Fascia has more ground substance than other forms of connective tissue, which causes it to move between a sol and gel state easily when manipulated by massage techniques. The superficial layer of fascia is often compared to a knit sweater that wraps the entire body to explain how fascia links all body regions together. Tension in one area of the body sweater influences freedom of movement and function in all other areas. For example, massage therapists often report that clients complain of pain in a particular region. The massage therapist massages all of the structures in that region over numerous massage sessions, but the client doesn’t improve significantly. Why not? More often than not, the pain is being caused by structural tension in a region removed from the area where the pain is experienced. The fascial network disperses the stress caused by the mechanical dysfunction throughout its web. In order to decrease the pain, the therapist must address the root cause of the pain. This means that the therapist must identify the tension pattern, wherever it is occurring, and correct that imbalance to decrease the client’s pain.

Functions of Fascia

Fascia performs many important functions in the body including structural integrity, protection and shock absorption, immune defense, and cellular exchange processes.

Structural Integrity

Fascia maintains the structural integrity of the body in many ways. It separates individual structures without losing the cohesion between them. We see this in the way that fascia wraps individual muscle fibers, fascicles, and individual muscles and then weaves them to tendons to attach muscles to bone. When you think of fascia, imagine a continuous network of connective tissue that links all of the different organs and regions of the body into wholeness. It provides the underlying supportive structure of blood vessels, lymph vessels, and nerves, defines the shape of organs, and tethers them in their proper places within the organism. Many authors comment that if all of the body’s organs, the blood vessels, the nerves, the muscles, and even the skeleton were removed, the remaining fascia would provide a comprehensive outline of the human form.

Tensegrity

Tensegrity, a term coined by architect and designer Buckminster Fuller, has been adopted by massage therapists and bodyworkers. Fuller’s architecture was based on a geometrical model in which structures maintain their integrity because of a balance of continuous tensile forces throughout the building.4 Tensile forces refer to stretching forces (tension) pulling at both ends of a structure. Fuller was famous for the geodesic dome, in which a network of intersecting triangles distributes the stresses of gravity across the entire structure, making the whole dome stronger as a complete unit than the individual components are on their own (Fig. 20-2).

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Compare this tensegrity model to a brick wall. The brick wall is formed when bricks are stacked one on top of another and cemented together, transmitting the weight of the structure to the earth. The forces are compressive as opposed to tensile. Not long ago the body was viewed like that brick wall, and it’s easy to understand how this misconception occurred because the head is stacked on the vertebrae, the vertebrae are stacked on each other, the femurs are stacked on the tibial bones, and the tibial bones are stacked on the calcaneus and talus bones. In this model of the body, stress to one structure is localized. For example, a light pole could fall on a part of our brick wall and only damage one small section of the wall. Similarly, a shoulder injury was viewed as an injury that affected just the shoulder region.

If we view the body as a tensegrity structure, however, we better understand the relationship of all body parts to each other and recognize that a shoulder injury is not localized to the shoulder region but affects every other body structure on some level. In the tensegrity model, muscles, tendons, and fascia provide the continuous tensile forces that maintain the upright structure of the skeleton against the forces of gravity and allow changes in tension to create movement. The head and neck form an inverted triangle connected to the triangle created by the shoulders and trunk and to the triangle created by the pelvis (Fig. 20-3). The configuration of these triangles disperses gravity and absorbs and distributes compressive forces.

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Ida Rolf was the first to help us understand that when myofascial tension is balanced, the body is best able to disperse and effectively use the forces of gravity. If one set of muscles exerts tension in one direction, the opposing muscles must exert tension in the opposite direction or the structure may begin to bow and demonstrate postural misalignment. The two sets of tensile forces must be equal or balanced for optimal function. Uneven tension places the entire structure under pressure and weakens it. The goal of massage is to ensure balanced tension so that the support beams (skeleton) and cables (muscles and connective tissue) can maintain their structural integrity.

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<TITLE>Concept Brief: Tensegrity

• Balance of continuous tensile forces = stretching (tension) at both ends
• Muscles + connective tissue = continuous tensile forces on skeleton
• Opposing muscles = sets of tensile forces: opposing tensile forces must be equal for balance and optimal function
• One set tensile forces excessively strong + other set weak = structure misalignment and stress
• Aligned inverted body triangles disperses gravity, absorbs shock, distributes compressive forces
• All body parts are related to each other and affected by each other (injury is not localized)

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Protection and Shock Absorption

The adaptability and variation of connective tissue in different regions allows it to play a fundamental role in protecting the body from dangerous forces. For example, in the periphery, the fascia tends to be thicker and denser. When a body area is under repeated stress, thickened fascia starts to replace muscle to cope with the heavy load. The viscoelastic properties of fascia and other connective tissue allow it to act as a shock absorption system throughout the body. This shock absorption goes beyond the function of cartilage like the meniscus in the knees or the fibrocartilage disks between the vertebrae. The fascial support system dampens and disperses the forces to which the body is subject, bufferng organs and diffusing compressive energy along multiple channels to minimize its impact.5

Immune Defense

Earlier we discussed the components of connective tissue and explained that macrophages, plasma cells, and leucocytes occur in connective tissue. These immune system cells fight pathogenic organisms and infections in the ground substance of connective tissue. Deane Juhan points out in Job’s Body that compartments of fascia throughout the body assist in preventing the spread of infections, diseases, and tumors because each compartment attempts to contain destructive agents and wall them off from other compartments.6 Some researchers note that certain internal conditions may negatively affect the quality of ground substance, and this may cause the cells its supports to become dysfunctional, pathological, or malignant.7 In addition, the immune function of the ground substance is altered, leaving the body vulnerable to disease and infection. Massage improves the quality of ground substance and thereby supports immune function.

Cellular Exchange

The ground substance of connective tissue is in contact with most cells in the body and makes up a good part of the intercellular fluids where many metabolic exchanges take place. Nutrients are passed from capillaries to cells and wastes are passed from cells to capillaries for removal across these fluid spaces. Good nutrition and proper hydration are important to maintain the health of ground substance to facilitate cellular exchanges. This is one reason massage therapists often suggest that clients increase water intake when healing from a soft-tissue injury.

Location of Fascia

We already know that connective tissue occurs throughout the body. Fascia is often described as occurring in layers or at specific depths in the body, but in reality fascia occurs at every layer because the body is a three-dimensional structure. For ease of discussion, this text describes a superficial layer of fascia and the deep layers of fascia. A brief look at fascial planes, bands, and chains helps us understand how myofascial tension in one body region affects the local area and also the function of distant but related regions.

Superficial Fascia

As the name suggests, superficial fascia occurs just below the skin and anchors the skin to underlying structures. It covers the body in different thicknesses depending on the location. On the back of the hand and top of the foot it is thin, while on the abdominal wall it is thick. The superficial fascia is composed of areolar connective tissue (remember that areolar refers to tissue that is loosely and irregularly arranged) and adipose tissue with arteries, veins, lymph vessels, and nerves running through it.

Deep Fascia

Deep fascia surrounds organs and muscles, carries nerves and blood and lymph vessels, and wraps these structures so that they can glide over each other without sticking to each other. As already discussed, the interweaving fascia wraps each muscle and penetrates into the interior of the muscle before forming the tendons that join muscle to the periosteum of bones. In the limbs, muscles that share similar functions and nerve supply are located in compartments that are defined by thick sheets of fascia. These fascial wraps limit the outward expression of contracting muscle bellies and so help act as a pump that pushes blood in veins back toward the heart. At the wrist and ankle, the fascia forms thick retinacula to lock down tendons. Broad, flat tendon sheets like the thoracolumbar aponeurosis and the iliotibial tract interweave the superficial fascia to deep fascia.

Myofascial Planes, Bands, and Chains

Various authorities illustrate the organization of myofascia by describing the planes, bands, and chain-like patterns it forms. Examining this organization of myofascia gives therapists insight into the way that fascia helps support the body and disperses tension and compressive forces. We can see how an imbalance in one plane, band, or chain can affect many structures including veins, arteries, lymph vessels, local organs, and joints.

Horizontal Myofascial Planes

Fascial sheets converge at joints where tendons, ligaments, joint capsules, and the periosteum of bones lead to interlacing and thickening of the fascia. Each joint line creates a horizontal pattern of fascia that runs both superficially and deeply (Fig. 20-4). Imagine tension and adhesions in any of these horizontal planes to understand how an entire joint or region might experience pain, restricted circulation, fluid accumulation, and decreased range of motion.

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Fascial Bands

In the Endless Web, authors Dr. Louis Schultz and Dr. Rosemary Feitis identify superficial fascial bands that they liken to the thickening of the retinacula of the ankle or the wrist.8 Some of these bands correlate with the horizontal myofascial planes described previously, but while the horizontal planes run deep, these bands reside in the superficial layer of fascia (Fig. 20-5). The authors note that fascial bands restrict fat deposits and so show up as contours or rolls of adipose tissue. Now imagine any of these bands being tightened. It’s not hard to understand the effect on breathing that might occur if the chest band is stiffened, or that headache pain might result if the band around the eyes is rigid. We know from earlier discussions about the bodymind connection that the suppression of emotion causes body armoring. Imagine that each of these bands is a piece of body armor, and it becomes easy to understand how massage can cause emotional release to occur as the band is loosened.

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Myofascial Chains

In Anatomy Trains, Thomas Myers shows how myofascia creates long chains, both superficial and deep, from the foot to the top of the head on both the anterior and posterior body (Fig. 20-6). For example, the superficial front lines run on both sides of the midline from the dorsal surface of the toe phalanges to the tibialis anterior muscles, to the subpatellar tendons, up the rectus abdominis muscle, to the sternalis and sternochondral fascia, to the sternocleidomastoid muscles (SCMs), ending at the scalp fascia. Mechanical tension is communicated along these lines, demonstrating how dysfunction in one region can influence function in a seemingly unconnected region. In Figure 20-6, it is easy to see that the anterior front lines and posterior back lines have a synergistic relationship. What happens if excess tension in the front lines pulls the fascia down and forward? It makes sense that this will bunch up the fascia of the back lines, leading to neck and shoulder problems, a collapsed chest causing breathing problems, and low back issues. Imagine tension in the back fascial lines. It makes sense that a tight Achilles tendon might lead to multiple problems such as plantar fasciitis, a hamstring tear, low back pain, and even a tension headache.9 Understanding the connected nature of myofascia means that we never look at an injury as localized. Instead, we view the injury as something that happens to the entire body, and we address compensating regions with as much vigor and focus as the injury site.

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