Fascia…the new target for soft tissue technique application: Part 2 – Understanding Fascial Planes

On my August 12^th post I discussed the reasoning behind our new soft tissue technique, Functional Range Release™, moving away from the “muscle focus” often seen with other techniques, to directing efforts on a new target, Fascia.  I noted that muscle tissue is simply a collection of proteins (actin, myosin, etc.).  These proteins are surrounded entirely by connective tissue that separates them into identifiable fibres, then bundles that increase in size to form the entire ‘muscle’ structure.  This surrounding fascia, is a tough connective tissue surrounding every muscle, bone, nerve, blood vessel, and organ of the body, down to the cellular level forming a web from head to foot without interruption.  Further that the goal of soft tissue therapies has never been to tear muscle proteins apart.  It has been to remove restrictive scar tissue, or fibrosis which is formed by, and within in fascia.  I therefore concluded that the soft tissue therapies that target muscle structure have been ‘shooting’ at the wrong target, and that soft tissue therapies currently being utilized are insufficient in treating the new target…..fascia.

Now….in a quest to re-vamp the way we view soft tissue dysfunction…I will discuss a very important property of fascial anatomy, fascial planes.

Fascia can be categorized into three main divisions:  fascia superficialis, fascia profunda, and ‘deepest’ fascia.

Superficialis

–      a layer of loose connective tissue located beneath the dermis of the skin.

–      Serves as a passageway for nerves, blood vessels, and in some areas skeletal muscle

–      Functions are mainly protective and supportive

Profunda

–       Fibrous layer found beneath the superficial fascia

–       Invests muscles and other internal structures

–       Can be segregated into several investing layers: epimysium (surrounds entire muscle), perimysium (covers bundles), and endomysium (surrounds individual fibers)

Investing layers of muscle tissue: epimysium (surrounds entire muscle), perimysium (covers bundles), and endomysium (surrounds individual fibers)

Deepest

The 'Deepest' fascial layer (aka. the dural tube)

–       Aka…the “dural tube” – surrounds and protects the CNS

In terms of soft tissue application, the Fascia Superficialis and Fascia Profunda are the planes of most interest… note that in most treatment systems, only one is addressed.

Both layers/planes, superficialis and profunda, are capable of sliding.  This occurrence is of utmost importance for normal functional movement as well as force transference.  In deep fascia, gliding over underlying muscle structures facilitates smooth and rapid motion (Wilson et al. 2001).  In addition, physical injuries are avoided when structural layers are able to slide freely.  Conversely, the loss of this sliding capability will have a detrimental effect on function.

The Superficial to deep fascial interface - Yellow superficial fascia reflected and showing its fuzzy relationship to deep fascia. Picture courtesy of The "Integral Anatomy Series Vol 1: Skin & Superficial Fascia, Gil Hedley, 2005" (with permission)

Disruption of the epimysium resulting from physical trauma changes the normal architecture of the underlying components.  The following changes occur in connective tissue following injury:

–       Changes in fibroblast size and shape – number of plump fibroblasts increases

–       Connective tissue becomes denser and more irregular

–       The defined boundaries of the epimysium-deep fascia interface can become obliterated, resulting in loss of effective sliding movement (Kragh et al, 2005)

……and as a result of scarring of the fascia, McCobe et al 2001 also showed that the interface between fascia and muscle will be limited in sliding ability and relative motion.

Some of the other change resulting from fascial scarring include (Kozma et al, 2000 as per Lindsay 2008):

–       An increase in collagen solubility

–       An increase in the ratio of collagen type III to I – collagen type III is more elastic, contains thinner fibrils, and is not as strong as type I; therefore the reduction in type I/III ratio gives rise to fascia with reduced mechanical strength

–       An increase in total glycosaminoglycan (GAG) types (chondroitin, dermatan) as well as an increase in fragmented, damaged, lower molecular weight Hyaluronic Acid (HA) – high molecular weight HA is vital in a wide variety of functions such as cell signaling, wound healing, adjustments in tissue and matrix water…..and lubrication over the epimysial surface vital for proper plane sliding.

Thus histologically, in order to restore proper tissue function, it is imperative that treatments focus on restoring normal fascial plane sliding BOTH between the Fascia Superficialis and Fascia Profunda….as well as between the Fascia Profunda and the underlying muscular tissues.  This will in turn restore the normal force transference through fascial tissue, will help to prevent re-injury, and will allow for re-establishment of functional ranges of motion.

In order to do so, soft tissue practitioners must alter their methods to account for the differing depths, locations, and functions of each layer.  We must also be cognizant of not simply assessing muscle tension, but in assessing relative tissue motion between muscles and other planes of tissue.  As stated in the August 12^th post, it would be easy to then assume that the soft tissue therapies currently being utilized have been working on the fascia and fascial planes all along.  However this assumption is incorrect.  This is because the research that has been performed on fascial tissue demonstrates that it does not respond in the same manner as muscular tissue; which has been the focus of many soft tissue therapies to date (i.e. following ‘muscle protocols’ of shortening and lengthening muscles in a predetermined direction and fashion).  Thus many changes in soft tissue application must be made in order to expect to induce permanent, favorable changes in fascial structure with soft tissue application.

The Functional Range Release™ methods include varied tissue palpation depths, contacts, and procedures to address, improve, and rehabilitate fascial mechanics including relative motion in each of the soft tissue planes.

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