From the Vault: “The Direction of Fascia”….discussing the downfalls of various soft tissue treatment systems

Although a current topic of interest, in the past various soft tissue techniques have been developed with the intent on releasing connective tissue and fascia.  However as is often the case, if the target is ill defined, so is the approach.  Historically fascia has been viewed as the tissue that lies on top of the muscles that shares connectivity with the skin.  This led to techniques such as skin ‘rolling’ and ‘pinching’ in order to separate these layers.  As our knowledge of fascial anatomy has grown, it has become apparent that this layer of fascia (the fascia superficialis) is only one of many composing the fascial system……yet many techniques still only address this component.

Literature then came out discussing the complexity of the fascial system noting that fascia in fact fills in any ‘blank’ spaces in the body which are commonly seen in dissection procedures….thus in the living body, there are no empty gaps.  Recall your cadaver dissection lab days.  When investigating the auxilla area, you will recall a ‘lack of tissue’ in the area creating a large, unfilled gap that was lined with muscular tissue such as the subscapularis, serratus anterior, and the latissimus.  In the living body, this gap would be filled with ‘auxillary fascia.’  This realization then lead to another misconception….which later spawned the creation of very unspecific treatment forms (some of which used instrumentation).  The target in this case was ill defined as the assumption was made that fascia had no real direction.  Rather it was deposited in a haphazard manner in order to fill these ‘gaps,’ making it necessary to direct treatment in various, and what seemed to be random directions…many techniques still only address this component.

However, now that our knowledge has grown once again, we realize that there are some components, or planes of fascial tissue where tension can develop in any number of directions necessitating a particular type of treatment – for example, movement of fascia superficialis on profunda (inter-layer sliding™) can develop tension in various directions.  Treatment of said tension would require imparting relative movement between layers.  This form of treatment (which is referred to by F.R. release™ practitioners as inter-layer release™) occurs in the absence of patient movement.  Rather movement is imparted by the practitioner on the superficial fascia, sliding it over the underlying profunda.  Subsequently, there are those fascial components that have ‘direction’ found in the profunda layer.  In this layer, treatments in random directions will not be as effective…..further, treatment techniques that do not  utilize patient motion, as well as impart ‘forces’ allowing relative motion between structures to occur (ie. Approaches where the treatment contact simply slides over the surface of the skin) will not be as effective.

The ‘Direction’ of Profunda Fascia

Figure 1 – electron microscope demonstration of the thicker perimysium bundles surrounding the fascicles (Purslow 2010)

As I have previously written when defining Profunda Fascia, it is “located deep to, but intimately interconnected with the fascia superficialis  This layer is composed of a denser fibrous connective tissue with little fat present.  This layer invests various internal structures including the muscles where it forms the encasing epimysium (surrounding whole muscles), perimysium (surrounding muscular bundles), and endomysium (surrounding indivisual muscle fibers).”  Thus, this layer of fascia in fact roughly follows the direction of the muscle fibers.  In fact, this layer of fascia is known to create the latticework in which muscle fibers lay.  Thus, even when we apply a treatment contact “into a muscle,” we are actually treating the fascial components

Figure 2 – Electron microscope (higher mag.) view showing the endomysial networks (Purslow 2010)

surrounding the muscle fibers…after all, “scar tissue” (ie. Fibrosis) does not accumulate in muscle cells, but rather in the connective tissue/fascia creating the perimysium and endomysium for example(see figure 1 and 2).

What does this mean:

• In order to have a complete treatment system, it must address both of the above-mentioned relationships.

• When assessing for tissue tension in the profunda layer (intra-layer palpation ™), we must utilize movement in order to define a line of tension….the direction of said lines will roughly correspond to muscle fiber direction (as outlined in the Tissue Tension Technique™ – a method utilized in the Functional Range Release™ system).

• Techniques that utilize ‘gliding’ on top of the skin’s surface cannot create relative motion between layers, and thus cannot address fibrosis leading to inter-layer, or intra-layer tension.

• A major portion of Fascia has direction, albeit not entirely specific.

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