fascia in the body

New research shows that fascia, a system of connective tissue, has a larger impact on health and wellbeing than was previously known. Every connective tissue, no matter if it's a flat tissue or a tendon - everything that separates, transmits power and gives shape to the body and muscles is fascia.

Healthy fascia

In the best case, you should care about your fascia before you start having problems with them. Healthy fascia need a healthy diet, holistic movements and sufficient fluid. They have a high protein content, which is why a balanced and protein-rich diet is ideal for their care.

If you want to help with the healing of your fascia, you should drink enough water. Your body is removing toxins and other waste from your body, where they reach your liver and kidneys. Your body can only do this with sufficient hydration.  

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The components in fascia

The body consists of cells and the matrix outside, between the cells, the extracellular matrix (ECM). The cells in the fascia produce, control and maintain all the complex ingredients of the ECM. The ECM has two parts, a fibrous part (fiber proteins) and a fluid part called ground substance.

Cells

  • Fibroblasts - produce collagen, elastin, carbohydrates, signal proteins, collagenase, etc, depending of mechanical signals of pressure and vibration. Fibroblasts build up, break down and maintain the ECM.
  • Fasciacytes - produce hyaluronan for the ground substance. Found near the sliding layers between the different fascial layers and in the endomysium.
  • Immune cells - T cells, mast cells, macrophages, lymphocytes, etc
  • Myofibroblasts - Fibroblasts can morph into myofibroblasts, cells which have a contracting ability. This ability helps to close wounds and heals injuries as they produce cytokines, which enhance the inflammatory response.
  • Telocytes - a new cell discovered in the fascia, presentated 2016, by Cretoiu et al. Mechanosensitive cells that seem vital to many physiological processes. Seems to be major players in communication between cells. Again, fascia forms a body-wide, cellular signaling network (Langevin 2006, Oschman 2003).
  • Adipocytes - also lipocytes or fat cells. Compose adipose tissue (body fat), which is a component in loose fascia. Energy storage and they also have important endocrine functions (produce hormones).

Fiber proteins

  • Collagen - The most abundant protein in the body. Type I and III are the types mainly found in fascia and they form fibers to resist tension and adapts to mechanical stress. It gives tensile strength and structure to the tissue.
  • Elastin - Is a more elastic protein that gives resilience and elasticity to the tissue. It is found for example in elastic cartilage, loose fascia, skin, lungs, vascular walls, but also in small amounts in tendons and ligaments to give the property to recoil.
  • Reticulin - Formed of collagen III fibers. Forms the collagen network around the organs and in the covering around muscle fibers, endomysium.

Ground substance

  • Glucosaminoglycans - GAGs - long polysaccharides made up of repeating disaccharide molecules. Resorb big amounts of water. Together with the strength of collagen it gives the ECM the property to resist compressive forces. Include hyaluronan, chondroitin sulfate, dermatan sulfate, heparan sulfate, heparin and keratan sulfate
  • Proteoglycans - PGs - occur when GAGs are bound to a protein chain. Peptides that binds water. Gives cushion properties.
  • Hyaluronan - HA - Hyaluronan (hyaluronic acid, but it is not an acid) is classified as a non-sulfated glukosaminoglucan. It is the largest polysaccharide in the
  • Link proteins - like integrins, connect to molecules ECM, like collagen fibers, to the intracellular actin fiber, the cytoskeleton.
  • Collagenase - An enzyme that break down collagen. Produced from fibroblasts when needed.
  • Integrins - Link proteins in the cell membrane that facilitate for the molecules in the ECM to adhere to the cell. Mediate cell to cell and ECM to cell interactions. Activate signal transduction from the ECM via the cytoskeleton to the nucleus.
  • Growth factors - Signaling molecules between cells, for example cytokines and hormones. Stimulate and regulate cell function, like rate of cell growth and proliferation. They bind to specific cell receptors on the surface of the target cell.

Source: The Fascia Guide

by: Dr. Jean-Claude Guimberteau

Role of fasciae in nonspecific low back pain

Authors: G. Casato, C. Stecco and R. Busin - 2019

More and more evidences show how the thoracolumbar fascia is involved with nonspecific low back pain.

Additionally, recent studies about anatomy have shown the presence of a continuity between the thoracolumbar fascia and the deep fascia of the limbs; but actually, a dysfunction of just the thoracolumbar fascia or of the tightly contiguous myofascial tissue is generally recognized as possible cause of nonspecific low back pain.

Five patients among those affected by nonspecific low back pain were manipulated just on those fascial spots that were painful, when palpated, and located in other areas of the body than the low back one. Each patient reported a clinically significant reduction of the painful symptoms (a Pain Numerical Rating Scale score difference ≥ 2) straight after the manipulation.

A dysfunction of the myofascial tissue that is not tightly contiguous with the symptomatic area is then suggested to be taken into consideration among the causes of nonspecific low back-pain.

Published online 2019 Aug 6.