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Defining the fascial system

Authors:
  • Integrative Anatomy Solutions

Abstract

Fascia is a widely used yet indistinctly defined anatomical term that is concurrently applied to the description of soft collagenous connective tissue, distinct sections of membranous tissue, and a body pervading soft connective tissue system. Inconsistent use of this term is causing concern due to its potential to confuse technical communication about fascia in global, multiple discipline- and multiple profession-spanning discourse environments. The Fascia Research Society acted to address this issue by establishing a Fascia Nomenclature Committee (FNC) whose purpose was to clarify the terminology relating to fascia. This committee has since developed and defined the terms a fascia, and, more recently, the fascial system. This article reports on the FNC's proposed definition of the fascial system.
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Defining the fascial system
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ABSTRACT!
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DEFINITION!OF!KEY!TERMS!USED!IN!THIS!ARTICLE!
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!Myers!made!this!claim!during!the!FNC!‘Anatomy!Consensus!Meeting,’!held!on!19!September!
2015!prior!to!the!Fourth!Fascia!Research!Congress!(FRC4),!near!Washington!D.C.!
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!Schleip!explained!this!at!the!same!(10!September!2015)!FNC!meeting.!
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Terminologia+Anatomica!Fascia!consists!of!sheaths,!sheets!or!other!dissectible!connective!
tissue!aggregations…![This!term]!includes!not!only!the!sheaths!of!muscles!but!also!the!
investments!of!viscera!and!dissectible!structures!related!to!them.!(FIPAT!2011,!p.!33)!
!
Gray’s+Anatomy!Fascia!is!a!term!applied!to!masses!of!connective!tissue!large!enough!to!be!
visible!to!the!unaided!eye.!Its!structure!is!highly!variable!but,!in!general,!collagen!fibres!in!fascia!
tend!to!be!interwoven!and!seldom!show!the!compact,!parallel!orientation!seen!in!tendons!and!
aponeuroses.!(Standring,!2008,!p.!39)!
!
Dorland’s+Illustrated+ Medical+ Dictionary+Fascia![is]! a! sheet! or!band!of! fibrous! tissue! such!as!
lies!deep! to! the! skin! or! forms! an! investment!for!muscles!and!various!other!organs!of! the! body.!
(Anderson!2012,!p.!679)!
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Stedman’s+ Medical+ Dictionary+ Fascia! [is]! A! sheet! of! fibrous! tissue! that! envelops! the! body!
beneath! the! skin;! it! also! encloses! muscles! and! groups! of! muscles! and! separates! their! several!
layers!or!groups.!(Stegman!2006,!p.!700)!
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!!See!https://en.wikipedia.org/wiki/Delphi_method!!!!!
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Fascia+Research+ Congress.+ Fascia! is!the!soft! tissue! component! of!the!connective! tissue! system!
that!permeates!the!human! body! forming! a! whole-body!continuous! three-dimensional! matrix!of!
structural!support.!It!interpenetrates!and!surrounds!all!organs,!muscles,!bones,!and!nerve!fibers,!
creating! a! unique! environment! for! body! systems! functioning.! The! scope! of! our! definition! and!
interest! in! fascia! extends! to! all! fibrous! connective! tissues,! including! aponeuroses,! ligaments,!
tendons,! retinacula,! joint! capsules,! organ! and! vessel! tunics,! the! epineurium,! the! meninges,! the!
periostea,!and!all!the!endomysial!and!intermuscular!fibers!of! the!myofasciae.!(Findley!&!Schleip,!
2007,!p.!2)!
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The!fascia!is!a! tough! connective! tissue!that!spreads!throughout!the! body!in!a!three-dimensional!
web!from!head!to!foot! functionally!without!interruption...! The! fascial!system!surrounds,! infuses!
with,! and! has! the! potential! to! influence! profoundly! every! muscle,! bone,! nerve,! blood! vessel,!
organ,! and! cell! of! the! body.! Fascia! also! separates,! supports,! connects,! and! protects! everything. !
This!three-dimensional!web!of!connective!tissue!is!alive!and!ever!changing!as!the!body!demands.!
Thus! it! is! a! network! for! information! exchange,! influencing! and! influenced! by! every! structure,!
system,!and!cell!in!the!organism.!Like!air!and!gravity,!its!influence!is!so!all-pervasive!that!we!have!
tended!to!take!it!for!granted.!!(Barnes!1990,!pp.!xi!&!3)!
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The!fasciae!constitute!an!uninterrupted!sheet!of!tissue!that!extends!from!the!head!to!the!feet!and!
from! the! exterior! to! the! interior.! This! is! a! perfectly! continuous!system! that! is! suspended! from!
bony!structures!to!form!a!fully!integrated!supporting!framework.!The!ubiquitous!fasciae!not!only!
invest!the!external!surface!of!all!the!body’s!diverse!structures!–!muscles,!organs,!nerves,!vessels!–!
but!also! form! the! internal! matrices! which! support!these!structures!and!maintain!their!integrity.!
(Paoletti!2006,!p.!xiii)!
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Fascia! is! an! uninterrupted! viscoelastic! tissue! which! forms! a! functional! 3-dimensional! collag en!
matrix.! It! surrounds!and! penetrates! all! structures! of! the!body! extending!from! head!to! toe,! thus!
making!it! difficult!to! isolate!and! develop!its! nomenclature...![it]! is!virtually! inseparable! from! all!
structures! in! the!body! and! acts! to! create! continuity! amongst! tissues! to! enhance! function! and!
support.!(Kumka!&!Bonar!2012)!
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... Essa continuidade de tecidos fasciais, representam o sistema fascial que é definido pela interconexão entre várias estruturas do corpo como tecido adiposo, aponeuroses, cápsulas articulares, ligamentos, tendões, septos, retináculos, bainhas neurovasculares e adventícias, epineuro, membranas, meninges, expansões miofasciais, fáscias superficiais, fáscias profundas, fáscias viscerais, periósteo, vias intramusculares, tecidos conjuntivos intermusculares, incluindo endomísio, perimísio e epimísio, permitindo que todos os sistemas do corpo funcionem de maneira integrada (ADSTRUM et al., 2017). ...
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... So wurden Faszien 1651 von Crooke als "membranous tendon" bezeichnet. Cruveillier beschreibt sie layer" und Still beschreibt sie 1899 mit dem Begriff "a global connective tissue system" (Adstrum, Hedley, Schleip, Stecco, & Yucesoy, 2016). Die Bedeutung einer einheitlichen Definition besteht vor allem in der Vergleichbarkeit von Studienergebnissen (Klingler, Bierbaum, & Schleip, 2017) Richtungen toleriert werden können (Stecco et al., 2011). ...
Thesis
1.1 Hintergrund und Ziele Foam Rolling (FR) ist eine zunehmend populäre Methode zur myofaszialen Eigenbehandlung mit verschiedensten Indikationen und therapeutischen Zielsetzungen. Die hervorgerufenen Gewebereaktionen sind jedoch weitestgehend ungeklärt, sodass die Anwendung im Wesentlichen erfahrungsbasiert erfolgt. Das Ziel dieser Studie war es, die Effekte einer standardisierten FR-Intervention auf die passive Gewebesteifigkeit des Muskel- und des Fasziengewebes erfahrener und unerfahrener Sportler/-innen mittels einer objektivierbaren Diagnostik zu untersuchen. 1.2 Material und Methoden Insgesamt wurden 40 gesunde Sportler/-innen in die vorliegende Studie einbezogen. Hierunter befanden sich: 20 erfahrene Sportler/-innen (EA, 25±2 Jahre, BMI: 22±2 kg/m2; FR-Anwendung: seit 3,4 ± 2,5 Jahre, für 35 ± 26 min/Woche) mit regelmäßiger FR-Ausübung (> 6 Monate, min. 15 min, verteilt auf mindestens zwei Anwendungen pro Woche); und 20 unerfahrene Sportler/-innen (UEA, 25±4 Jahre, BMI: 23±2 kg/m2) ohne vorherige FR-Anwendung. Die Proband/-innen führten eine standardisierte FRIntervention des lateralen Oberschenkels mit fünf Sätzen bestehend aus jeweils 45 s Belastung und 20 s Pause durch. Die viskoelastischen Gewebeeigenschaften wurden mittels Acoustic Radiation Force Impulse (ARFI) Elastosonographie als intrafaszialeund intramuskuläre Scherwellengeschwindigkeit (SWV) erfasst. Die Datenerhebung erfolgte jeweils in oberflächlicher und tiefer Muskelgewebeschicht (M. vastus lateralis, MVL; M. vastus intermedius, MVI), sowie im faszialen Bindegewebe (distaler Ansatz des Tractus iliotibialis, TI). Der Messort wurde zunächst mittels B-Bild Sonographie (Acuson S2000; Siemens Healthineers, 9L4 Schallkopf) determiniert, gefolgt von 10 quantitativen Messungen der SWV jeder untersuchten Struktur. Die unter Ruhebedingungen ermittelten Werte wurden mit Nachuntersuchungszeitpunkten nach 0 min, 30 min, 6 h und 24 h verglichen. Das Signifikanzniveau wurde auf p<0,05 festgelegt. 1.3 Ergebnisse In beiden Gruppen wurden keine signifikanten Unterschiede in Bezug auf ihre anthropometrischen Daten (p≥0,28) und die Gewebesteifigkeit unter Ruhebedingungen des 2 MVL, MVI und TI (p≥0,09) festgestellt. Im Fasziengewebe konnte für die EA eine kurzfristige signifikante Abnahme der SWV des TI unmittelbar nach der Intervention (0 min) erfasst werden (-13%, p<0,01). In der UEA-Gruppe wurde hingegen zum gleichen Messzeitpunkt (0 min) ein nicht-signifikanter Anstieg der SWV des TI detektiert (+6%, p=0,16). Ebenso ergaben die Messungen nach 6 h einen signifikanten Abfall (-12%, p=0,02) für die EA. Für alle weiteren Nachuntersuchungszeitpunkte konnten für beide Gruppen keine signifikanten Änderungen der SWVs des TI nachgewiesen werden (p≥0,08). Im Muskelgewebe des MVL und MVI zeigten sich zu allen Messzeitpunkten für beide Gruppen keine signifikanten Änderungen der SWV (p≥0,11). 1.4 Schlussfolgerung Unsere Studie liefert Erkenntnisse über akute Effekte des FRs auf die viskoelastischen Eigenschaften des Muskel- und Fasziengewebes. Die vorliegenden Ergebnisse konnten erstmalig nachweisen, dass (a) sich die Ruhesteifigkeit des Muskel- und Fasziengewebes zwischen EA und UEA nicht unterscheidet, (b) das Fasziengewebe direkt nach einer FR-Intervention unterschiedliche Gewebereaktionen bei EA und UEA zeigt und (c) keine signifikante Veränderung der Gewebesteifigkeit im Muskel resultiert. Die kurzfristige Abnahme der Fasziensteifigkeit nach der FR-Intervention in EA könnte nicht nur für die Therapie lokaler Gewebeverhärtungen, sondern insbesondere auch bei bevorstehenden schnellkräftigen Bewegungsmustern von biomechanischer Bedeutung sein. Im Fokus stehen hier z.B. Sprints, Richtungswechsel oder Sprünge, für die eine erniedrigte Gewebesteifigkeit negative Auswirkungen auf Energiespeicherung und -rückgewinnung im Rahmen des Dehnungs-Verkürzungs-Zyklus zur Folge haben könnte. In Anbetracht der erstmalig nachgewiesenen unterschiedlichen faszialen Gewebereaktion in Abhängigkeit der FRErfahrung müssen zuvor publizierte Studien in Hinblick auf die Trainingsgewohnheiten der einbezogenen Proband/-innen hinterfragt werden. Um die zugrundeliegenden Mechanismen der aufgezeigten Unterschiede identifizieren zu können, sind weitere Studien notwendig.
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