Keeping Your Fascia Healthy to Prevent and Address Chronic Pain

Until recently, fascia was considered to just be like a packing material supporting all the structures in the body. Now, we know that fascia is much more than just packing material. It is an intricate communication network between all cells, organs, and tissues within the body. As such, it plays an important role in movement and the development of chronic pain and joint pain issues.

What is fascia? Fascia is both a system and a tissue. Fascia as a tissue is the dense and loose layers of connective tissue that attach, enclose, and separate internal organs. These layers or sheets of connective tissue are designed to glide between each other to support movement and flexibility.

According to the Fascial Research Society, …”The fascial system surrounds, interweaves between, and interpenetrates all organs, muscles, bones, and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner.” The fascia system or network provides connection throughout the musculoskeletal system and even connects every cell within our body by providing a cytoskeleton.

Fascia is the biggest sensory organ that communicates to your nervous system about any need to increase or decrease tension in a given area, including the mind. There are more nerve endings in the fascia than in any other organ system in your body. Fascia penetrates the tissues and organs and serves to communicate via our nervous system to all cells in the body.

Clinicians use orange as an example of how fascia work. The white connective fibers in the orange help keep the orange sections both separate and together. You can peel and separate the different layers of the orange by separating and removing the white fibers. This analogy is similar to how fascia and the fascial system interconnect the various parts of our body.

Fascia is mainly made out of collagen. Collagen provides both strength and flexibility. The type of collagen is a triple helix formation of collagen fibers, called triple collagen. These fibers create a neural network of tubes called nano tubules that travel throughout the body. Fascia also has elastic properties because it contains elastin, which provides flexibility and allows the fascia to stretch.

Fascia supports tissues and organs, eases muscle tension and friction, and has reflexive properties allowing it to tighten. There are three main types of fascia. Superficial fascia is mostly associated with the skin. Deep fascia is mostly associated with the muscles, bones, nerves, and blood vessels. Visceral (or Subserous) fascia is mostly associated with the internal organs. Superficial fascia is right under the skin and can sense pressure and heat. Deep fascia plays a role in proprioception, also called kinesthesia and balance.

Fascia can also thicken and constrict with trauma, poor posture, stress, or inflammation, impacting our ability to heal. Inflammation and trauma can dry up the hyaluronic acid causing more friction and not allowing the tissues to move as they should.

Why is fascia important? Fascia is an intricate communication network connecting us to our environment as well as all the parts of our internal body. Light, sound, and electrical frequencies can be conducted through the fascia because it fascia exists as liquid crystals similar to our smartphones or computers.

When compressed, fascia can create sparks of electricity and an electrical current.  Fascia can transmit light signals from our retina throughout our body. All of our cells have a circadian clock and the fascia are responsible for conducting the photons of light information from our environment throughout our bodies, connecting us to the outer world. Movement creates a vibration of the fascia of photonic sound.

When healthy, the fascia is slippery and smooth, allowing you to stretch as you move. Fascia contains about 7.5 liters of fluid that exists outside of our vascular system, providing nutrients to our cells, circulating interstitial fluid, and draining waste into our lymphatic system. Fascia helps the flow of lymphatic fluids. Without the fascia and physical movement, lymph would stagnate and be unable to move and drain out toxins and waste.

How is fascia linked to chronic joint pain? When there is a lack of movement, misalignment of joints, scar tissue, or emotional trauma, fascia can become thicker, drier, and stickier. Fascia can stick and constrict and wrap tighter around muscle fibers. This can restrict movement and cause stiffness. With scarring after trauma or surgery, fibrin can accumulate, also restricting the fascia. This restriction of movement can create inflammation and adhesions.

With chronic joint pain, such as osteoarthritis, most of the past focus on pain has been on the joints, the cartilage, synovium, joint capsule, and underlying bone. However, it is now known that the fascial layers are highly sensory innervated, meaning that issues with the fascia may contribute to issues with tissues, causing pain and stiffness. Even after a total joint replacement, pain can continue if there are issues with the fascia.

With autoimmune arthritis, such as Rheumatoid Arthritis (RA), fascial involvement may be contributing to morning stiffness and pain. In one study, age-related changes in fascia thickness were found to be a possible contributing factor to restrictions in joint range of motion.¹

Emotional trauma can also be stored in our fascia, leading to blockage and pain. When emotions are repressed or not released, they can get stuck and stored in the tissues.

What are the clues that your fascia may not be working properly?

• Restricted movement-Your posture and body position may feel restricted or even appear to be misaligned. For example, you may have a forward head posture where your head is not appropriately aligned with your spine, and instead, extends forward. This is sometimes caused by leaning over a computer for extended periods or texting on a mobile device (eg., text neck) and can result in chronic neck and shoulder pain and other symptoms. Maybe you have a frozen shoulder or you can no longer turn your neck to look over your shoulder while driving.
• Pain with movement-Restricted fascia can send signals to your brain, which can limit movement and result in feelings of pain.
• Other symptoms: Other symptoms such as mood changes, energy issues such as fatigue, or even sleep issues can be a result of issues with the fascia.

It’s important to get an appropriate evaluation to see what may be triggering symptoms. A physical exam can help to identify areas where there may be issues with muscle damage or areas where there has been trauma.

There may be more than one underlying trigger of fascial issues. Functional lab testing can be helpful to look at issues that may be contributing to fascial dysfunction such as hormonal, immune, digestion, detoxification, energy, or neurological imbalances.

Functional medicine practitioners look at the whole body as an interconnected system similar to the roots, branches, and leaves of a tree and believe that by identifying underlying root causes of issues, the individual’s health problem may be reversed or solved. The health of every cell in your body depends on its ability to get nutrients and eliminate waste. Restricted fascia can limit this flow, which is why figuring out what is triggering the fascia to constrict is important.

What can you do to make sure your fascia is healthy? To function well, the fascia needs:

• Oxygenation-Proper breathing supports getting oxygen to the tissues and cells. Breathing practices can support a healthy diaphragm and help to get the oxygen to where it is needed.
• Hydration-Water is important for hydrating the brain, the vital organs, then the tissues of the muscles, fascia, and joints. This supports the movement and hydration of the fluids in the extracellular matrix.
• Good posture-When we don’t have good posture, our body can get out of alignment. This can happen with prolonged sitting, texting, computer work, and other situations.
• Regular and varied movement-this includes movement of all your joints to keep the fluid flowing. It is important to keep your spine healthy, promoting movements that provide flexion, extension, rotation, side bending, and inversion (bridging). Moving in different ways is key to keeping your fascia working smoothly and not thickening and tightening up.
• Optimized Nutrition and Diet-Diet is an important component of fascia health. Too much sugar, for example, can tighten fascia.
• Manage stress-Too much chronic stress can increase the stress hormone in your body, such as cortisol, causing a variety of health issues including blood sugar imbalances, sleep issues, and chronic disease. Stress can trigger the fight or flight reaction, and cause the body to constrict and prepare for an attack. This can result in shallow breathing and diverting blood flow from digestion. Chronic stress can result in the negative emotions and energy of stress not getting processed appropriately and getting stored in your tissues.
• Supplementation-While a healthy diet is key if you are taking collagen supplements, hydrolyzed collagen protein is a better form. Vitamins D, B, C, and Zinc are good basic nutrients to support fascia health.
• Essential oils-Essential oils can help with healing, addressing infection, balancing hormones,  being very healing. They come from plants that have very powerful immune systems. They can also be used with other techniques such as meditation, foam rolling, or massage.

What are some types of therapies that may be helpful for fascia-related pain:

• Physical therapy-Physical therapy techniques can help to increase mobility and address issues such as fibrin which may be blocking the ability for fascia to move freely.
• Microcurrent therapy-Microcurrent therapy uses electrical frequencies to target issues such as pain. Microcurrent therapy uses electrical frequencies to target muscle or skin tissues. Microcurrent may help to boost collagen, and elastin production, as well as to help regenerate cells. In one study of myofascial neck pain, microcurrent electrical neuromuscular stimulation improved pain parameters in chronic myofascial pain syndrome on upper trapezius muscles. ²
• Myofascial Release Therapy: The application of a self-myofascial release program can improve the health-related quality of life of people with FM, provided that regular, structured practice is carried out. Myofascial trigger point release (MTR) is an effective technique for shoulder pain.²
• Essential Oils- Essential oils can help soften the myofascial tissue to help it better stretch and move. They can also provide significant pain relief, can assist in reducing inflammation, remove toxins, and promote collagen production.
• Massage
• Foam Rolling
• Yoga
• Acupuncture/Acupressure
• Energy work-Qi gong, Tai Chi
• Meditation-Meditation practice can help with bringing focus to positive emotions. Positive emotions have much higher frequency vibrations in the body. When communicating positive vibrations in the fascia, can help to release the negative emotions causing restriction. Practicing gratitude can also help communicate positive emotions through your body.
• Emotional Freedom Technique (EFT)-EFT can be used to unlock emotions that are stored in your fascia.

Summary: The study of fascia has been growing over recent years with the discovery that it served a purpose more than holding our body parts together. With chronic pain or joint pain, it is important to uncover underlying triggers of pain and fascial dysfunction to help our bodies work the way that they are supposed to. This often requires a thorough evaluation and more than one strategy. It is important to work with a practitioner who is open to referring their clients to other expert practitioners who offer different therapies based on an individual’s specific issues and preferences.

Resources:

HealthMeans (2022). The Fascia and Chronic Pain Health Summit

References:

1.          Wilke J, Macchi V, de Caro R, Stecco C. Fascia thickness, aging and flexibility: is there an association? J Anat. 2019;234(1). doi:10.1111/joa.12902

2.          Gordon CM, Andrasik F, Schleip R, Birbaumer N, Rea M. Myofascial triggerpoint release (MTR) for treating chronic shoulder pain: A novel approach. J Bodyw Mov Ther. 2016;20(3). doi:10.1016/j.jbmt.2016.01.009