What is it:
When we exercise, we mostly think about how our muscles, bones, tendons, and ligaments are affected by getting stronger and more durable. When we feel soreness in our muscles, we usually think about ways to ease the muscle tension by stretching, foam rolling, and massage. But there is also another layer in our anatomy that is highly involved with our muscle and bone health, the fascia, which can also get damaged as we exercise or stress our body in other ways.
Fascia is dense connective tissue similar to tendons and ligaments located right beneath the skin and around muscles and organs. The fascial system forms a continuous sheet of fibrous membrane, like a matrix of connective tissue, that covers the body from head to toe. Fascia provides strength and protection to the body. It enables structures to stay in place and glide effortlessly between each other, which is helpful for effective muscle contraction and optimal movement.
There are two types of fascia: superficial fascia, which sits right under our skin, and deep fascia, which surrounds muscles and even the tiniest muscle fibers inside the muscle belly. Although fascia has an essential structural role, it also has nerves, making it almost as sensitive as our skin. Repetitive overuse, injury, and chronic stress can cause fascia to tighten up and cause pain.
Myofascial pain:
Fascia is mainly made of collagen and has multiple layers with liquid in between called hyaluronan. It can dry up and tighten around muscles, hindering movement. Fascia surrounding the muscles has been linked to pain from surgery, musculoskeletal injuries from sports and exercise, and aging. Up to 30% of musculoskeletal pain could be caused by fascia. Myofascial pain is a regional pain syndrome characterized by trigger points and fascial constrictions. A trigger point is a taut band of skeletal muscle that has a local ‘twitch response’ when palpated and is associated with referred pain in other parts of the body. Research has found that muscles with active trigger points fatigue and exhaust sooner and recover slower than healthy muscles. When diagnosed, myofascial pain can be treated via different therapy methods:
Proprioceptive Neuromuscular Facilitation (PNF) / Tense & Relax Stretch
Heat
Electrical Stimulation (Neuromuscular Electrical Stimulation (NMES)) - A physical therapy technique that uses electrical impulses to cause muscle contractions.
Myofascial Release Therapy
Trigger Point Injections - Usually administered with a local anesthetic in combination with a corticosteroid, botulinum toxin, or without any injection substance (dry needling).
Acupuncture
Pain Medication
Kinesio Taping
What the science says:
Proprioceptive Neuromuscular Facilitation (PNF, or Tense and Relax Stretch) is a stretching technique in which the client actively participates in the movement while the therapist helps facilitate the stretch. The PNF technique targets the nerves and muscles, facilitating new proprioceptive information to the nervous system. Proprioceptors are sensory receptors that receive stimuli from the body, especially about position and movement. The fascia contains abundant innervation with mechanoreceptors, which are receptors that sense the touch, including pressure and vibration.
This treatment method can help reduce states of dysfunction pertaining to coordination, control, and range of motion. The central nervous system can learn a new, healthier state of mobility. This treatment method is most often used in conjunction with myofascial release therapy, and research usually confirms this.
For example, a recent study that compared the effectiveness of PNF technique and myofascial release therapy in patients with subacromial impingement syndrome, the most common type of shoulder pain, found that PNF was more effective in reducing activity pain, whereas myofascial release therapy was more effective in increasing flexion, external and internal rotation ROM, as well as flexion and abduction muscle strength after the first session.
Although most people reach for ice when experiencing muscle pain, heat and the recommended thermal therapy for chronic myofascial pain are more effective. Heat will allow your muscles and fascia to relax and increase the blood flow, whereas cold, although it can decrease inflammation and ease the pain in the short term, has the opposite effect. A recent study done in conjunction with American and Korean physical therapists found that the efficacy of using heat therapy on trigger points was significantly better in treating pain in the neck and plantar fascia than the sham therapy. A sham therapy mimics the procedure but is inactive in order to study the procedure's effectiveness.
Myofascial release therapy (i.e., fascial manipulation) is a type of massage targeting trigger points in the layers of fascia and muscle tissue that are stuck together. Injury to the fascia can take a long time to repair, probably because it has a limited blood supply similar to tendons and ligaments. Myofascial work primarily aims to break up scar tissue and adhesions in the tissue, realign fibers, and speed up blood flow and healing while slowing down and, eventually, eliminating pain. The therapy uses slow and deep strokes, and the therapist needs to take into account the patient's tolerance and sensitivity to pain, as the fascia can be quite sensitive due to abundant innervation and inflammation from the trauma.
Kinesio taping has become popular among professional athletes to treat sports injuries and various muscular pain issues. The intention is to support the musculoskeletal structure without over-immobilizing the symptomatic part of the body. The KT taping intends to lift the space under the skin and soft tissue so the circulation of blood and lymph fluid can be facilitated, and the healing rate of the tissue can be increased. The proposed mechanism for relieving myofascial pain using the KT method relies on expanding the fascia space to improve circulation and remove the heat from inflammation. Pain sensation can be further diminished due to a reduction of the pressure on nociceptors.
Interestingly, a lot of the claims for using the KT method to decrease pain and increase mobility aren't supported by research. A European study that compared Kinesio tape with a placebo showed that there was no difference between these two groups in patients with chronic low back pain and went as far as advising physiotherapists not to use Kinesio tape with these kinds of patients. A meta-analysis that looked into 12 studies of the effectiveness of kinesio taping on shoulder pain and disability concluded that there is "limited evidence of its benefit as a complementary treatment in shoulder pain syndromes." The researchers also said there was insufficient evidence of its efficacy when used as a stand-alone treatment for shoulder pain.
Fascia and disease:
Fascia can also contribute to bacterial infections and disease. The connective tissue surrounds muscles, organs, and other body structures, creating a physical barrier that can become a highway if compromised. The neck is an especially problematic area as the germs can travel through several layers of fascia. In some rare but severe cases, surgical removal of dead tissue is required to save the healthy tissue. Some studies have found a small risk of infectious complications after a hip replacement where infection in the prosthetic hip has evolved to a psoas abscess. A severe bacterial condition called necrotizing fasciitis, which usually originates from a cut or a puncture to the skin, also travels and spreads in the body via fascia. This condition is rare but can be deadly if not treated promptly.
Our take:
Healthcare professionals have long overlooked fascia, but it is vital to our overall musculoskeletal health. Equal care should be given to your fascia, muscles, and other connective tissues via professional or home-care treatments such as stretching, foam rolling, and gentle movement. Treating fascia pain often requires using more than one therapy, and individuals might find some treatments work better for them than others. If you suffer from myofascial pain, Apeiron Life provides certified healthcare practitioners in multiple modalities that can take care of your fascia and body as a whole.
Will this benefit you:
Taking care of your body holistically is always more beneficial than addressing just some of its many functioning systems. As with all living tissues in our body, healthy lifestyle habits such as proper nutrition, adequate sleep, and movement are the first steps in caring for yourself and your musculoskeletal health.
If you’re still interested, here’s what to keep an eye on:
Since most fascial treatments require skills and expertise, always turn to professionals qualified to treat myofascial pain and fascial conditions, such as Apeiron Life therapists.
References and additional reading:
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