Fascia is so 1997

Have you been told that all your problems could be solved by "releasing your fascia?"
Does your trainer say that you have to do foam rolling to loosen your fascia?
Do you tirelessly and painfully roll your foot on a golf ball to treat your plantar fasciitis?

So many healthcare practitioners, gym goers, yoga aficionados are OBSESSED by FASCIA. If you think you may be suffering from fascia obsession, this article may be the cure you need for just this sort of ailment.

The truth is, there isn't a ton of research that links what we know about fascia to the indications and methodology related to treatment of it. Heck, there's not a ton we know about even the biology of fascia. If we don't completely understand how it works, how can we possibly understand how to treat it? What does exist is a lot of anecdotal and downright wrong "evidence" to justify painful, a bit silly-looking and sometimes harmful interventions aimed at fixing the problems of your fascia.

The reasoning and explanations for why fascia is so important has a dirty little secret....marketing and money! Of course. There is a sh**load of money to be made by selling you the story that your fascia is the key to unlocking your pain and movement dysfunctions. That being said, some people swear that by painfully, tearfully rolling out their IT band with a foam roller, they cured their knee pain. Well that's great. Truth is, though, the research doesn't support that "releasing" the IT band had anything to do with their experience. And that's okay. We just need to own up to the fact that there isn't solid evidence and we don't fully understand how all interventions work. What's important is that we, as therapists, stop spreading this false information using warped science to fit our agendas, and perpetuate misunderstanding. It's okay to not be able to explain fully why something works.

Here are some of the FASCIA MYTHS that have been and continue to be immortalized in a wide variety of therapeutic approaches, movement-based practices and fitness.


Piezoelectricity

This word is pretty damn fancy. I think that's why it's thrown around so often.

MOMENT OF TRUTH ALERT: I admit that I have used the following explanation with my clients (or some derivative of it) and even taught it to my students. I officially apologize to any one I have misinformed using ignorance and garbage science.

The piezoelectric effect is believed to be an electric charge released from crystalline structures that occurs when they bend. From here, the story goes that these electric charges represent tissues "releasing" and that this happens in fascia to change it's shape and make it healthier. So here's the problem, the piezoelectric effect on its own is poorly understood, but most believe that these electrical charges do occur. The idea that this is the mechanism behind tissue release is plain ol' false. Dr. Robert Schleip, and others, have done a lot of research related to the changes that do occur in fascia. None of that research shows that manual pressure applied for a short duration, like massage, can influence the construct of fascia in this way. That's just not how it all works. Further, in Schleip's "Fascial plasticity: a new neurobiological explanation", he states that the "life cycles [of collagen and ground substance] appear too slow to account for immediate tissue changes that are significant enough to be palpated by the working practitioner."

So when your therapist tells you they felt your fascia"release", well there's just no science that implies that is at all true, and it certainly isn't the piezoelectric effect that made it happen.


The FUZZ

I was introduced to this concept only a couple years ago. It sounded odd to me and I also hate flowery language and silly words used to describe scientific concepts. Big pet peeve. Here's a link to the fuzz speech.

The fuzz is described as this network of tendrils that permeates all tissues and cells. It webs around organs and through them, encapsulates muscles and creates the framework for many tissues. According to Gil Hedley, who proposed the fuzz concept, when we are at rest or in a position for a length of time, the fuzz hardens up and that explains why we experience stiffness. Every morning we must overcome the strength of the fuzz, breaking free of its hold on our tissues by moving and stretching.

One of the problems with the fuzz is that Hedley was using cadavers as reference to observe it. The fascia in living tissues is very different than that of tissues in a cadaver. The fuzz concept has been well loved by many manual therapists, as are the implications that fascia can be "released", and this is just not true.

The article “Three-dimensional mathematical model for deformation of human fasciae in manual therapy” by Chaudhry et al, published in the Journal of the American Osteopathic Association in 2008 demonstrated that fascia was just too strong to mechanically be changed. The study concluded that "very large forces, outside the normal physiologic range, are required to produce even 1% compression and 1% shear in fascia lata and plantar fascia." Researchers also remarked that "the palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations."

Another very prominent researcher in the field of fascia, Schleip, in Fascial plasticity: a new neurobiological explanation, found that slow soft tissue manipulations were not strong enough to elicit deformation in fascia. Based on the research, and on the claims manual therapists make about being able to "release" fascia, Schleip proposed a thought experiment that goes like this:

In everyday life the body is often exposed to pressure similar to the application of manual pressure in a myofascial treatment session. While the body naturally adapts structurally to long-term furniture use, it is impossible to conceive that adaptations could occur so rapidly that any uneven load distribution in sitting (e.g. while reading this article) would permanently alter the shape of your pelvis within a minute.

Back to the fuzz...
When met with some criticism, Hedley retracted/altered his position a little, admitting that he took some creative license to paint a picture of an idea he had about how fascia MAY behave. Too late! The damage had been done, and tribes of manual therapists and fitness professionals had already grabbed hold of the fuzz, unwilling to let go of this pseudo-science.


Thixotropy

Oooooo another fancy word. This skewed concept came from Ida Rolf.

Did she just say Ida Rolf? Yes she did.
The Ida Rolf, founder of Rolfing Ida Rolf? Yep. That's the one.

Mind Blown? Read on!

Rolf has influenced virtually all myofascial treatment approaches with her ideas rooted in thixotropic effects. She explained that fascia was arranged in sheets that need deep manual pressure to change from a more dense to fluid state. This is the property of a thixotropic substance, the ability of certain gels to become less viscous when shaken or subjected to shearing forces.

ANOTHER CONFESSION: I have taught this. Shame on me, and apologies to my hoards of students that I have mislead. *hangs head in disgrace*

Here's the TRUTH.... Ida didn't have any basis for claiming this. It was just a thought, an idea. She admitted that it was not based on any sound science or evidence. Her musings became dogma and that dogma continues.


What Now?
Now, given all this evidence, there will still be people that refute the ACTUAL science. I always find this amazing. For some reason, the fact that therapists and their clients see benefit to a particular intervention is not good enough. For some reason, the perpetuation of the LIES told to "prove" the need for a therapy do not stop. Why is this? Why is it not enough to say "There really isn't a lot of evidence to explain what is happening but this is what we think may be happening...." Why will some of you, after having read this, and perhaps looking at some of the sited research, still go into your clinics and remark "Ah. I just felt your fascia release" or tell someone that their fascia is tight and needs to be stretched or foam rolled to get it looser?

(Note: The idea that loose connective tissue is healthy and better is completely outdated. Connective tissue is strong and tough for a reason, and there are not many situations were you would want it to be loose)

If you don't believe me, would you believe Tom Meyers, author of Anatomy Trains? Here is what he had to say about the topic:

I am so over the word 'fascia' I have touted it for 40 years — I was even called the ‘Father of Fascia’ the other day in New York (it was meant kindly, but…) — now that ‘fascia’ has become a buzzword and is being used for everything and anything, I am pulling back from it in top-speed reverse. Fascia is important, of course, and folks need to understand its implications for biomechanics, but it is not a panacea, the answer to all questions, and it doesn’t do half the things even some of my friends say it does.















The few links below will take you to many other pieces of research and articles written about more current ideas about fascia, manual and movement therapy.

Jump down the rabbit hole if you are willing to drop the dogma. What pill will you choose?


Further Reading & References:

Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy. J Am Osteopath Assoc 2008;108(8):379-390.

If We Cannot Stretch Fascia, What Are We Doing? http://www.massage-stlouis.com/if-we-cannot-stretch-fascia-what-are-we-doing

Ingraham, Paul. Does Fascia Matter? https://www.painscience.com/articles/does-fascia-matter.php ****This is the article that lead me to create this blog. It made me jump down that rabbit hole myself and explore the literature related to fascia. I used this article to create this blog. Ingraham, in his article, explores this topic much deeper)****

Schleip, R. Facial Plasticity: a new neurobiological explanation. http://www.somatics.de/schleip2003.pdf

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