Conversational Fascia

To my readers and friends in yoga who are new to anatomy: please take heart. The conversation is loaded with jargon, and it gets especially slippery where fascia is concerned. To sort out the extensive controversies in nomenclature, the Fascia Research Society established a Fascia Nomenclature Committee (FNC) in mid‐2014.¹ Take a look at the website with the most recent updates to the FNC paper to get a longer read on just how confusing and fractious the topic of fascia has become in recent decades!

The present post is a kind of "phrasebook of fascia" to establish commonality for how I use the term in my work. To be honest, I don't even like using the term 'fascia' because it is so divisive. But what is it? Here I am simplifying the nomenclature to guide you into the conversation at ground level with resources to get you conversing comfortably in the wild.

Fascia is one word for a subsystem of Connective Tissue (CT)

The above is pretty much all anyone can almost agree on. In the world of anatomical nomenclature, there seem to be two broadly opposing views on fascia:

1. Those who give the distinction "fascia" only to certain discrete anatomical units selected based on seemingly random criteria in consideration of their historical significance, differing widely and changing often subject to politics and fashion.²
   
   
2. Those who see fascia as "the fascial system;" a global interconnected sensory web.³

There seems to be some agreement that Connective Tissue (CT) is a tissue type that includes the fascial system. My own point of view is that the secretions of all cells weigh into the balance of the fascial system, which in turn influences the cells that again feed back accordingly in an endless tango of tissue maintenance. 

Fascia points:

• Fascia is a multi-dimensional fibrous matrix characterised by (but not limited to) collagen
  
  • multi-dimensional as in: including time and not limited to the normal 3D! 
• collagen comes in different types (keep scrolling for the types)
• the matrix constitutes soft tissue on a spectrum from gooey (synovial fluid, blood) to hard (bone: mineralised fascia)
• the fascial system is secreted by cells (fibroblasts secrete collagen)
• In the main, the material referred to with varying terms based on 'fascia' starts out in the so-called embryonic mesoderm, which is where van der Waal derived his term for the system-wide matrix: the meso. 

• in the meso sense, fascia includes all structures deriving from the mesoderm:
  • tendon
  • ligament
  • bones
  • aponeuroses
  • IT "band"
  • epimysium
  • muscle
  • superficial fascia "layers"
  • all coverings of bones and muscles
  • the bones and muscles themselves
  • peritoneum and visceral coverings
  • synovial fluid
  • more
• CT is made up of collagen, among other proteins, in different concentrations and fibrillar organisation.
• Myofascia is the term emerging to encompass the old "musculoskeletal" system - myo = muscle
• Different types of collagen:
  • Type I: skin, tendon/ligament, vasculature, organs, bone 
  • Type II: cartilage  
  • Type III: reticulate, the more extensible kind, commonly found alongside type I.

• Fascia is a continuum comprising bones, muscle, and organs amongst and throughout seamless, interpenetrating vectors with actions across timescales
• Cells fit into the matrix (like burrs in velcro)
• The fascial system is a "body-wide signaling network" constantly remodeling itself through electrical, cellular, and regenerative mechanosensitive means.⁴
• mechanosensitive = sensing movement, like how specialised structures of the ear are sensitive to vibration and convert sound to electrical impulses processed in the brain.

Structure for the sensorimotor playground

As you can see, fascia is loaded term because it contains all our aspirations for oneness. I tend to go with the great embryologist and fascia-influencer, van der Waal, when he talks about the meso as the structural envelope of the body.⁵ I also love his term "transanatomical" because that's what we mean by fascia; ie, something that spans anatomy to make it more than the sum of its parts. My mentor, Joanne Avison, brings it together for functionality with her suggestion of the term biomotion for how the locomotor system comes to life in movement.

My friends in the biotensegrity interest group, BIG, look at fascia as the balance of tension and compression in an organism. Graham Scarr helped me understand cross-ply in the fascial system as part of my lietmotif of spirality - chirality at every scale in nature. Currently, I'm listening with great interest to the literature around from Bordoni who has suggested the term "fascintegrity" instead of "biotensegrity" to account for the impact of the fluid fasciae on the matrix of force attenuation.⁶ 

What is hypermobility?

Hyperflexibility aka hypermobility is an umbrella term that encompasses a range of presentations. On the clinical end of the spectrum, it is assessed with the Beighton Score: https://www.ehlers-danlos.com/assessing-joint-hypermobility/

The emerging conversation around hypermobility is seated in the fascial system. My view is that there is a spectrum of compliance within each of us: we are flexible and stiff to varying degrees as a whole, and also we present with different levels of flexibility in different joints depending on a host of factors over our lifespan.

The prefixes "hypo" and "hyper" mean that a phenomenon is either too little or too much, respectively, to support proper homeostasis. In the case of someone suffering with unmanaged hypermobility, their joints are often unable to calibrate healthy compliance or return to appropriate stiffness in a reasonable timeframe following a deformation, which often leads to pain and injury. I'm working on a blog post around this - watch this space!

What happens to the body matrix in yoga:

• water content changes
• stretch reflex loop is downregulated (muscle spindle/golgi tendon)
• habituation to sensation (you get used to the feeling!)
• differentiation of stem cells
• increase in number/length of sarcomeres
• the fascial matrix self-tunes to be "stronger" and can recoil faster; so in a sense it is 

Watch this video on the physics of "stretching"

NO MORE STRETCHING

Stretching is a term we need to banish forever from the yoga world. Stretching means a material has undergone plastic deformation. When something STRETCHES, it is ruined forever! Biologic tissue such as myofascia is viscoelastic. It can be compliant while retaining its elasticity, which is how we can have an expansive inhalation and yet return to the default during postural yoga. 

viscous: flows and behaves like a fluid

elastic: "bounces back" and thus behaves like a solid

Resources

1. Schleip, R., Hedley, G., & Yucesoy, C. A. (2019, October 1). Fascial nomenclature: Update on related consensus process. https://doi.org/10.1002/ca.23423

2. Greathouse, D. G., Halle, J. S., & Dalley, A. F. (2004, January 1). Terminologia Anatomica: revised anatomical terminology. Undefined.

3. Findley, T. (n.d.). Fascia Research II: Second International Fascia Research Congress.

4. Langevin, H. M., & Langevin, H. M. (n.d.). Connective Tissue: A Body-Wide Signaling Network?

5. van der Wal J. 2009. The architecture of the connective tissue in the musculoskeletal system—An often overlooked functional parameter as to proprioception in the locomotor apparatus. Int J Ther Massage Bodyw 2:9–23.

6. Bordoni, B., Varacallo, M. A., Morabito, B., & Simonelli, M. (n.d.). Biotensegrity or Fascintegrity?