FASCIA and the PAIN CONNECTION

HIGHLIGHTS:

Every structure in the body is wrapped with fascia, including blood vessels, nerves, viscera, meninges, bones, and muscles forming varying depths of tissue in a 3-D metabolic and mechanical matrix. Fascia is a connective tissue that communicates through the fascial continuum providing tension and integrity for fluidity of movement. Thus, it is primary for transmitting muscle force for correct motor coordination while maintaining organs at their originating site. The significance of fascia becomes a factor when practitioners are developing a treatment plan for the wellness and health of patients.


The most subcutaneous fascia, as well as fascia that permeates the entire body and organs, forming the stroma, the neurovascular branches, within the muscles, and deep fascia consist of fibroblasts, embedded in a gelatinous extracellular matrix along with glycosaminoglycans, proteoglycans, and polysaccharides. The superficial fascia is richly hydrated with liquid crystals and communication is via a microvacuolar webbing of vessels and nerves, and is independent of the lymphatic and blood pathways, called the Bonghan duct system thereby allowing ease of communication in the body.


The deep fascia has a well developed vascular and lymphatic system, and contain corpuscles in charge of proprioception.


SO WHY IS FASCIA IMPORTANT?

The fascial continuum

  1. transmits muscle force via fascial integrity for correct motor coordination

  2. creates tension via sarcomeres for muscle activity at different speeds and varying directions

  3. preserves organs at their site

  4. is vital to the body by enabling the individual to communicate and live independently.

When the muscular system is affected by pathologies, systemic disorders, and even epigenetics, the function of the system undergoes a nonphysiological alteration resulting in a decrease of function & properties, thereby causing symptomatology in the fascial system resulting in deteriorating health of the patient. As an example, persistent chronic fatigue for several years can be related to the fascial system. Studies have shown common physiological mechanisms be involved in pain and fatigue when pain perception/sensation from the fascial system are heightened through the central nervous system.

The development of neuropathic pain could come from increased levels of circulating cytokines from systemic pathologies in the connective system. Since connective tissue contains nociceptors, it can directly relay pain signals from mechanical stimuli. In addition, proprioceptors from nonphysiological mechanical stimuli can become nociceptors.


WHAT DOES THIS MEAN:

The fascial continuum can become a source of pain for several reasons:

  1. 1. nociceptors synthesize neuropeptides that can alter the surrounding tissue generating an inflammatory environment

  2. the epineurium, a layer of connective tissue wrapping a nerve, and the perineurium, connective tissue wrapping a bundle of nerve fibers, are innervated by the nervi nervorum, the intrinsic layer of nerve sheaths, can develop pain sensation when in contact with pro-inflammatory molecules causing cyclical pain

  3. for fascia to slide and glide concentrated hyaluronic acid must be present; but, when its quantity decreases or is not regularly distributed, the tissue’s viscoelasticity is compromised activating nociceptors. Hyaluronic acid becomes adhesive and less lubricated. This mechanism could be one of the causes of articular stiffness and pain in the morning related to fascia, not joint pain

  4. when hyaluronic acid is low in concentration or poorly distributed, the tissue is dehydrated preventing catabolites of cellular metabolism from being properly removed

  5. hyaluronic acid deficiency alters fascial pH making a more acidic cell environment due to accumulation of metabolites, thereby affecting fascial slide & glide and limiting the functionality of the ECS, which is vital in maintaining homeostasis.

It is believed that within the ECS, the cannabinoid receptor CB1 is housed not only in the nervous system, but also the fascial system, in fibroblasts, and near the neuromuscular junction to better manage inflammation and pain originating in the fascial tissue with daily remodeling.


CLINIC SCENARIOS:

When comparing patients who suffer from chronic lumbar backache with nonsuffering subjects, research indicates

  1. the presence inflammation of the local fascial area

  2. patients experience degenerating variations of collagen fibers and microcalcifications

  3. 25% increase in thickening of the perimuscular fascial tissue

The thoracolumbar fascia plays a key role in this pathological condition. The decreased ability of fascial sliding in the lumbar area and the morphological changes of the tissue generate a nonphysiological mechanical tension resulting in a lack of coordination in the activation of the muscles and mechanical instability. Bottom line: low back pain. Fascial innervation by the sympathetic nervous system, especially near blood vessels intensifies pain when stress levels rise. Thus, a vasospasm and ischemic pain are likely by-products that affect posture and walking. Muscle anatomy of the thoracolumbar fascia transitions into the gluteus maximus, thigh, leg, and plantar fascia of the foot, and is closely related to the pelvic floor. Thus, instability in the ankle can be hypothesized due to alterations of proprioception of the fascial continuum and the muscular coordination. An aching ankle has been proven to cause urogenital and visceral disorders, such as dyspareunia. The muscular connection between the pelvic floor and the ankle (rectum abdominis, adductor longus and triceps surae), produce hypertoned pelvic musculature. To complicate things even more, the fascial continuum can also develop symptoms in areas far from the origin of dysfunction making it difficult to assess the patient’s clinical scenario. For this reason, a patient must be observed as a sole entity.


NOW WHAT ABOUT THE PAIN IN YOUR NECK:

Research has indicated cervicalgia results in an alteration in the thickness of fascial layers, spinal mobility, and pain because of fascial stasis, a reduced flow of fluids. The cervical spine is of fundamental importance for proper occlusion and postural balance. Dysfunction alters mastication and balance.


Cervical fascia and visual control are closely related: reflexes such as the vestibulo-ocular reflex (eye movement as a result of vestibular information), the optokinetic reflex (eye movement in response to stimulation of visual movement), and the cervico-ocular reflex (occurring when the head is turned, in order to stabilize the image on the retina while the head is moving). Cervical fascial dysfunction will negatively impact these reflexes due to the lack of muscular coordination, and the connection with the cranial fascia.


The occipitofrontalis muscle is connected with Muller’s muscle (levator palpebrae). Because the connective tissue of Muller’s muscle is rich in mechanoreceptors, hyperreflexia translates into hyperstimulation of occipitofrontalis resulting in chronic tension of the head and neck.

Bordoni, B., Zanier, E. (2014). Clinical and symptomatological reflections: the fascial system. Journal of Multidisciplinary Healthcare, 7, 401-411. doi: 10.2147/JMDH.S68308

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