ArticlePDF Available

Defining the fascial system

Authors:
  • Integrative Anatomy Solutions
  • Technical University of Munich

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)!
!
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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... Fascia is a specialized connective tissue sheath and is most often misplaced as a synonym for connective tissue, simply because it is not known that it is a general name for various phenotypic structures like the stratum membranosum, deep fascia, epi-peri-endomysium, capsules, and ligaments, which are interconnected (Table 1) [9,10]. In other words, it is a fascial network that consists of different fasciae [17]. A fascia is a sheath of connective tissue that forms beneath the skin to attach, enclose, and separate not only muscles but also bones, nerves, blood vessels, and organs [10]. ...
... This biomechanical content is expressed in viscoelasticity, which determines the stiffness and thereby the resistance to stress and strain. Consider these elements, this anatomical structure could be classified into 1) a fascia, 2) fasciae (multiple fascia), and 3) the fascial system [9,10,17], connected from the skin to the bone within an ArthroMyoFascial complex. (foot) Scarpa's fascia (abdomen) This table provides a brief overview/subdivision of anatomical fascial structures. ...
... The superficial fascia is a connective tissue network with a membrane that separates the superficial adipose tissue from the deep adipose tissues. The superficial fascia membrane is superiorly attached to the dermis via retinacula cutis superior and inferiorly to the deep fascia via the retinacula cutis inferior [17,23]. For functional purposes, at some locations, this linkage is more firm via skin ligaments (cooper's ligaments), and at other locations, it is filmier and loose [24]. ...
Preprint
Full-text available
Background: In physiotherapy, a classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of fasciae within the muscle-bone concept. Method: Narrative review and ultrasound observation. Results: Based on literature and ultrasound skeletonization, the ArthroMyoFascial complex has been defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. Conclusion: The ArthroMyofascial complex consists of multiple layers from superficial to deeper anatomical structures, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system from the skin to the bone. This information is crucial for manual thera-pists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fasciae within the musculoskeletal domain. Understanding fascia within the mus-cle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.
... In other words, it is a fascial network that consists of different fascial tissues (i.e. fasciae) [17]. A fascia is a sheath of connective tissue that forms beneath the skin to attach, enclose, and separate not only muscles but also bones, nerves, blood vessels, and organs [10]. ...
... This biomechanical content is expressed in viscoelasticity, which determines the time-dependent stiffness and thereby the resistance to stress and strain. Considering these elements, this anatomical structure could be classified into (1) a fascia, (2) fasciae (multiple fascia), and (3) the fascial system [9,10,17], connected from the skin to the bone within an ArthroMyoFascial complex. This table provides a brief overview/subdivision of anatomical fascial structures including their anatomical identifier codes. ...
... The superficial fascia is a connective tissue network with a membrane that separates the superficial adipose tissue from the deep adipose tissues. The superficial fascia membrane is superiorly attached to the dermis via the retinacula cutis superior and inferiorly to the deep fascia via the retinacula cutis inferior (IFAA ID: A16.0.00.005) [17,23]. For functional purposes, at some locations, this linkage is more firm via skin ligaments (Cooper's ligaments), and at other locations, it is filmier and loose [24]. ...
Article
Full-text available
Background: In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. Method: This study is a narrative review and ultrasound observation. Results: Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. Conclusion: The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists , including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.
... This conceptual gap has been at least partly filled by new principles and concepts, such as the hydraulic principle (e.g., Gutmann, 1977Gutmann, , 1985Gutmann, , 1988Gutmann, , 1989, the constructional principle of soft and hard skeletal systems as an early conceptualization of tensegrity (Gutmann, 1988(Gutmann, , 1989(Gutmann, , 1991Vogel & Gutmann, 1981), expanded biomechanical concepts (Vogel, 2013), the concept of tensegrity (Bordoni & Myers, 2020;Chen & Ingber, 1999;Levin, 1995Levin, , 2006Scarr, 2014), and the concept of a pervasive fascial system (Adstrum et al., 2017;Bordoni & Lagana, 2019;Bordoni & Myers, 2020;Guimberteau & Armstrong, 2015;Stecco, 2016). Despite their significant heuristic value for the description and functional interpretation of complex morphological entities, these concepts and principles have only begun to be applied to descriptive morphology, but see, for example, Haidarliu et al. (2024);Homberger (1986Homberger ( , 2003Homberger ( , 2017a; Homberger & de Silva (2000; Homberger & Meyers (1989); Kier & Smith (1985); Maina (2017); Meyers et al. (1986);Wood et al. (2018). ...
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There is general consensus among evolutionary biologists that natural selection drives phenotypic modifications within populations over generational time. How to reconstruct this historical process, however, has been discussed mostly in theoretical terms, and recommendations and explanations on how to translate such theoretical insights into practice are needed. The present study aims at providing a theory‐supported practical guide on how to reconstruct historical evolutionary processes by applying a morphology‐centered approach through a series of interdependent steps of descriptive morphology, functional analysis, ecological observation, integration of paleoecological data, and evolutionary synthesis. Special attention is given to the development of tests regarding the accuracy, closeness to reality, and plausibility of the hypotheses at every level of the reconstructive process. This morphology‐centered approach had its beginnings in the wake of the evolutionary synthesis and is part of the scientifically necessary process of reciprocal testing of hypotheses generated by different methods and data for the reconstruction of evolutionary history.
... Beneath the skin lies another crucial type of connective tissue, the fascia, whose role is increasingly appreciated [11]. The fascial system connects the entire body, allowing it to function systematically [12,13], thereby manipulating, resisting, and distributing mechanical forces throughout the body. ...
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Exposure to mechanical stimuli such as pressure and stretching prompts the skin to undergo physiological adaptations to accommodate and distribute applied forces, a process known as mechanotransduction. Mechanotherapy, which leverages mechanotransduction, shows significant promise across various medical disciplines. Traditional methods, such as massage and compression therapy, effectively promote skin healing by utilizing this mechanism, although they require direct skin contact. This study introduces a novel contactless modality, Shear Wave Stimulation (SWS), and evaluates its efficacy compared to traditional massage in eliciting responses from human skin and fascia. Fifteen healthy volunteers received SWS, while another fifteen volunteers received massage. Tests of skin mechanical properties revealed significant enhancements in skin shear modulus for both methods, showing an increase of approximately 20%. Additionally, deformation analysis of ultrasound images showed distinct responses of the skin and fascia to the two stimuli. SWS induced extension in the dermis (∼18%), hypodermis (∼16%), and fascia (∼22%) along the X and Y axes. In contrast, massage compressed the skin layers, reducing the dermis by around 15% and the hypodermis by about 8%, while simultaneously stretching the superficial fascia by approximately 8%. The observed extension across the entire skin with SWS highlights its potential as a groundbreaking contactless approach for promoting skin healing. Furthermore, the differing responses in blood flow reaffirm the distinct stimulation modes of SWS and massage. These findings establish a foundation for future innovative skin therapy modalities.
... Fascia is a dense, irregular, and malleable connective tissue that penetrates the human body to form a continuous three-dimensional structural support matrix of the whole body, which can adjust mechanical, thermal, and metabolic stress, and can be restored to its physiological state through external manipulative treatment. 20 The deep fascia refers to all the ordered, dense, fibrous layers that interact with the muscles, connecting different structures of the musculoskeletal system and transmitting muscle power far away. 7 Located at the junction of the deep fascia and the muscle surface, Hyaluronic Acid (HA) is a lubricant that enables normal sliding between the deep fascia and the epimysium. ...
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Lower limb spasticity and clonus are common sequelae after cerebral stroke. An important part of their etiopathogenesis has been related to the peripheral component of spasticity. Rheological properties of the tissues seem to be involved. Several studies highlighted anatomical and functional changes in the connective structures. The fasciae might be implicated in the pathological process. Thus, this study intends to investigate the effect of the Fascial Manipulation (FM) technique on triceps surae in stroke patients through a clinical randomized controlled trial, to provide a reference for clinical treatment of lower limb spasticity and ankle clonus. A total of 40 patients with post-stroke ankle clonus were selected and divided into a control group and an observation group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation therapy, while the FM group received Fascial Manipulation based on conventional rehabilitation therapy. Before the first treatment and after 3 weeks of treatment, the Comprehensive Spasticity Scale (CSS), the Passive Range Of Motion (PROM), the simplified Fugl-Meyer motor function score (FMA), and the Modified Ashworth Scale (MAS) were used to assess the degree of ankle clonus, ankle passive range of motion, and lower limb motor function of the two groups of patients. Before treatment, there was no statistically significant difference between the control group and the FM group in terms of CSS, PROM, FMA, and MAS of the affected lower limbs (P>0.05). After 3 weeks of treatment, the CSS and MAS of the affected lower limbs in the control group and FM group decreased, while PROM and FMA increased compared to pre-treatment evaluation, with statistically significant differences (P<0.05). Moreover, the FM group showed a statistically significant decrease in CSS and MAS, as well as an increase in PROM and FMA, compared to the control group (P<0.05). Conclusions: Fascial manipulation in addition to conventional therapy can effectively reduce spasticity and ankle clonus in stroke patients in a short time, and improve the passive range of motion of the ankle joint and the function of lower limbs.
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*PDF available at SSRN Elsevier.* Abstract Background: Low Back Pain (LBP) is a global musculoskeletal disorder affecting quality of life, with 90% of cases categorized as non-specific, indicating that the underlying cause is unknown. One of the current treatment modalities that physiotherapists use are fascia tissue manipulations (FTMs), such as soft tissue mobilization, myofascial release, and elastic tape, to enhance joint mobility and muscle flexibility in nonspecific LBP individuals. Purpose: This review and experimental research explores the plausible working mechanisms of Skin displacement (SKD) by hand or by elastic tape. Methods: Several hypotheses regarding the working mechanisms of FTMs are discussed based on inductive reasoning based on literature and experiments using ultrasonography and cadaver dissection. We focus on the role of lumbar fasciae, skeletal muscles as well as the linkages between skin, fasciae, skeletal muscles, and joint in SKD-induced stress transmission between these structures. Furthermore, how stiffness of these structures can be altered. Results: The skin connects densely to the fasciae, back muscles, and spine, contributing to stiffness in the lumbar region. SKD maneuvers transmit stress to deeper tissues, causing strain and displacement of the thoracolumbar fascia and back muscles. Conclusion: The skin is strongly connected to the thoracolumbar fascia, back muscles, and spine. Stress applied to the skin by SKD is transmitted to the underlying anatomical structures and can alter the stiffness of fasciae and skeletal muscles. The working mechanisms of SKD as a FTM potentially alter the quantity and composition of matrix components, as well as the activity of muscle fibers, myofibroblasts, and other cells within the matrices between the skin and the joint. Improvement in joint mobility can be expected through various mechanisms involving these components. Keywords: Physical Therapy Modalities, Fascia, Muscle, Skeletal, Connective Tissue Cells
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It has been reported that at least 700 anatomical eponyms were in existence at the end of the 19th century, yet the number of eponyms expressly relating to fasciae is unknown, and these anatomical expressions have yet to be described as a group. This study accordingly aimed to assemble a comprehensive-as-possible list of these terms, to investigate their customary usage, and to consider whether their existence might usefully shed light on contemporary fascia-relating terminological development. A search for fascia-relating eponyms incorporated within a range of English language anatomical and medical publications during the past 400 years resulted in the discovery of 44 eponyms that explicitly refer to aspects of fascia. This article outlines and discusses the origin, meaning, and use of these terms, and concludes that an understanding of the history of fascial eponyms may be of value when addressing contemporary concerns with the language used to describe fascia. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Despite their importance in anatomy, physiology, pathology and surgery, the fasciae and the fascial spaces have been poorly described in classic textbooks. This little attention depends on the fact that these fasciae vary in thickness and composition, especially at the cervical level. Indeed, in the main literature they have been described in different forms. Furthermore, the definition itself of the fascia is not consistent in a variety of authors. As a consequence, different criteria have been used to define and classify the fascial systems. In this paper, a brief terminological history and the most common nomenclatures and classifications of the fascia have been summarized. Copyright © 2014 Elsevier Ltd. All rights reserved.