Clinical Relevance of Fascial Tissue and Dysfunctions

Abstract

Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role in force transmission has recently been disproven. Fascial tissue contains contractile elements enabling a modulating role in force generation and also mechanosensory fine-tuning. This hypothesis is supported by in vitro studies demonstrating an autonomous contraction of human lumbar fascia and a pharmacological induction of temporary contraction in rat fascial tissue. The ability of spontaneous regulation of fascial stiffness over a time period ranging from minutes to hours contributes more actively to musculoskeletal dynamics. Imbalance of this regulatory mechanism results in increased or decreased myofascial tonus, or diminished neuromuscular coordination, which are key contributors to the pathomechanisms of several musculoskeletal pathologies and pain syndromes. Here, we summarize anatomical and biomechanical properties of fascial tissue with a special focus on fascial dysfunctions and resulting clinical manifestations. Finally, we discuss current and future potential treatment options that can influence clinical manifestations of pain syndromes associated with fascial tissues.

Interfascial Plane Blocks

“…7 The deep fascia is a membrane that extends throughout the whole body and is kept under basal tension via numerous muscular attachments. It is devoid of fat and forms sheaths for the nerves and vessels and envelops various organs.…”

“…Another example is the Achilles tendon and its fascia, which operates like an elastic spring and is able to absorb, store, and release energy. 7,21 It is possible that fascial planes, rather than being viewed as rigid, inelastic, and inert structures, may act more like piezoelectric materials of second harmonic generation that convert mechanical forces applied to fascia into energy. 22 To fully understand the clinical effects and role of interfascial plane blocks, we suggest that the biomechanical behavior for each deep fascia be investigated.…”

Untitled

“…Fortunately, more recent work appears to have addressed this by providing a coherent description of this fascia [19]. With the attribution of multiple physiological functions [20] and their attendant clinical implications [21][22][23] fascia has become a growing consideration in manual practice and its role in the Bow-string technique appears potentially significant.…”

Needle biopsy‐derived myofascial tissue samples are sufficient for quantification of myofibroblast density

“…However, the question arises whether the size of extracted material is sufficient for a quantified assessment of the local MFB density, particularly as this cell type is usually found in very scarce density in normal collagenous connective tissues (Klingler et al, ; Remvig et al,; ).…”