovascular ves travel throughout the body. the superficial branches through sels send perforating fascial membrane to feed the tissues of the region. An implication for health is that if the membrane is placed under tension and consequently stiffens, it could poten tially pinch off and restrict flow within these vessels: in could cause sensory abnormalities impinged nerves cluding numbness, tingling or pain; impinged veins and lymph vessels could create congestion in the region by causing the buildup of metabolic waste products; and arterial impingement could cause ischemia, denying lo cal tissue of its nutrient supply. Retinacula Cutis Fibers The superficial fibrous membrane is connected to the skin via superficial retinacula cutis fibers; and it is con nected to the deep fibrous fascial membrane via deep - - - - CROSS-SECTION FROM THE SKIN TO THE MUSCULATURE, SHOWING FASCIAL MEMBRANES AND FASCIAL SHOWING THE SKIN TO THE MUSCULATURE, FROM FIGURE 2. CROSS-SECTION

RETINACULA CUTIS FIBERS. CUTIS FIBERS. RETINACULA Superficial Fascia Superficial Superficial fascia, also known as subcutaneous fascia is skin, the beneath immediately located is it because Some sources by various sources. defined differently is that membrane fibrous the just as narrowly it define located between the skin and the initial deep fibrous fas ture of the body and the meridians of energy flow that flow of energy meridians the and body of the ture are the basis of acupuncture and acupressure. cia layer that envelops the musculature. Other sources include the superficial and deep retinacula cutis fibers that connect to the superficial fascial membrane as part of the superficial fascia (Figure 2). Defined either entirely composed is fascia superficial ways, these of because adipose and other of fibrous tissue. However, cells, as well as molecules (e.g., glycosaminoglycan mol ecules) often occupy the spaces between the retinacula cutis fibers, some sources include all the tissue in this region as superficial fascia. Because these other cells and molecules are loosely organized, subcutaneous fas cia may be described as loose fascia or areolar fascia. the body as well. Interestingly, fascia is also embedded fascia is also the body as well. Interestingly, when motor fibers. And autonomic with sympathetic can cre- fascia applied into consider that pressure we electric charge ate a piezoelectric effect, and that this web, fascia may can then be conducted along the fascial physical struc prove to be the missing link between the ILLUSTRATED BY GIOVANNI RIMASTI. (MODELED FROM AN ILLUSTRATION BY STECCO.) AN ILLUSTRATION (MODELED FROM RIMASTI. BY GIOVANNI ILLUSTRATED 76 mtj/massage therapy journal spring 2012 Canada inMarchof2012. Vancouver, BritishColumbia, Congress willbemeetingin Fascialthe 3rdInternational Tom Further, andothers. Myers Schleip, Tom Findley, GilHedley, well asSergePaoletti, Robert Antonio, Stecco, andCarla as have ofLuigi, alookatthework body mechanics

the skin and the superficial fascial membrane, tech to this phenomenon. In the case of adhesions between lieve thatthe this couldbecomethesource ofpain.Somesourcesbe fascia, tugging at it. Given fascia’s sensory innervation, pressure appliedtotheskinwouldbetransferred the skintoslidealongthesedeepertissues.Further, any skin tothefascialmembranesdecreasesabilityof membranes canbecome“glued”together. Binding the viscosity, thentheskinandsuperficialdeepfascial that iftheconnectivetissue is dehydratedandlosesits sively restrictmotionandnegativelyimpactfunction. retinacula cutis can beviewed as adhesions that exces other regionsofthebody, increasedthickeningofthe palm ofthehandandheelfoot.However, in each other;thisnaturallyoccursandisdesiredinthe by firmlyadheringtheskinandfascialmembranesto they canformverticalseptathatacttorestrictmotion and deepfascialmembranes.However, whenthickened, for sliding motionbetween the skin and thesuperficial retinacula cutisfibers.Thesefibersallow SEATTLE, 2006, EASTLANDPRESS) ANATOMY,DYSFUNCTION ANDTREATMENT, (MODELED FROM PAOLETTI, S: THE FASCIAE: ILLUSTRATED BYGIOVANNI RIMASTI EXTREMITY. FIBROUS FASCIA OFTHELOWER For moreonfascia,

FIGURE3.SUPERFICIAL It iscommonlyasserted,andindeedmakessense, tender pointsoffibromyalgiamaybedue

- - - niques suchasskinrollingwouldlikelybeverybenefi pH tomakethetissuelessacidic) alsoreversesentan- been foundthatincreasedalkalization (i.e.,raisingthe to dehydrateandthereforestiffen thetissue).Ithasalso be moreeffectivethandryheat becauseitislesslikely along each other (it should be noted that moist heat may the body’s fascialinterfacestomoreeffectivelyglide ing and soft tissue manipulation. Increased heat allows likely explainstheefficacyofusingheatbeforestretch found toreversehyaluronicacidentanglements.This of hyaluronicacidandneckpain. found arelationshipbetweenincreasedconcentrations decrease range of motion. A research study has even sions thateffectivelygluethetissuestoeachotherand ingly bond with each other and entangle, creating adhe- opposite occurs. Thehyaluronic acid molecules increas- creasing lubricatingviscosityandthereforemotion,the of hyaluronicacidproduction.However, insteadofin or excessiveexercise,thedeepfasciaincreasesitsrate physical stress,perhapsduetoposturalstrains,overuse, tween them.Whenthisregionissubjectedtoexcessive of theunderlyingmusclesothatglidingcanoccurbe between the deep fascial membrane and the epimysium cial membrane.Itspurposeistolubricatetheinterface molecule thatiscreatedandsecretedbythedeepfas between them. Hyaluronic acid is aglycosaminoglycan is usuallya layer of hyaluronic acid molecules located brane istheepimysiumofmusculature;however, there deep retinaculacutis.Deeptothefascialmem- is connectedtothesuperficialfascialmembraneby not located).Asdiscussed,thedeepfascialmembrane osteum oftheboneinregionswheremuscletissueis musculature that is deep to the skin (or envelops peri The deepfascialmembraneenvelopstheunderlying Deep Fascia can resultindecreasedmobilitybetweenalllayers. or increased thickening or densification of these tissues of thesuperficialfasciaandskin.Ofcourse,dehydration underlying deepfascia(andmusculature)independent fascial membrane.Thisallowsforgreatermotionofthe brane ismoreadherenttotheskinthanitdeep (see Figure2).Asaresult,thesuperficialfascialmem ficial fascialmembraneandthedeep ally thinnerandorientedobliquelybetweenthesuper membrane. Thedeepretinaculacutisfibersaregener dicular directionbetweentheskinandsuperficialfascial The superficialretinaculacutisfibersruninaperpen cial. It isimportanttonotethatincreasedheathasbeen ------