The addition of the International Fascia Research Congress onto the scene of educational conferences has ignited an increased focus on understanding how fascia works in the body. Of course, we know fascia plays a role in compartmentalizing and separating various structures in the body, yet we also know that fascia must allow communication with the rest of the body. Is fascia simply a structural tissue that plays a mechanical role? Or does fascia hold memories, accessible during bodywork, as discussed in this article?
It may seem logical that fascia could contribute to compressive forces on the skeleton, on muscles and neurovascular structures, possibly contributing to musculoskeletal disease. Is myofascial tension sufficient to cause enough mechanical stress to create micro-damage and histochemical responses? Can this then lead to ankylosing spondylitis or axial spondyloarthritis, as discussed in this article published in Arthritis Research & Therapy? And if fascial thickness and tension is a proposed culprit of conditions such as compartment syndrome, why did these researchers find no correlation and in fact a negative correlation between fascial stiffness in patients with compartment syndrome?
Do we really know the implications of fascially-directed assessments and interventions at this time? Is the research on fascial therapy being interpreted correctly if science is still trying to figure out what fascia is, how fascia works, how fascial forces affect the body and body functions? If we don't yet understand the intricacies of the neurophysiological mechanisms that drive fascia, should we jump to conclusions about the science that may or may not be measuring the right variables? (To this end, is a test of the fascial strength meaningful if taken from a biopsy now that the tissue is disconnected from the nervous system?)
I am not a fascial researcher, and I appreciate those who do give their time and energy towards working on these questions. As a pelvic rehabilitation provider, I know that fascial relationships within the pelvis are multi-faceted and somewhat unique: the obturator internus (OI) attaches directly into a thick fascial line running between the OI and the levator ani muscles. The potential implications of this relationship on muscle strength and tension are constant clinical considerations, and ones that we hopefully will know more about as tools such as functional MRI lend improved data.
Clinicians who utilize myofascial assessments and treatment have more understanding of the role of substances such as hyaluronic acid in fascial health, yet we are still searching for accurate ways to describe how stretching and connective tissue manipulation can ease chronic pain. While we continue to explore the science behind the techniques, you can further your knowledge of fascia and fascial techniques at the continuing education course Myofascial Release for Pelvic Dysfunction, offered for the last time this year in Ohio this month.