The deep fascia and its role in chronic pain and pathological conditions: A review

Abstract

The deep fascia is a three‐dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. A state‐of‐the‐art review was conducted in PubMed and Google Scholar following a two‐stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra‐cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro‐inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.

Preventive Assessments and Training for Shoulder Joint Injury

“…The fascia's structural characteristics and sensory ability may cause sensory discomfort after exercise, which is often caused by strenuous and unaccustomed exercise [16]. Fascia is a threedimensional continuation of connecting tissue surrounding the bones, muscles, nerves, and blood vessels throughout our body [17]. It can be summarized in three characteristics [18], interconnecting sheets and layers of body-swathing membranes; an inconstant range of ostensibly distinct parts (fasciae and fibrous structures); a body-wide soft connective tissue system with several forms of connective tissue.…”

Differential Sensitization of Muscle versus Fascia in Individuals with Low Back Pain

“…Consequently, treatment modalities for myofascial pain have largely focused on muscles, including muscle injections [ 14 ], manual therapy [ 8 , 15 ], dry needling [ 16 , 17 ] and others [ 13 ]. Previously, emphasis was given to the role of the muscles in myofascial pain, however, in recent years, the role of fascia has drawn attention [ 18 , 19 , 20 ]. Anatomical studies demonstrate physiological features of the deep fascia, allowing it to play important roles in proprioception, force transmission and nociception [ 19 , 21 ].…”

“…Previously, emphasis was given to the role of the muscles in myofascial pain, however, in recent years, the role of fascia has drawn attention [ 18 , 19 , 20 ]. Anatomical studies demonstrate physiological features of the deep fascia, allowing it to play important roles in proprioception, force transmission and nociception [ 19 , 21 ]. These findings are further corroborated by studies reporting alterations in the deep fascia in individuals with chronic myofascial pain.…”

Comparative Study of the Efficacy of Hyaluronic Acid, Dry Needling and Combined Treatment in Patellar Osteoarthritis—Single-Blind Randomized Clinical Trial

“…The physiotherapeutic treatment of osteoarthritis may include dry needling of myofascial trigger points (MTrPs), which aims to reflexively relax the target musculature. This causes the central nervous system to begin a process of regeneration of this damaged muscle so that more nutrients arrive, and if the puncture has been successful, the muscle relaxes completely and symptoms, such as local and radiating pain and muscle shortening, disappear [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ] in the short term.…”