Fascia: What Is It and Why You Should Care

By Nancy Alexander, PT, CSCS

Fascia is being talked about more and more these days in the health and physical fitness arenas. This thin casing of connective tissue surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. To appreciate its importance, fascia plays a role in every movement that you make. It acts to create continuity amongst tissues to enhance function and support. Researchers have focused on this structure recently and as a result, we have a better understanding of its role in your overall health. By mobilizing your fascia with certain techniques and treatment strategies, you can help yourself move with greater efficiency and ease.

Health practitioners including physical therapists, chiropractors and massage therapists increasingly are paying therapeutic attention to this long-overlooked part of the body. As well they should, says Maureen Watkins, associate clinical professor in Northeastern’s Department of Physical Therapy, Movement and Rehabilitation Sciences. “Fascia is basically a thin layer of connective tissue that separates muscles and organs from other structures and keeps things moving smoothly by reducing internal friction,” says Watkins, who holds both physical therapy and massage licenses. Like a stocking, it engulfs the entire body and dynamically stabilizes it, she says. “It’s everywhere doing everything. It’s vital for our mobility, our stability, our movement,” says Scott Diamond, a chiropractor in Boston who holds a degree from Northeastern.

What Is It?

Lack of consistent terminology to describe fascia contributes to its mystery. Various studies have attempted to identify specific categories for it, but in the end, it is simply difficult to further identify a structure that is continuous in the body. According to Kumba and Bonar in, Fascia: a morphological description and classification system based on a literature review (NIH), “Fascia is an uninterrupted viscoelastic tissue which forms a 3-dimensional collagen matrix. It surrounds and penetrates all structures of the body extending from head to toe, thus making it difficult to isolate and develop its nomenclature.” That is, there is no start and no end to it.

To keep things simple for our purposes here, we can identify two forms of fascia in the body: dense and loose. Dense fascia gives your body its shape. It consists of sturdy collagen fibers that hold muscles, organs, blood vessels and nerve fibers in place. It helps stabilize your joints and helps your muscles contract, relax and stretch. Loose fascia is more slippery and facilitates gliding of structures against each other in your body such as joints, muscles and even your organs. This connective tissue runs under your skin and encases every muscle and even each fiber within the muscle. To help visualize it, think of preparing a chicken breast in the kitchen and seeing a thin wispy-like structure encasing it. That is fascia. When healthy, this structure – which is often compared to cling wrap – helps us move like a well-oiled machine.

Although fascia appears to consist of one sheet of tissue, it’s actually made up of multiple layers with liquid in between called hyaluronan, according to Johns Hopkins researchers. It’s designed to stretch as you move. In 2007, an anatomy professor named Carla Stecco at the University of Padova in Italy, found fascia is alive with nerve endings. This means it can be a source of pain. The longer it is damaged or inflamed, the more sensitive it becomes. (Danielle Friedman, New York Times)

Because fascia is richly innervated (has nerve endings), this web of tissue also plays an important role in proprioception – your body’s ability to sense movement, action and location. Healthy fascia, then, may help improve your balance and coordination.

When you’re sedentary for a long time, fascia can shorten, become overly rigid and congeal into place, forming adhesions that limit mobility, said David Krause, a physical therapist at the Mayo Clinic. Fascia can become damaged from repetitive movements, chronic stress, injury, or surgery — becoming inflamed, overly rigid or stuck together. And it stiffens with age. What was once a smooth, slippery, and flexible structure, becomes sticky, gummy, and crimped.

Fascial restriction, according to Healthline.com has a variety of causes, which are mostly related to trauma, injuries, or not moving enough. These causes include:

• overuse
• repetitive movements
• injuries
• weak muscles
• poor posture
• physical, mental, or emotional stress
• extended periods of sitting or standing
• overall lack of physical activity
• misalignments and imbalances

But how do you distinguish pain that comes from fascia versus that of other structures? This can be difficult. Some sources say that fascia pain typically gets better with movement, not worse. But so does pain from other sources. In my practice over the years, patients with fascia restriction and pain often had other injuries at the same time.

To further complicate matters, fascia structures can literally be intertwined with other structures. Consider plantar fasciitis, for example. This is a painful condition experienced at the bottom of your foot made worse by weight-bearing and walking when injured and inflamed. In some respects, plantar fascia is not true fascia and is considered more like an aponeurosis. By definition, an aponeurosis is a flattened tendon by which muscle attaches to bone or fascia. It is composed of multiple layers and helps absorb energy during the movement of the muscle. Still, the name “plantar fasciitis” says it all and the above causes certainly apply to this condition.

In general, and given the causes noted above, damage to fascia is likely a very common occurrence. And therefore, treatment to address it should be considered a part of any good exercise or rehabilitation program.

Prevention

The key to prevent fascia impairment is to keep fascia moving. As a result, you need to move to mobilize your fascia. And move in as many directions as possible. Consider a regular stretching and joint mobility routine to help maintain flexible and healthy fascia. Stretches are a great place to start including elongation stretches and specific muscle/muscle group stretching such as the Buff Bones® limb reach, standing fascia stretch, and yoga’s downward facing dog pose. Take a look at this month’s feature video which explains how to perform a standing fascia stretch using a hip-hinge at its foundation. This version is even safe for those with osteoporosis and osteopenia.

To help prevent or minimize fascia pain include as much physical activity that is tolerable for you. It does not need to be strenuous. In fact, it shouldn’t be. If you choose to stretch, perform this at the end of a class, program, or activity when the muscles and fascia are their warmest. This will improve its effectiveness and help you feel and perform better.

Post-injury treatment

For pain that persists post-injury or surgery, a safe and reasonable stretching program like that noted above is a great place to start. Foam rolling may also be beneficial. By using your own body weight and rolling on a cylindrical foam roller, you can perform self-massage that helps release fascia restrictions, break down adhesions and smooth out tight fascia. Foam rollers come in various lengths, diameters, and densities. If you are trying one for the first time, go with a softer roller that has some give to it. A firm or harder roller may hurt too much for you to get effective relief. Also note, if you have a thoracic kyphosis or Dowager’s Hump at your spine, a foam roller (even a soft one) may not be right for you to use at that area. Please check with your healthcare provider prior to purchasing one.

Speaking of self-massage and the plantar fasciitis example discussed above, rolling your affected foot over a golf ball on the floor can be an effective way to free up adhesions at the bottom of your foot.

Other generalized treatment strategies include massage, yoga, physical therapy, or a visit to a pain control clinic where injections may be used to assist you. Additional treatment options include heat and acupuncture.

Within the realm of manual therapy (hands-on) and massage techniques, there is a specific type of treatment called myofascial release. Certified specialists in this area have undergone extensive training to help you restore health and mobility to restricted fascia and other areas of your body. During the course of my career, I know of several therapists who only focused on this type of care in their practice and they were very effective at helping their patients recover. Ask your physician or therapist for a referral if you feel this specialized care might be beneficial for you.

Move

Remember to always reach out to your physician or movement specialist if you are experiencing pain that is not easily relieved and/or getting worse. They know your health history best and can lead you to strategies that serve you safely and effectively. Whether you are recovering from injury or not, don’t forget to incorporate some type of movement in your exercise program to maximize the mobility and health of your fascia. Take the mystery out of it, and keep moving.

Sources:

https://news.northeastern.edu/2024/01/22/fascia-health-wellness/

https://www.healthline.com/health/exercise-fitness/fascia-stretching

https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430451/