Did you know fascia has muscle cells within its layers?
This discovery is not new, in fact it has been known for many years. The research suggests that these muscle cells act like smooth muscle cells and enable fascia to contract of its own autonomous accord. These cells are not found evenly throughout the fascial system, hence not all areas of fascia have the same ability to contract. At present there are only a few areas of the human body that have been explored, lumbar fascia being one, fascia lata (thigh) and plantar fascia. Lumbar fascia showed significantly higher concentration of these cells and hence the ability to contract its associated fascia. Where these contractile cells are most concentrated throughout the body is still being defined. There are many in vivo and in vitro studies for those interested – Yahia et al, 1993, Staubesand and Li, 1996, Bhattacharya et al, 2010, Minasny, 2009, Langivin et al, 2001)
These cells seem to be linked to the autonomic nervous system and have shown marked increase in contraction with sympathetic activation (fight and flight). Considering the large psychological contributing factors to lower back pain (Yang et al., 2016; Burgel and Elshatarat, 2017), this is an area of discussion for all Therapists dealing with patients who present with potential psychomotor components to their signs and symptoms. What does this mean? In essence, someone who is stressed, in pain or anxious or in some form of fight and flight (all which activate the sympathetic nervous system), their fascia is more likely to be ‘stiff’ due to its ability to contract when the sympathetic nervous system is activated. Hence the perception of stiffness will be greater, as will that of palpatory assessment.
The research (Sjolander et al, 2002) also suggests that any tensioning of local connective (via fascial contraction in this case) and mechanosensation will have an effect on muscle coordination and reflex regulation of functional joint stability. Thus, soft tissue stiffness changes in fascia might be efficient to impact neuromuscular coordination. This may then disrupt the accuracy of proprioception and coordination and possible contribute to injuries (Panjabi, 2006; Tong et al. 2017). Furthermore, the contraction of these cells, unlike smooth muscle cells, seem to be more prolonged and result in permanent tissue contracture (Bochaton-Piallat et al, 2016) and eventually connective tissue thickening and further cross linking.
What does this mean?
If these cells are activated by the sympathetic nervous system, especially in a chronic sense, then there is likelihood of more permanent stiffness changes to the local fascial system. In the process of this occurring, there will be changes to the bodies ability to coordinate and perceive itself in space (proprioception) – increasing the potential for injury. In certain circumstances it has been proposed that this might be the mechanism that drives pathological Connective tissue contractures such as Dupuytren’s and Frozen Shoulder (adhesive capsulitis).
Although this research is in its infancy, there is enough evidence to suggest that our ‘state of mind’ may play a role in fascial stiffness. Sympathetic overdrive (fight and flight) would increase fascial stiffness and therefore reduce mobility, coordination and proprioception. Conversely, it can be suggested that Parasympathetic activity (Vagal tone for those who love the Vagus nerve) will have the opposite effect of reducing fascial stiffness or ‘tone’.
How does manual therapy effect the fascia’s ability to contract?
We don’t really know. We can only hypothesise and use case studies to try and determine what is achievable and how. It does seem logical that reducing sympathetic drive and encouraging the parasympathetic nervous system (rest and digest – see any Vagus nerve site) will have an effect on reducing fascial ‘tone’. Do we have an effect on the contractile component with ‘fascial manipulation’? That has yet to be determined. But considering long term contractility (based on the fascial systems contractility as described above) seems to increase cross linking between fascial layers, then it is feasible that we can change this scenario. There has been plenty of suggestions that sheer force applied to our fascial system helps destabilise these cross links and allow fascial mobility. And it looks as though our ability to create a positive, safe, relaxing environment for our patients, increasing parasympathetic drive may have a similar effect.
You never know what our hands may or may not be achieving with the human body. And don’t underestimate what our environment, demeanour and expression can do for someones mind let alone their physical body.
Brad Hiskins