IPPS Highlight: Fascia and Pain

At the most recent International Pelvic Pain Society Meeting in Las Vegas, Thomas Findley, MD , PhD, discussed the continuously emerging science of fascia and the mechanisms that can produce pain when fascial tissues are dysfunctional. He described the fascial cells in the body as similar to tents, bearing compression or creating structure. It is the microtubules that bear compression in living cells. The fascial connective tissue "connects and disconnects." If you have seen the Bodies exhibit, you may recall the bodies that had everything removed except fascia, yet the structure still looked very much like a body.

Fascia covers every muscle, every nerve, every vessel, every fascicle of muscle. Dr. Findley explained that while muscle fibers have been found to be 7-8 cm long, fascicles can be found in the body that are 35 cm long. The concept of muscles that stop and start at an origin and an insertion is an illusion according to Dr. Findley, because the amount of connectivity from the muscle to the tendon and to nearby fascia create continuity that allows for functionality. One function of these fascial connections is to take part in dynamic compression of joints and loading of tissues. He gave the example that 85% of the gluteus medius muscle fibers attach into the fascia lata, not the muscle attachment itself. It is this connectivity that can help transmit force along the length of the thigh.

In relationship to pain, there is a layer of hyaluronic acid within the fascia that creates glide by acting as a lubricant. This acid can also act as an irritant and a "glue" when there is too much compression or dysfunction in the tissue. Fascia contains fibers for both nociception and proprioception. Some fiber elements of fascia turn over every 24 hours according to Dr. Findley. Within the pelvis, there are many layers of fascia with connections from the abdomen, the buttocks, trunk, and the thighs. We must continue to take into account these important fascial structures when treating those who have pelvic pain. We must also continue to take part in and look for research that expands the scientific knowledge as well as the clinical experiences of providers treating conditions such as pelvic pain.

Dr. Findley is the Executive Director of the Third International Fascia Research Congress to be held in Vancouver, BC, in March of 2012. For more information about how emerging fascial research can influence your practice, join the multidisciplinary gathering of clinicians and scientists at the meeting. The Institute incorporates myofascial treatment techniques in many of the courses offered, including a new course created by Ramona Horton, called Myofascial Release for the Pelvis.