What is fascia?
The fascia is the connective tissue that surrounds and connects every muscle and organ, forming continuity throughout the body. The fascia around individual muscles is also known as muscle sheaths. The adjacent picture shows a simplified cross section of the subcutaneous tissue of the body. From top to bottom you see:
- the skin
- a layer of loose connective tissue
- the superficial fascia
- a layer of loose connective tissue
- the deep fascia
- muscle tissue.
Formerly, it was thought that fascia was only a kind of package material. Therefore, most anatomy books provide only a very limited view of the fascia. However, in recent years one has discovered that the fascia serves many essential functions in the body. The fascia is an organ in itself. The fascia transmits a considerable part of the force generated by muscles. The fascia plays an important role in the metabolism and the transport of fluids in the body. The fascia contains blood and lymph vessels and is richly innervated. All external forces working on the body and all forces produced by the muscles cause tension in the fascia, which propagates over certain long ‘lines of pull’ from one place to another. The free nerve endings in the fascia detect this tension and enable this way the cooperation between different muscles. The nerve endings in the fascia also provide information to the brain about the condition of the adjacent tissues. When your fascia does not function properly, that will hinder the functioning of your whole body.
The composition of the fascia
The fascia consists of several layers or membranes. Each membrane consists of collagen and elastin fibres and fluid. The ratio between the different kinds of fibres and the amount and composition of the fluid determine the mechanical properties of the fascia. The membranes are connected by a network of elastin and collagen fibres aka loose connective tissue, which allows — within certain limits — movement between the membranes. In this network there are, among other things, fat cells, interstitial fluid, blood and lymph vessels and nerves. The same vessels and nerves also run through the membranes of the fascia. If this system functions normally, all structures within it can glide along each other without friction. This enables the body to move smoothly and without pain.
Treatment of the fascia
Thanks to the increasing amount of knowledge that has become available about the functioning of the fascia, the treatments have softened considerably. Initially one tried to forcefully stretch the fibres in the fascia. However, according to recent research, movement restrictions in the fascia and nerve entrapments are usually caused by “drying up” of the fascia or by a change in the composition of the fluid. Soft techniques aimed at restoring the hydration of the fascia often have more success that forceful stretching and are more pleasant for the client.
In the course of time many fascial treatment methods have been developed. Almost all practitioners claim that their treatment method enabled them to help clients that had not found benefit from any other method including orthodox medicine. Therefore, it makes sense to know a lot of methods. I myself am familiar with the following:
- Functional Fascial Release
- Kalevala bonesetting
- Classical osteopathy
- Connective Tissue Manipulation
- Myofascial release
- Fascial Manipulation®
Because the fascia and muscles are in close contact with each other, it is impossible to treat them separately. The difference between classical and fascial massage lies mainly in the depth of the massage. Classical massage treats muscles through the fascia, while fascial massage stays more at the surface of the muscles. That does not mean that fascia massage always stays closely below the skin. Part of the fascia lies deeper than where classical massage therapists have learned to treat.
All fascia treatments, also the very softest, can cause pain during the two days following the treatment. Too strenuous physical activity too soon after the treatment can undo the results of the treatment. Please do not visit a sauna or take a sunbath until the day after the treatment. If possible, rest after the treatment and avoid strenuous activity during the first two days after the treatment.
A more detailed description of the above methods follows below:
Functional Fascial Release
Functional Fascial Release is a simplified and shortened version of Structural Integration, which is also known as Rolfing®. These methods aim in the first place to educate the body to have better alignment relative to gravity. In an upright position, you can maintain a good posture with the least possible effort and the strain on the spinal column and all other joints is relieved. The second aim is to eliminate the restrictions in mobility of the fascia. Other places in the body must compensate these mobility restrictions and in doing so, they get overloaded and painful. Functional Fascial Release uses mainly a combination of fascia massage and movements, which are preferably made by the client himself or herself. This way the fascia is stretched and freed from adhesions. I have learned these techniques in the Fascial Release for Structural Balance workshops, which I completed in August 2016.
The treatment of the fascia is an important part of the bone setting in the Kalevala style. The treatment is quite soft, basically pain-free and uses a lot of movement. It affects therefore mainly the fluid in and between the fascial membranes. Compared to the other treatment methods mentioned on this page, the Kalevala bonesetting stays more at the surface and avoids the more sensitive parts of the body, such as the abdomen. In principle the whole body is treated in a session of about two hours. I have been certified in this method since August 2016. There are more forms of bone setting in Finland, but those are less directed at the fascia.
Fascial mobilization and nerve mobilization form part of the classical osteopathy. I have acquainted myself with these soft techniques in osteopathic text books and educational videos. Many of these mobilizing techniques are similar to those used in Kalevala bonesetting, in which I have been trained. Some osteopathic techniques require a deeper touch, which I have learned to carry out safely in the Functional Fascial Release training. Therefore, it is not difficult for me to perform osteopathic mobilizations. In addition, the osteopathy explains the effect of the mobilizing techniques used in Kalevala bonesetting, which helps me in the choice of the techniques as well as in their technical execution.
Connective Tissue Manipulation
Connective Tissue Manipulation or Bindegewebsmassage was developed in 1929 by the German physiotherapist Elisabeth Dicke. The therapist loosens the connective tissue by sliding superficial or deeper layers of the skin, pulling edges of the fascia or rolling skin folds. This removes tension and stimulates the circulation. However, connective tissue manipulation is in essence a reflex therapy, which aims to affect distant organs and body parts via the autonomous nervous system. Characteristic for the pulling techniques is a cutting sensation. The treatment is mainly directed to the back, but is it also possible to massage other body parts with the same techniques. In Germany, this kind of massage belongs to the regular health care.
In myofascial release, the fasciae are slowly and gently stretched until the point where they resist. When the therapist keeps the muscles and fascia in this position for some time, they give up their resistance and allow further stretching. The treatment is basically pain free. I occasionally utilize this method in my massages.
Fascial Manipulation® has been developed at the end of the previous century by the Italian physiotherapist Luigi Stecco. Since several years, this method has also been taught outside Italy. The manipulation is directed at altered, “densified” places in the fascia, which result in restricted and painful movements. These places often correspond to acupoints or trigger points and usually lie at a distance from the place of the symptoms. Deep massage of the fascia at these points restores the mobility and eliminates pain and other possible other symptoms. Fascial Manipulation® distinguishes itself from the other fascial treatment methods described on this page in several aspects: Only specific points are manipulated. The points needing manipulation are tracked down by means of special movement tests. In these points an intentional local inflammation is brought about, which usually lasts two days. I myself treat the fascia in this way only on special occasion and only with the client’s consent. If you want to try out such a treatment, you should rather consider to seek a therapist on the website of the AMF.