Fascinating Fascia

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Look at any muscle map and you will see all the individual muscles carefully displayed. They may be shown as photographs or expertly drawn.  Anatomy books will go through each muscle to describe their attachment points (Origin and Insertion), what they do (Action) and what the muscle name means – be it Greek or Latin. The name often gives a clue as to the action or location.  But rarely do they show fascia and it is entirely absent from anatomical charts.

Early human dissections often ignored the fascia because it made it hard to see the muscles underneath and until relatively recently that has very much been the mainstream approach.   Instead, fascia has often been described as the stuff that has to be cleaned off in order to see what’s beneath. Now though the fascia’s role in enveloping and connecting all muscles and soft tissue to each other to form continuous networks, has begun to attract more attention, study and research.

So What is Fascia?

When it comes to understanding fascia and its relationship with the soft tissue, it is helpful to think of any citrus fruit with segments. For our purposes I’m using a lemon.

Using citrus fruit to demonstrate the role of fascia

Citrus fruit is good for our purpose as it is made up of an outer skin, pith underneath, fruit segments covered by a skin and the individual flesh of the segment.  Even the pips can be useful (think of them as those adhesions that prevent free movement).  Using this analogy we can see the individual flesh equating to muscle fibers.  In the body these would be covered by fascia (perimysium) connecting each muscle fiber together to form bundles – the fruit segments.  The fascia covering the bundles is called epimysium and acts to connect all the bundles together to make the muscle as a whole.  The fascia covering the muscle is called endomysium and it connects with the perimysium, epimysium to extend beyond the muscle, merging wth the dense connective tissue of the tendon to attach the muscle to bone.  The fascia continues beyond the bone to merge with superficial and deeper fascia to form networks that allow force and function to be carried and shared throughout the body. The pith and skin can be useful here is demonstrating how fascia extends throughout the body forming multi-layered networks.

There has been some confusion about what terms should be applied to fascia, as well as what should be included and excluded from definitions.  Accepted terms like “fascia superficialis” and “fascia profunda” – basically superficial or loose and denser fascia – are used predominately in English speaking countries.  At the superficial level of fascia is included the intramuscular fascia of the perimysium and and epimysium.  Debate remains, for example, as to whether the endomysium should be counted as fascia. The dense fascia includes the visceral fascia of ligaments, tendons and aponeuroses.

These fascial networks have prompted some to question whether there are 640 individual muscles in the human body or, if they are all connected by fascia, just 1.   I confess that I find that idea to be endlessly fascinating and rather marvellous.  If I think of those anatomical charts with their individual muscles all depicting muscles working in splendid isolation, it is hard to see how the body is able to carry on working if one becomes injured, without the other muscles acting to compensate and take up the strain.

Bringing the networks of fascia into the equation, however, and it becomes easy to see how the body adapts and carries on working through sprains, strains, overuse and fractures.  The fascial networks seem to take up the burden from weakened muscles and carry on.

The work of Thomas Myers into Myofascial Meridians – specifically Anantomy Trains – and inspired by the work of Dr Ida Rolf and Dr Moshe Feldenkrais continue to build the case for fascia and I’m sure this is only the beginning of the story.

28 October 2015