It is everywhere in your body, but what is 'fascia'? Discover the biological spandex that helps determine your health.
We are wrapped up in it, but science has long ignored fascia, the connective tissue around organs and muscles. Now it is discovering how this 'biological spandex' affects our health, from chronic pain to immune and digestive problems.
Fascia and Tai Chi?
You will gradually notice subtle changes in your body when you practice Tai Chi for a few years. A good Tai Chi teacher will guide you to become aware of the five inner sensors:
- Condition of the muscles
- Position of the joints
Read this article and discover the connection between the Fascia and the Inner sensors.
Human anatomy is not an area where you expect to find surprises. As early as 275 BC, the Greek physician Herophilus dissected human bodies and gave lessons in anatomy. Vesalius published the first manual on human anatomy in 1534.
Andreas Vesalius (Latinized from Andries van Wezel, 1514 – 1564)
He was a 16th-century anatomist, physician, and author of one of the most influential books on human anatomy, De Humani Corporis Fabrica Libri Septem.
Vesalius is the founder of modern human anatomy. He was born in Brussels, then part of the Habsburg Netherlands. He was a professor at the University of Padua (1537–1542) and later became an Imperial physician at the court of Emperor Charles V.
But in 2022, scientists are making new discoveries about our fabric. For example, they are zooming in on the "fascia". This is a complex network of connective tissue throughout our bodies that some belief could be a new sensory organ.
This tissue was discovered in the 19th century when anatomist Sir William James Erasmus Wilson called it "a natural bandage". Three layers of white translucent tissue rest directly under the skin, deeper under the fat cells and even deeper over the muscles. This 'matrix' of connective tissue surrounds our organs, blood vessels, bones and nerves and consists of strong collagen fibres and more elastic elastin fibres.
There is also more "loose" fascia with fewer fibres but gaps filled by slimy substances: hyaluronic acid, which acts as a kind of natural lubricant, and proteoglycans, molecules that provide a cushion effect.
Fascia is indispensable. Like organic spandex, it holds our organs, blood vessels, bones, nerve fibres and muscles in place and ensures, among other things, that everything moves smoothly and moves with us.
But because all those fibres and layers get in the way when you want to reach a muscle, bone or organ, anatomists and surgeons have been cutting it away without a second thought for decades. The consensus was that it was just packing material.
It is only now becoming clear that all that connective tissue forms one large interconnected whole that is in contact with and influences many different body parts.
If you google 'fascia', you come across all kinds of therapists who treat Fascia in a specific, 'soft' way manually to help alleviate a range of complaints, from chronic pain to "movement and functioning disorders of both physical and psychological nature", as you can read on Fascia.be.
One of the founders of this therapy is the Italian physiotherapist Luigi Stecco. He has treated patients with head, muscle and joint pains for almost forty years. His approach is based on the idea that the Fascia, under the influence of stress, among other things, can become stiff and that all kinds of physical misery can arise as a result. With targeted manual treatments, the layers of connective tissue become supple again, and the pains and discomforts melt away, is the reasoning.
Physio- and kinesitherapists have established that this reasoning is correct. Especially with non-specific complaints such as chronic pain for which no clear cause can be found, people are often helped by 'fasciatherapy'. In addition to the special manual treatments, this consists of movement exercises.
But for a long time, this approach was in the corner of alternative medicine, and it is still there for some. There is no scientific evidence that this therapy benefits the Fascia and can thus relieve pain.
Carla Stecco, Luigi's daughter and orthopaedic surgeon and anatomist at the University of Padova, found this out when she wanted to find out if her father's therapy was based on science.
Carla Stecco then performed more than a hundred dissections on people to better understand the anatomy of Fascia. This revealed that the layers of Fascia are connected like a '3D matrix', giving the body structure and helping it function and move in an integrated way.
Driven by Carla Stecco's work, more and more scientific research has been set up. "I estimate that about a thousand articles a year are published in professional journals," says Philippe Rosier. He teaches fascia therapy at the Fascia College and has a doctorate in the subject.
It has been discovered that there are many types of fasciae (plural) and that Fascia is made up of collagen, elastin and different types of cells such as fibroblasts and the recently discovered fasciocytes.
Receptor of Tension
It also appears that fasciae are full of nerve endings. Expert Robert Schleip (Technical University of Munich) estimates the number at 250 million, just slightly more than the number of nerve endings in the skin. What has long been regarded as an inert shell thus turns out to be a very sensitive body part.
Some even argue that it should be recognised as a new sensory organ specialising in communication about our body's internal state. More research shows how all these nerve fibres in the Fascia enable us to sense pressure, movement, temperature or our position in space, and also pain stimuli are transmitted in this way.*
Note*: These inner sensors are the cornerstones of our Tai Chi School.
The latter is potentially helpful for many people who suffer from chronic pain with no apparent cause. Experiments with volunteers who are painfully pricked in the skin, muscles and Fascia indicate that the nerves in the skin lead to localised, concentrated pain, while those in the Fascia result in more radiated pain. And that is the hallmark of all kinds of chronic pain.
One of these is fibromyalgia, a condition whose main symptoms are fatigue, pain and stiffness all over the body. Some studies suggest a link between fibromyalgia and inflammation of the Fascia.
The widespread complaint of lower back pain may also be related to the Fascia. Even in these patients, doctors often fail to find a cause. Fascia researchers see two potential connections with Fascia. First, it appears that the amount of pain receptors in the Fascia increases the longer this connective tissue remains inflamed. So you become more and more sensitive to a pain for which no cause has been found.
Second, according to Carla Stecco, the "thoracolumbar fascia" plays a major role. It is a diamond-shaped structure at the bottom of the back. "It's like a big receiver of tension in the upper extremities, the abdominal cavity and spine," she tells New Scientist, which recently devoted a cover story to the Fascia. "The sensory nerves in this fascia potentially register that tension as pain."
Research by the US National Institutes of Health also shows that the thoracolumbar Fascia is 20 per cent stiffer in people with low back pain than in others. This limits your movements, and it has been found in pigs.
But preventing the Fascia from stiffening or inflaming is not so simple because it is not just a passive structure. "It is like a tissue that reacts intensively to all kinds of physical stimuli and also to psychological stress," says Rosier.
Under stress, the Fascia even changes its consistency, claims Schleip. In case of high stress, the fight-or-flight response causes a peak of adrenaline. This also causes the production of an inflammatory substance, TGF-beta. When fibroblasts in the Fascia are exposed to this, they turn into myofibroblasts within a few hours, according to this researcher. These are four times stronger cells, but they also make the Fascia a lot stiffer.
And hormones may also play a role. "Estrogen, for example, makes the fascia more elastic," Stecco tells New Scientist. "It's a very dynamic tissue that responds to chemical, hormonal and mechanical inputs. And that together determines how supple or stiff the Fascia is."
The list of conditions associated with stiffened or inflamed fasciae is growing.
"There are few diseases in which the fascia does not play a role," even Frederick Grinnell, professor of cell biology at UT Southwestern Medical School, tells The Washington Post. In the Journal of Bodywork and Movement Therapies, scientists also state that Fascia plays a role almost everywhere in the body. "Every organ, muscle, vein and nerve - there is no structure in our body that is not connected to it," they conclude.
As well as problems with movement and pain, Fascia could therefore be linked to more unexpected conditions such as digestive problems and lymphoedema.
Antonio Stecco, brother of Carla and Professor of Physical Medicine and Rehabilitation (New York University), points to a possible link to swollen arms and legs in a study, as rigid fasciae inhibit lymph flow. Loosening the Fascia could resolve this. Constipation, reflux and stomach distension are also linked to poor fluid flow, according to Stecco, and can be alleviated through the Fascia.
In a study by Harvard Medical School and published in Nature, researchers even see a link to cancer: stretching the Fascia inhibits the growth of breast cancer tumours in mice. But everyone cautions that many more studies are needed to conclude this with scientific certainty.
This is true for all new insights about the Fascia. "This field of research is only thirty years old. There are many leads, but much more research is needed to uncover the exact role of Fascia in all kinds of disorders," says Rosier.
According to Rosier and Carla Stecco, in any case, it is high time that medicine pays more attention to this tissue. "Without proper knowledge of the fascia, the study of diseases is actually not possible," she says.
Meanwhile, more and more studies on potential treatments are coming out. For example, there is research showing how fascia therapy helps people with chronic fatigue, neck pain and disturbed muscle function. It is also what Rosier and colleagues see in practice. "We work with a very gentle manual treatment where the fascia is stretched just enough but not too much so that the tissue itself is encouraged to relax deeply," says Rosier.
In addition, the therapists classically work with 'movement awareness'. "You learn to stand still very slowly when doing a movement correctly so that you feel how it can actually be done without having pain," says fascia therapist Ann Coppe. She too sees people with chronic pain improving thanks to this approach.
Stretching also appears to be a helpful intervention. Helene Langevin (Harvard Medical School) discovered in studies on rats and pigs that stretching lengthens the fibroblasts in the Fascia, which relaxes the connective tissue and reduces inflammation. The test animals had more anti-inflammatory molecules after stretching sessions. A pilot study by Harvard Medical School on healthy volunteers who regularly stretched for an hour would also indicate this.
Whether fascial techniques, including manual treatments, have such an anti-inflammatory effect has not yet been demonstrated. It could be, according to some, that the manual therapies mainly or only warm up the Fascia, making it temporarily more supple. Langevin argues that we need to wait for more studies on what exactly happens with fascia therapy before we can be sure that it does anything beneficial in the long term.
But the fasciatherapists continue their work. "We don't work with evidence-based but practice-based evidence," says Coppe. "We test the experiences and effects that our treatments bring about against the available scientific insights. At the same time, we participate in scientific research. It is not so strange in medicine that clinicians first establish something in practice and only afterwards are there studies that prove it."
Paul Sercu, founder of fascia therapy in Belgium and of the BodyMind Academy, demonstrated with colleagues that fascia fibres change the structure, improve flexibility and reduce pain when they learn to move consciously. "The fascia is really a tissue that makes the connection between body and mind, between the physical stimuli and their processing in our brain," says Sercu.
That is precisely why it is crucial to uncover its secrets. But that is also why fascia therapists are still fighting the label 'alternative medicine'.
"To counter this, the BodyMind Academy and the Fascia College only offer this training to doctors and physiotherapists and participate in research done at universities," says Rosier. He is preparing research on Fascia and lower back pain at the UGent. Sercu is working on a research project at UHasselt.
There is an annual Fascia Research Congress on an international level, where Sercu is speaking this year. "We are still in the early stages," says American expert Thomas Findley (Rutgers Cancer Institute of New Jersey). "Every time a question is answered, new questions pop up." Some scientists find this exciting. Others warn against expecting too much.