Zugel M, Maganaris CN, Jukat-Rott K, Klinger W, Wearing S, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury, and diagnostics: consensus statement. Br J Sports Med 2018; 52: 1497-1505.
The purpose of this paper was to produce a consensus statement on the “state of knowledge” regarding fascial tissue relative to sports medicine. The contributors were many of the respected researchers in this field. It covered research from a number of disciplines and summarizes what is known about fascia, what the next research initiatives might be, and the present limitations of the measurement tools. One fascinating section of the “consensus” provides great evidence that normal cellular healing responses can become excessive. Whether increased in degree or time, the “prolonged presence of macrophages and cytoxic levels of cytokines” can result in continued damage. As a result, fibroblast proliferation, as well as the pain response, can become excessive.
This blog will focus on the section related to the “mechanobiology” of fascial tissues. The challenge for all of us in the training or rehabilitation professions is that optimum fascial tissue biology is a “Goldilocks” dilemma. Consider the fibroblast conundrum. Does the tissue need more fibroblasts to add tissue material or fewer fibroblasts to allow tissue gliding? Ultimately it would seem that both are desirable in healing tissue. Fibroblastic activity that allows for healing and maturation of tissues without restricting tissue gliding is the goal! Tissue loading via movement will provide the mechanical stimulus for maturation of new cells. Three-dimensional movements create the gliding while allowing the tissue’s cells to be oriented along the lines of functional stress. So we must provide the correct dosage of movements (load, speed, repetitions) as our programs are designed and modified. The 10 Observational Essentials of CAFS (Certification in Applied Functional Science®) provide the strategies for the logical progression of programs. (Find out more here: https://www.grayinstitute.com/courses/cafs.)
There is substantial evidence that tendons respond to the application of loads by becoming stiffer, and the absence of load by becoming more compliant. These studies have demonstrated changes in short periods of time (weeks). But movement specialists must consider where on the stiff-elastic continuum the tissue specifically, and our patients / clients generally, are functioning. The article lists aging as a factor that increases the stiffness of fascial tissue. In this case, that stiffness is not a positive shift towards the optimum, but rather a negative shift that reduces the elasticity to absorb force. Stiffness in the fascial tissues requires more work from the muscles, with increased energy expenditure. Three-dimensional flexibility programs, performed in functional positions would appear to be of great benefit to delay the negative excessive stiffness of aging. At Gray Institute®, based on the Applied Functional Science® Principle of load to explode, dynamic loading in the Transformational Zone of the movement is preferred over static stretching.
Considering the fascial connections throughout the entire body, our flexibility and tissue loading movements should be as global as possible. The effects of restricted movement of the fascia on different regions of the body can’t be identified (and rectified) with local joint movements alone. During local motion the body can “buy room” for the restriction by compensating elsewhere in the body. To prevent this compensation, tensioning of the fascial system is needed by positioning or moving body segments anatomically distant from the region of the restriction. This will enhance the local interventions. The interplay of global and local strategies is highlighted in CAFS, as well as the new and powerful Functional Soft Tissue Transformation specialization from Gray Institute®. (Find out more here: https://www.grayinstitute.com/courses/func-soft-tissue.)
Finally, the consensus article did not intend to address the neuro-perceptual importance of fascial tissues. But at Gray Institute®, one of the critical default strategies is “when in doubt, consider the proprioceptors.” This strengthens our conviction that all training programs must emphasize three-dimensional movements, in authentic functional positions, created by different body part drivers (hands, feet, head, pelvis). Our movements need to provide the system with proper afferent proprioceptive information so that the muscles can be organized into effective and efficient synergies. But this raises the challenge of aberrant neuro-perceptual information generated by local aberrant tension resulting from trauma or surgical interventions. At Gray institute®, we like to “attack” this problem from both sides of the coin. The global movements driven by the patient / client create the local tissue motion. Local interventions during the movements promote fascial layer mobility and gliding. By improving local tissue mobility and strength, the aberrant neuro-perceptual information will become more normal. By combining global movements with local interventions, the system learns to integrate the “normalized” (new normal) information with proprioceptive information from the rest of the body to accomplish the intended task.