Crucial to health: your body is full of it, but what is fascia?

To understand what Yin Yoga is about, it’s about your fascia, which weighs +/_ 20 kg of your body weight. It is the organ you stretch while practicing Yin yoga.

We’re wrapped up in it, but science has long ignored fascia, the connective tissue around
organs and muscles. Now she’s discovering how this “biological spandex” affects our health,
from chronic pain to immune and digestive problems.

Human anatomy is not a field in which you expect any surprises. As early as 275 BC, the
Greek physician Herophilus was dissecting human bodies and teaching anatomy. Vesalius
published the first textbook on human anatomy in 1534. Yet in 2022, scientists are making new discoveries about our manufacturing materials. For example, they are increasingly zooming in on the “fascia. This is a complex network of connective tissue throughout our bodies that some believe could prove to be a new sensory organ.

This tissue was discovered in the 19th century, when anatomist Erasmus Wilson called it “a
natural bandage.” It is three layers of white translucent tissue that rest directly under the skin,
deeper under the fat cells and even deeper just on top of the muscles. That “matrix” of
connective tissue envelops our organs, blood vessels, bones and nerves and is made up of
strong collagen fibers and more stretchy elastin fibers.

Here and there is also more “loose” fascia in which there are fewer fibers, but in which gaps
are filled with slimy substances: hyaluronic acid, which acts as a kind of natural lubricant, and
proteoglycans, molecules that provide a cushion effect. Fascia is indispensable. Like an organic spandex, it holds our organs, blood vessels, bones, nerve fibers and muscles in place and ensures, among other things, that everything moves smoothly and moves with us. But because all those fibers and layers get in the way when you want to get to a muscle, bone or organ, anatomists and surgeons have been cutting it away without a second thought for decades. It’s just packing material anyway, was the consensus.

GENTLE TREATMENT
That all that connective tissue forms one big connected whole that interacts with and affects a
lot of body parts is only now becoming clear. If you google ‘fascia’, you come across all kinds of therapists who treat fascia in a specific, ‘soft’ way manually to help alleviate a range of complaints, from chronic pain to “movement and functioning disorders of both physical and psychological nature”, you can read for example on fascia.be. One of the founders of this therapy is the Italian physiotherapist Luigi Stecco. He has been treating patients with head, muscle and joint pains for almost forty years. His approach is based on the idea that the fascia, under the influence of stress, among other things, can
become stiff and that all kinds of physical misery can arise. With targeted manual treatments,
the layers of connective tissue become supple again and the pains and discomforts melt away,
is the reasoning.

Physical therapists and physiotherapists have established that this reasoning is correct.
Especially with non-specific complaints such as chronic pain for which no clear cause can be
found, people are often helped by ‘fascia therapy’. Besides the special manual treatments, this
also consists of movement exercises. But for a long time this approach was in the corner of alternative medicine and for some it is still there. Because there is no scientific evidence that this therapy benefits the fascia and can thus remedy pain. This is what Carla Stecco, Luigi’s daughter and orthopedic surgeon and anatomist at the University of Padova, discovered when she wanted to find out if her father’s therapy was based on science.

Carla Stecco then performed more than a hundred dissections on humans to better understand
the anatomy of fascia. It became clear that the layers of fascia are connected like a “3D
matrix” and thus give structure to the body and help it function and move in an integrated
way. Spurred on by Carla Stecco’s work, more and more scientific research has been set up. “I
estimate that about a thousand articles a year are published about this in professional
journals,” says Philippe Rosier. He is a lecturer in fascia therapy at the Fascia College and has
been doctoring on the subject.

It has been discovered that there are many types of fasciae (plural) and that fascia is
composed of collagen, elastin and different cell types such as fibroblasts and the only recently
discovered fasciocytes.

RECIPIENT OF TENSION
It also appears that fasciae are full of nerve endings. Expert Robert Schleip (Technical
University of Munich) estimates the number at 250 million, just slightly more than the
number of nerve endings in the skin. So what was long seen as an inert shell turns out to be a
very sensitive body part.

Some even advocate recognizing it as a new sensory organ specializing in communication
about the internal state of our body. For even more research shows how all those nerve fibers
in the fascia cause us to sense pressure, movement, temperature, or our position in space, and
pain stimuli also pass through this route.

The latter may be useful for the many people who suffer from chronic pain with no apparent
cause. Experiments with volunteers who receive painful punctures in the skin, muscles and
fascia indicate that the nerves in the skin lead to localized, concentrated pain, while those in
the fascia result in more radiated pain. And that is the hallmark of all kinds of chronic pain.
One of these is fibromyalgia, a condition whose main symptoms are fatigue, pain and stiffness
all over the body. Some studies suggest a link between fibromyalgia and inflammation of the
fascia.

Also the very common complaint of lower back pain might be related to fascia. Also in these
patients doctors often cannot find a cause. Fascia researchers see two potential connections
with fascia. First, it appears that the amount of pain receptors in fascia increases the longer
this connective tissue remains inflamed. So you become more and more sensitive to a pain for
which no cause has been found.

Secondly, according to Carla Stecco, the “thoracolumbar fascia” plays a major role. It’s a
diamond-shaped structure at the bottom of the back. “It’s like a big receiver of tension in the
upper extremities, the abdominal cavity and spine,” she tells New Scientist, which recently
devoted a cover story to the fascia. “The sensory nerves in this fascia potentially register that
tension as pain.”

Research by the U.S. National Institutes of Health also shows that the thoracolumbar fascia is
20 percent stiffer in people with low back pain than in others. This limits your movements, it
has been found in pigs.

But avoiding stiffening or inflaming the fascia is not so easy. Because, then, it’s not just a
passive structure. “It appears to be like a tissue that reacts intensively to all kinds of physical
stimuli and also to psychological stress,” says Rosier.

Under stress, the fascia even changes consistency, claims Schleip. In case of high stress, the
fight-or-flight response causes a peak of adrenaline. This also causes an inflammatory
substance, TGF-beta, to be produced. When fibroblasts in the fascia are exposed to this, they
turn into myofibroblasts within a few hours, this researcher claims. These are four times
stronger cells, but they also make the fascia a lot stiffer.

And perhaps hormones also play a role. “For example, estrogen makes the fascia more
elastic,” Stecco tells New Scientist. “It’s a very dynamic tissue that responds to chemical,
hormonal and mechanical inputs. And that together determines how supple or stiff the fascia
is.”

SWOLLEN LEGS
As a result, the string of diseases associated with stiffened or inflamed fasciae is getting
longer. “There are very few diseases in which the fascia does not play a role,” even Frederick
Grinnell, professor of cell biology (UT Southwestern Medical School) concludes to The
Washington Post. In journal Journal of Bodywork and Movement Therapies, scientists also
state that fascia plays a role almost everywhere in the body. “Every organ, muscle, vein and
nerve – there is no structure in our body that is not connected to it,” they conclude.
In addition to problems with movement and pain, then, fascia could be linked to more
unexpected conditions such as digestive problems and lymphedema.
Antonio Stecco, brother of Carla and Professor Assistant in Physical Medicine and
Rehabilitation (New York University), points out in a study a possible link to swollen arms
and legs, as stiff fasciae impede lymph flow. Loosening the fascia could resolve that.
Constipation, reflux and a distended stomach are also a result of poor fluid flow, according to
this Stecco, and can be relieved via the fascia.

In a study by Harvard Medical School and published in Nature, researchers even see a link to
cancer: stretching the fascia inhibited the growth of breast cancer tumors in mice. But
everyone cautions that many more studies are needed to decide anything with scientific
certainty about this.

That in itself is true of all new insights about the fascia. “This field of research is only thirty
years old. There are many leads, but much more research needs to be done to uncover the
exact role of fascia in all kinds of disorders,” says Rosier.

In any case, according to Rosier and also Carla Stecco, it is high time that medicine pays
more attention to this tissue. “Without correct knowledge about the fascia, the study of
diseases is actually not possible,” she states.

ANTI-INFLAMMATORY
Meanwhile, more and more studies on potential treatments are also coming out. For example,
there is research that shows how fascia therapy helps people with chronic fatigue, neck pain
and disrupted muscle function. It’s also what Rosier and colleagues see in practice. “We work
with a very gentle manual treatment where the fascia is stretched just enough but not too
much, so the tissue itself is encouraged to relax deeply,” Rosier says.
In addition, the therapists classically engage in “movement awareness. “You learn to stand
still very slowly when performing a movement correctly, so you feel how it can actually be
done without having pain,” says fascia therapist Ann Coppe. She too sees people with chronic
pain getting better thanks to this approach.

Stretching also appears to be a useful intervention. Helene Langevin (Harvard Medical
School) discovered in studies in rats and pigs that stretching lengthens fibroblasts in the
fascia, relaxing connective tissue, and that stretching also reduces inflammation. The test
animals had more molecules that fight inflammation after stretching sessions. A Harvard
Medical School pilot study of healthy volunteers who regularly stretched for an hour seems to
indicate the same.

What has not yet been demonstrated is whether fascial techniques that include manual
treatments also have such an anti-inflammatory effect. It could be, according to some, that the
manual therapies mainly or only warm up the fascia, making it temporarily more flexible.
Langevin therefore argues that it will be necessary to wait for more studies on what exactly
happens with fascia therapy before we can be sure that it does something beneficial in the
long term.

But fasciatherapists continue their work. “We don’t work evidence-based but with practice-
based evidence,” Coppe says. “We test the experiences and effects produced by our treatments
against the available scientific evidence. At the same time, we participate in scientific
research. It’s not so strange in medicine that clinicians first establish something in practice and
only afterwards are there studies that prove it.”

Paul Sercu, founder of fascia therapy in our country and of the BodyMind Academy, was able
to demonstrate with colleagues that fascia fibers change structure, improve flexibility and
reduce pain when they learn to move consciously. “The fascia is really a tissue that makes the
connection between body and mind, between the physical stimuli and their processing in our
brain,” says Sercu.

That’s precisely why it’s crucial to uncover its secrets. But that’s also why fascia therapists are
still boxing up against the label of “alternative medicine.

“To counter that, the BodyMind Academy and the Fascia College offer this training only for
doctors and physiotherapists and participate in research that happens at universities,” says
Rosier. He is preparing research at UGent on fascia and low back pain. Sercu is collaborating
on a study at UHasselt.

At the international level, there is an annual Fascia Research Congress, where Sercu is
speaking this year. “We are still in the early stages,” says American expert Thomas Findley

(Rutgers Cancer Institute of New Jersey). “Every time a question is answered, new questions
pop up.” Some scientists find that exciting; others caution against expecting too much.

BARBARA DEBUSSCHERE — 8 June 2022