Gone have the days when Fascia was described as a thin connective tissue layer around a muscle, the superfluous white film which was cast aside during dissections. Over the last decade, there has been considerable momentum in the research around this silvery white sheet seen around a muscle. Although, research is still in its infancy, their has been a fundamental change in thinking around the significance in this connective tissue; both horse and human.
Guimberteux and Armstrong (2015) describes Fascia as -
"Fascia is a continuous fibril network within the body, extending from the surface of the skin to the nucleus of the cell. This global network is mobile, adaptable, fractal, and irregular. It constitutes the basic structural architecture of the human body."
The Fascia network is far reaching throughout the body, penetrating and interweaving throughout all organs, muscles, bones and nerve fibers. It is described as both a tissue and a system. At its base, Fascia is the extracellular matrix, also known as the ECM, consisting of fibers and fluid. Collagen makes up the majority of the fiber proteins and the viscous fluid, known as "ground substance" contains mostly water and large organic molecules.
The Fascia's fluid component both fills the spaces between the body's cells and fibers and permeates the inside of the cell. This provides a molecular transport system between the lymph, blood and cells. It has the ability to provide shock absorption and the "slide and Glide" properties of the collagen fibers. The fibers themselves provide a support and structural element to the body. They produce both stability and elasticity in the mechanical connections between the cells.
The extensive network of fibers and ECM fluid extends from the very surface of the skin, migrating out in all directions right into the very depth of the nuclei of each cell. It is interwoven into the periosteum, all organs, cells and musculature. It is the very life system of the body, the structural fabric which facilitates regulation for the circulatory, nervous, lymphatic, musculature and endocrine systems. It has profound implications for the functionality of the body, physically, mentally and mechanically.
Lesondak (2017) has categorised Fascia into four types based on composition, function and location. These include -
Superficial Fascia - The fascia sheet which lies directly beneath the skin
Deep Fascia - the most extensive, comprising of an intricate series of fascial sheets, bands and tubes and rich in ground substance (hyaluronan) holding muscles, and other structures such as bones, blood vessels, nerves etc in place throughout the body. It is divided into axial and appendicular fascia based on location within the body
Meningeal Fascia - a fascial layer which surrounds the brain and nervous system.
Visceral fascia - surrounds the organs in cavities such as the abdomen, lung (pleura) and heart (pericardium).
FUNCTION
Despite the separate distinct types of fascial tissue, all are interwoven into a ever moving, proprioceptive organ providing many functions to retain the homeostasis of the functioning body.
1. Protective - Fascia provides structural and shock absorptive qualities for nerves, vessels and lymphatics.
2. Myofascial Force transmission - the intimate relationship between muscle and fascia, results in the fascia playing a vital role in force transmission. Simply put when a muscle produces force through contraction it is transmitted towards the joint's direction and the musculature surface. The surface fascia of that muscle is then responsible for up to 30% of such force transmission.
3. Vascular Support Function - Deep lower limb fascia serves as a "compression device" to increase the venous return of blood back to the heart.
4. Slide & Glide - The Fascial fibers and ground substance provide a lubricated surface for one part/muscle/elements of the body to slide against the other, allowing the fluidity of movement of the body from skin to organ to muscle to systems such as blood, hormone, immune and nervous.
5. Sensory organ - embedded in nerve endings and mechanoreceptors it plays a vital role in the perception of movement and posture, effecting the propriception and coordination of the body. When the posture is changed in the body through movement the fascial tissues mechanoceptors contort and activate. This afferent Information is sent into the spinal cord and brain, which is interpreted into efferent information which in turn is relayed to our muscles.
As Fascia has a fundamental function throughout the moving body, this makes it vulnerable and open to dysfunction. Dysfunction is defined as the abnormality or impairment in the operation of a specific system. Fascia throughout the distinct types, function, location etc is all at risk of disruption, interference and disorder. Such can alter the mechanical coordination, balance, movement, proprioception, musculoskeletal, organ, immune, circulatory, lymphatic, endocrine and nervous system. This leads to a body that feels stuck, stagnant, stiff, unstable, crooked, with possible widespread effects on the physical, emotional and mental well being and functioning of that individual.
Between horse and human, the physiology is no different. Dysfunction can occur due to injury, habitual postural issues, lack of movement, inflammation, emotional injury, sub optimal nutrition and anything that cause the body to lose its physiological adaptive capacity. Compensatory patterns of movement results, inflicting further stress on the fascial system to slide and glide. Fascia can then respond by shortening, thickening, solidify or overstretching which presents as pain, stiffness, tissue fatigue, organ dysfunction and reduced performance. Essentially, the fascial body becomes bound down.
TREATMENT
It is likely that every person, horse, animal, being that possess a fascial system will be experiencing some form of fascial dysfunction. Whether this results in a level of dysfunction which causes issues in the physical, emotional and physiological function of the individual is related to the extent of the disorder. This is where specific manual therapies such as myofascial release, sports therapy, myofascial cupping and specifically applied foam rolling comes into play.
It is at this point at which now we come to the end of part one of this blog! I all hoped you have enjoyed it - questions, comments and ideas are welcomed!
Stay tuned for Part 2 - where we outline the treatment modalities for Fascial dysfunction including the implication of scarring, injury and the importance of rehabilitation.
REFERENCES
Adrianna Gatt1; Sanjay Agarwal2; Patrick M. Zito3. Anatomy, Fascia Layers In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Vibeke Sødring Elbrønd, Rikke M. Schultz (2021) Deep Myofascial Kinetic Lines in Horses, Comparative Dissection Studies Derived from Humans Open Journal of Veterinary Medicine, Vol.11 No.1
Elbrønd, V.S. and Schultz, R.M. (2015) Myofascia—The Unexplored Tissue: Myofascial Kinetic Lines in Horses, a Model for Describing Locomotion Using Comparative Dissection Studies Derived from Human Lines. Medical Research Archives, No. 3.
What is Fascia? Anatomy & Physiologyhttps://fasciaguide.com/fascia-anatomy-physiology/
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