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Update on fascial nomenclature
... Routinely dismissed as a packing tissue of little consequence [51][52][53], the fascial tissues are now recognized for their involvement in structural stability and motion control [24,[52][53][54]. The term fascia, however, has a long and varied history that continues to evolve [55] with Adstrum et al. (2017) [56] raising concerns over the coexistence of several differing meanings and proposing a comprehensive definition of the fascial system that could drive further research [57]. "The fascial system consists of the three-dimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body. ...
... It incorporates elements such as adipose tissue, adventitiae and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons, visceral fasciae, and all the intramuscular and intermuscular connective tissues including endo-/peri-/epimysium. The fascial system surrounds, interweaves between, and interpenetrates all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner" (italics added) [57]. ...
... The process of updating anatomical maps in ways that include the fascial system is thus already underway way [24,57,110] and provides support for the MMAM hypothesis presented here, although its general acceptance will ultimately depend on further research and clinical usefulness [85], and an inclusive systems-biology approach to the mapping of functional anatomy is advocated [3,24,40,122,138]. ...
The improvement of the human condition is the driver behind a vast amount of ongoing research and naturally employs the most up-to-date methods in its endeavours. It has contributed greatly to our understanding of the body and benefitted our healthcare systems in remarkable ways, but there is a problem. The mapping of anatomy to its physiological functions is essentially derived from the work of Vesalius and traditionally favoured mobility over stability, and as a consequence has allowed the entrenched and simplifying assumptions of the musculoskeletal duality to persist to the present day, despite advances in technology.
The lever model of motion, for example, assumes that the body is an intrinsically unstable system that requires an external controller (e.g. neural) to provide the necessary ‘catch-up’ stability for transient muscular latencies, and it is likely that the vulnerabilities inherent within such a mechanism would severely compromise living tissues. The foundational biomechanical assumptions of steady-state forces and kinematics has meant that the disproportionate and potentially damaging consequences of transient peak loadings have been largely overlooked, and which added to the long healing times required for post-traumatic recovery, suggests that such a mechanism would lead to material fatigue and destructive tissue failure.
The musculoskeletal duality, however, was not always so dominant but conceptually rivalled in the 17th and 18th centuries by Hooke’s ‘cells’ and Malpighi’s ‘cellular tissues’, both of which have been largely forgotten but now deserve a re-evaluation. The definition of the term ‘cell’ as a small compartment within a larger structure had quite different connotations then than it does today, but this compartmental aspect of connective tissue anatomy gradually faded and is now only recognized for its pathological significance.
This paper examines musculoskeletal anatomy from both historical and more recent viewpoints and highlights the concept of the fascial system as a distinct and intrinsically stable functional entity. It is a perspective that enables every anatomical ‘part’ to be included within a ‘cellular’ framework that differs substantially from the mobility-driven machine model: a tensioned fibrous network encompassing a complex heterarchy of regionally specialized compartments under compression, each of which has its own physical and parenchyma-driven characteristics that contribute to the functional whole. In other words, an updated fascia-centric interpretation of architectural anatomy that maps muscles and bones in a substantially different way from traditional models, renders the term musculoskeletal obsolete and greatly expands the meaning of compartment syndrome.
... The fascial system builds a "three-dimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body" and incorporates elements such as "adipose tissue, adventitiae and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons, visceral fasciae, and all the intramuscular and intermuscular connective tissues including endo-/peri-/epimysium" (Stecco, Adstrum, Hedley, Schleip, & Yucesoy, 2018). This system "surrounds, interweaves between, and interpenetrates all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner" (Stecco et al., 2018). ...
... The fascial system builds a "three-dimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body" and incorporates elements such as "adipose tissue, adventitiae and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons, visceral fasciae, and all the intramuscular and intermuscular connective tissues including endo-/peri-/epimysium" (Stecco, Adstrum, Hedley, Schleip, & Yucesoy, 2018). This system "surrounds, interweaves between, and interpenetrates all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner" (Stecco et al., 2018). Beyond this broader and more functional definition of the 'fascial system', a narrower anatomical definition states that "a fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs" (Adstrum, Hedley, Schleip, Stecco, & Yucesoy, 2017). ...
... Deep fasciae (also known as muscular fasciae) are elements of the fascial system that correspond to all the well-organized, dense, fibrous layers that interact with the muscles, connect different elements of the musculoskeletal system and transmit muscular force over a distance (Stecco, 2015;Stecco et al., 2018). There are two main types of deep muscular fasciae -the aponeurotic and the epimysial fasciae. ...
Background
Failure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.
Objectives
To identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.
Methods
A systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.
Results
From a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n=4), abdominal (n=7), femoral (n=4) and crural (n=3) regions. These studies addressed issues concerning either diagnosis (n=11) or treatment benefits (n=7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies.
This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).
Conclusion
The US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.
... Adstrum et al. [29], Stecco et al. [30] in Adstrum and Nicholson [28] Fascia is multi-layered and has both loose and hard fibrous connective tissue components. Loose fascia functions to help slide and glide between structures and dense fascia exerts a tensile strength in tissues like tendons. ...
... Fascia contains cells (fibroblasts, fasciacytes, myofibroblasts, and telocytes), an extracellular matrix (ECM), nerve elements (proprioceptors, interoceptors, and nociceptors), and a system of vascular micro-channels (the primo vascular system) [30,31]. The fasciacytes produce hyaluronan in response to shear stresses [32]. ...
... Fascia is one of the essential biological structures that combines with muscles, tendons and bones to create the tensioned and compressed parts that create the biotensegrity properties of the human body [40]. Fascia has active mechanical, proprioceptive, nociceptive, and biomechanical and biotensegral properties [30,39,41]. Fascia is essential for physiological and metabolic haemostasis as well as healing and repair [30,31]. ...
Humans exhibit biotensegrity, whereby the whole body is a three-dimensional visco-elastic vehicle whatever position it adopts: bones form non-contact compression struts embedded in a networked and tensioned myofascial matrix; each part of the organism combines with the mechanical system to create an integrated functional movement unit and contributes to the stability of the whole system. When tissue at/below the dermis is breached by surgery/injury, healing leads to scar tissue formation. Scars can cause local and distant effects that are not purely cutaneous. Restriction of normal movement of underlying tissues from defective fascial sliding generates anomalous tension that affects the fascial continuum leading to distorted biomechanics, altered biotensegrity and chronic pain. Scars are common in children and significant contributors to chronic pain presentations. Scars can be released (soft tissue mobilization and/or needling) to sustainably improve pain, flexibility and range of motion. This chapter outlines the importance of skin and fascia in the biotensegrity model. Emphasis is placed on the fundamental need to assess scar history and scar characteristics to determine if scars should be treated as a component of multidisciplinary chronic pain management. Case studies outline some key clinical observations. Appropriately controlled research studies are required to fully demonstrate the highlighted benefits.
... Despite offering precious medical advances, this approach is unable to fully explain the origin of musculoskeletal pain. However recent research has brought to light that the fascial system, commonly defined as the "threedimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body" (Stecco et al., 2018a), may help us solve this mystery. ...
... However research in the past few decades has shown that fascia plays various roles from regulation of nearby structures through force transmission (Wilke et al., 2018) to proprioception (van der Wal, 2009;Stecco et al., 2013;Stecco et al., 2018a) and nociception (Fede et al., 2020;Mense, 2019;Stecco et al., 2007;Stecco et al., 2013). ...
The deep fascia is a three‐dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. A state‐of‐the‐art review was conducted in PubMed and Google Scholar following a two‐stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra‐cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro‐inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
... The committee proposed two definitions of fascia: an anatomical and functional one. The first one describes fascia as connective tissue in the form of a sheath which is formed under the skin to connect, close off, and separate muscles from internal organs (95,96). The functional definition is broader and describes fascia as a system that surrounds organs, bones, muscles, ligaments, tendons, joint capsules, nervous fibres as well as blood vessels and it provides the body with functional and structural integrity as it brings together the functions of all the body's systems (95,96). ...
... The first one describes fascia as connective tissue in the form of a sheath which is formed under the skin to connect, close off, and separate muscles from internal organs (95,96). The functional definition is broader and describes fascia as a system that surrounds organs, bones, muscles, ligaments, tendons, joint capsules, nervous fibres as well as blood vessels and it provides the body with functional and structural integrity as it brings together the functions of all the body's systems (95,96). The research has shown that the fascial tissue is innervated by nociceptors and mechanoreceptors which provide information both on the somatic and the autonomous nervous system. ...
... The term "fascia" has in the past been employed to refer to various types of connective tissue but there was no universally adopted terminology. In an attempt to address this confusing situation the Fascia Nomenclature Committee, appointed by the Fascia Research Society, has recently proposed a new definition (Stecco and Schleip, 2016;Adstrum et al., 2017;Stecco et al., 2018). This recognises the existence of a "fascial system", described as a "three-dimensional continuum of connective tissues that endows the body with a functional structure and enables all body systems to operate in an integrated manner". ...
... Levin (2018) observes that anatomists are moving away from thinking in terms of independent structures and are instead starting to think in terms of functional anatomy and integrated systems. The "loose and dense fibrous connective tissues that permeate the body" described by Adstrum et al. (2017) and Stecco et al. (2018) are much more pervasive than previously acknowledged. For many anatomists, the new definition by the Fascia Nomenclature Committee is therefore a welcome step forward in providing a global, allencompassing definition of fascia. ...
This article presents an overview of research conducted by Dr Jean-Claude Guimberteau into the architecture and spatial organization of living matter and the relationship between the cells and the extracellular matrix. His research is discussed in the context of previous and current research into fascial anatomy. Andrew Taylor Still, the founder of Osteopathy, did not have access to modern research and yet his observations are proving to be surprisingly accurate in the light of recent findings. This article sets out to highlight the relevance of his insights from a purely anatomical perspective, and to draw parallels with a new way of thinking about the architecture of the living human body that is slowly emerging. Dr Guimberteau's research shows that a force applied to the surface of the skin is transmitted deep into living tissue via a continuous bodywide multifibrillar network. It also confirms the concept of the body as a dynamic functional unit, as proposed by A.T. Still. Still also proposed that structure and function are interrelated at all levels within the living human body. There is a growing body of research to support this. Intratissular endoscopy has highlighted the importance of the quality of the mobility and adaptability of the network of collagen and elastin fibers that structures the ECM in healthy living tissue. Factors such as abnormal stiffness of collagen fibers in the ECM are thought to have adverse effects on local tissue health.
... It is important to also note that muscle in the in vivo context is not isolated from its surroundings. Instead, it has connections to the neighboring muscles and non-muscular connective tissues (Huijing and Baan 2001; Maas et al. 2001), operating as an integral part of the fascial system (Adstrum et al. 2017;Stecco et al. 2018;Schleip et al. 2019). It has been shown that muscle's extramuscular and epimuscular (i.e., collagen reinforced connective tissue structures including neurovascular tracts, general and compartmental fascia, intermuscular septa, interosseous membranes connecting muscle's epimysium to non-muscular structures and also other muscles, respectively), connections affect not only the global mechanics of the muscle i.e., the muscle force (Maas et al. 2003;Yucesoy et al. 2006), but also locally the myofascial loads (Yucesoy et al. 2007;Yucesoy 2010) can alter the mechanical equilibrium determining length changes along the muscle fascicles (Pamuk et al. 2016;Karakuzu et al. 2017). ...
Shorter sarcomere effect was shown in recent modeling of truly isolated muscle as the characteristic mechanism determining active state titin’s contribution to muscular mechanics via manipulation of muscle fiber direction strains. For muscle with extra- and epimuscular connections to surrounding tissues, epimuscular myofascial force transmission (EMFT) leads to myofascial loads, which affects mechanical equilibrium that determines local strains. Consequently, compared to truly isolated muscle, we hypothesized that for such integrated muscle active state titin’s effects on muscular mechanics are manipulated by EMFT. The aim was to test this. Isolated vs. integrated rat extensor digitorum longus muscles were modeled at long muscle lengths (λ m = 28.7-32.7mm) and three cases were studied: passive state titin (no change in titin constitutive equation in the active state), active state titin-I (constitutive equation involves a higher stiffness in the active state) and active state titin-II (constitutive equation also involves a strain shift coefficient accounting for titin’s reduced free spring length). For isolated muscle, shorter sarcomere effect i.e., limited lengthening locally along the muscle fiber direction and force enhancement (maximally 77.4%) was consistent. However, for integrated muscles, variable fiber direction strains showed even longer or shortened sarcomeres locally and consequently, force enhancement was inconsistent being even diminished (7.8%) or elevated (96.8%) at different lengths. Shift of muscle’s optimum length to a longer length in isolated muscle (λ m = 29.6mm) increased (λ m = 29.9mm) or vanished (λ m = 28.7mm) for extra- or epimuscularly connected muscles, respectively. In conclusion, in the integrated muscle context, effects of active state titin on muscular mechanics are manipulated by EMFT.
... In both sports and rehabilitation, the interest in connective tissues has increased, as they play an important role in force transmission, which has been observed within the socalled myofascial chains (Do Carmo Carvalhais et al., 2013;Krause et al., 2016;Stecco et al., 2018;Wilke et al., 2016). There is evidence that one such chain, the superficial backline (SBL), extends from the plantar fascia, over the Achilles tendon, the gastrocnemius muscle, the ischiocrural muscles, the sacrotuberous ligament, the thoracolumbar and spinal continuity to the skull attachment, thus connecting the muscles of the dorsal chain (Stecco et al., 2019;Wilke et al., 2016). ...
This cohort-based cross-sectional study compares the original (OV) and a newly developed standardized version (SV) of the Bunkie Test, a physical test used to assess the dorsal chain muscles. Twenty-three participants (13 females, 10 males; median age of 26 ± 3 years) performed the test, a reverse plank, with one foot on a stool and the contralateral leg lifted. In the SV, the position of the pelvis and the foot were predefined. The test performance time (s) and surface electromyography (sEMG) signals of the dorsal chain muscles were recorded. We performed a median power frequency (MPF) analysis, using short-time Fourier transformation , and calculated the MPF/time linear regression slope. We compared the slopes of the linear regression analysis (be-tween legs) and the performance times (between the OV and SV) with the Wilcoxon test. Performance times did not differ between SV and OV for either the dominant (p = 0.28) or non-dominant leg (p = 0.08). Linear regression analysis revealed a negative slope for the muscles of the tested leg and contralateral erector spinae, with a significant difference between the biceps femoris of the tested (-0.91 ± 1.08) and contralateral leg (0.01 ± 1.62) in the SV (p = 0.004). The sEMG showed a clearer pattern in the SV than in the OV. Hence, we recommend using the SV to assess the structures of the dorsal chain of the tested leg and contralateral back.
... The authors reported muscle tissue displacement in the dorsal thigh, despite the fact that knee angle was kept constant, and explained this with myofascial force transmission across the knee joint. Such mechanical interaction via the fascial system (Adstrum et al., 2017;Stecco et al., 2018;Wilke et al., 2018) between muscles within the same limb segment (e.g., Huijing et al., 2011;Marinho et al., 2017;Ateş et al., 2018a) and even across segments, e.g., in the gastrocnemius after an imposed anterior pelvic tilt (Cruz-Montecinos et al., 2015) have been reported in numerous studies. In fresh postmortem human subjects, strain mechanisms in lower limb deep fascia induced by passive knee movement were studied using motion analysis and digital image correlation techniques (Sednieva et al.). ...
... Fascia used to be seen as a simple connective packaging tissue. However, that has changed over the past few years and it is now considered to be a three dimensional, functional structure which supports the interaction of body systems (Adstrum et al., 2017;Stecco et al., 2018). This highlights fascias' active role as an expansive tensegrity network with proprioceptive and nociceptive functions (Adstrum et al., 2017). ...
Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.
... More recently, the decellularization of entire fetal sheep shows that the connective tissue network is continuous throughout the body and that the connective tissue of nerves creates structural continuity between the nervous system and other tissues 3 . Dissection of human bodies likewise demonstrates continuity across large, multiorgan regions of the body, including the entirety of the dermis and the fascia of diverse organs and organ systems [10][11][12][13] . ...
Bodies have continuous reticular networks, comprising collagens, elastin, glycosaminoglycans, and other extracellular matrix components, through all tissues and organs. Fibrous coverings of nerves and blood vessels create structural continuity beyond organ boundaries. We recently validated fluid flow through human fibrous tissues, though whether these interstitial spaces are continuous through the body or discontinuous, confined within individual organs, remains unclear. Here we show evidence for continuity of interstitial spaces using two approaches. Non-biological particles (tattoo pigment, colloidal silver) were tracked within colon and skin interstitial spaces and into adjacent fascia. Hyaluronic acid, a macromolecular component of interstitial spaces, was also visualized. Both techniques demonstrate interstitial continuity within and between organs including within perineurium and vascular adventitia traversing organs and the spaces between them. We suggest that there is a body-wide network of fluid-filled interstitial spaces that has significant implications for molecular signaling, cell trafficking, and the spread of malignant and infectious disease. Odise Cenaj et al. find that the fibrous interstitial spaces within and around organs may in fact be continuous networks throughout the human body. Using traceable particles injected into colon and skin interstitial spaces in human tissue samples, they demonstrate the interconnectedness of these fluid-filled spaces.
... Despite the efforts to objectively limit the boundaries of this review to deep fasciae, their sliding mobility and respective in vivo US evaluation methods, the heterogeneity of the terminology used by the different authors to describe the fascial structures and their sliding mobility may have influenced the selection and analysis of the articles. Fascia has generated a passionate debate between clinical specialists and researchers, which has justified the creation of "The Fascia Nomenclature Committee" to reach consensus on related terminology (Adstrum et al., 2017;Stecco et al., 2018). ...
Background
Failure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.
Objectives
To identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.
Methods
A systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.
Results
From a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n=4), abdominal (n=7), femoral (n=4) and crural (n=3) regions. These studies addressed issues concerning either diagnosis (n=11) or treatment benefits (n=7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies. This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).
Conclusion
The US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.
... It is not necessary to take a hard stand as to what is or is not fascia as the science in the field keeps evolving. As Schleip et al (2012) and subsequent associated researchers (Adstrum et al 2016, Stecco et al, 2018 are essentially saying, fascia is what we define it to be. Muscle has muscle cells within its fascial encasement, bone has osteoblasts and osteoclasts within its fascial encasement, cartilage has cartilage cells within its fascial encasement, just as pericardium has heart cells within its fascial encasement, mesentery has digestive cells within its fascial encasement, the meninges have neural cells within their fascial encasement, and pleura has lung cells within its fascial encasement. ...
... In this way, we offer a conceptualization that uses "top-down" and "bottom-up" neural pathways to support the hypothesized mutual association between MI and fascia. Further, we propose that performance and well-being, including as affected by body schema and pain, may be addressed through such neuro-cognitive paths, including those associated with bodywork and movement therapies [6,9,[19][20][21][22]. We then propose fascial MI (FMI) as a subtype of MI that focuses on fascial tissue, and introduce a codified MI approach that specifically addresses fascial tissue-fascial dynamic neuro-cognitive imagery (FDNI)-and suggest applications for research and clinical settings. ...
Mental imagery (MI) research has mainly focused to date on mechanisms of effect and performance gains associated with muscle and neural tissues. MI's potential to affect fascia has rarely been considered. This paper conceptualizes ways that MI might mutually interact with fascial tissue to support performance and cognitive functions by, among others, positively affecting pain and body schema. Drawing on cellular, physiological, and functional similarities and associations between muscle and fascial tissues, we propose that MI has the potential to affect and be affected by fascial tissue. We suggest that fascia-targeted MI (fascial mental imagery; FMI) can therefore be a useful approach for scientific as well as clinical purposes. We use the example of fascial dynamic neuro-cognitive imagery (FDNI) as a codified FMI method available for scientific and therapeutic explorations into rehabilitation and prevention of fascia-related disabling conditions.
... The great structural complexity of the IMCT network evidenced by scanning electron micrographs suggests that this traditional classification may be simplistic and that a higher order organization of muscle ECM yet needs to be defined (Gillies and Lieber, 2011). Research into fascial tissues further considers the layers of IMCT as part of a complex system of interconnected and interwoven connective tissues that "surrounds, interweaves between, and interpenetrates all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner" (Adstrum et al., 2017;Stecco et al., 2018). This system, which is commonly referred to as fascial system, is increasingly recognized as important target in sports medicine (Zügel et al., 2018). ...
Skeletal muscle represents the largest body-composition component in humans. In addition to its primary function in the maintenance of upright posture and the production of movement, it also plays important roles in many other physiological processes, including thermogenesis, metabolism and the secretion of peptides for communication with other tissues. Research attempting to unveil these processes has traditionally focused on muscle fibers, i.e., the contractile muscle cells. However, it is a frequently overlooked fact that muscle fibers reside in a three-dimensional scaffolding that consists of various collagens, glycoproteins, proteoglycans, and elastin, and is commonly referred to as extracellular matrix (ECM). While initially believed to be relatively inert, current research reveals the involvement of ECM cells in numerous important physiological processes. In interaction with other cells, such as fibroblasts or cells of the immune system, the ECM regulates muscle development, growth and repair and is essential for effective muscle contraction and force transmission. Since muscle ECM is highly malleable, its texture and, consequently, physiological roles may be affected by physical training and disuse, aging or various diseases, such as diabetes. With the aim to stimulate increased efforts to study this still poorly understood tissue, this narrative review summarizes the current body of knowledge on (i) the composition and structure of the ECM, (ii) molecular pathways involved in ECM remodeling, (iii) the physiological roles of muscle ECM, (iv) dysregulations of ECM with aging and disease as well as (v) the adaptations of muscle ECM to training and disuse.
... (C. Stecco, Adstrum, et al., 2018) ...
Diese Arbeit befasst sich mit dem Zusammenhang des Fasziensystems – dem dreidimensionalen Netzwerk im menschlichen Körper – und der Propriozeption – der Wahrnehmung der Lage des Körpers im dreidimensionalen Raum – aus trainingswissenschaftlicher Sicht. Es wird ergründet, was Propriozeption ist, welchen Einfluss sie auf die sportliche Leistungsfähigkeit hat und inwiefern sie durch Training verbessert werden kann. Im Anschluss daran wird darauf eingegangen, worum es sich beim Fasziensystem handelt, welche Bedeutung es für die Propriozeption hat und welche Möglichkeiten es gibt, fasziale Strukturen zu trainieren. Abschließend soll geklärt werden, welche Schlussfolgerungen sich hieraus für das Training der propriozeptiven Fähigkeiten ergeben.
Bei der Propriozeption handelt es sich um bewusste wie unbewusste
Wahrnehmungsresultate, die die Körperposition- und -bewegung im Raum betreffen. Im engen Sinn bezieht sie sich auf die Informationen aus Rezeptoren in der Körperperipherie. Im weiten Sinn beruht sie auf der Integration des multimodalen Inputs aus verschiedenen Sinnessystemen und supraspinalen Instanzen. Begriffe, die sich auf die sinnesphysiologischen Grundlagen beziehen, sind vom Begriff
„Propriozeption“ abzugrenzen. So umfasst der Begriff „propriozeptives System“ die Kette physikochemischer Ereignisse, die an der Aufnahme und Weiterleitung von sensorischen Informationen aus der Körperperipherie über Bewegung und Position
beteiligt sind.
Die Propriozeption ist gelenkspezifisch und dient der Bewegungskontrolle.
Insbesondere die propriozeptive Wahrnehmung des Sprunggelenks ist von
Bedeutung für die sportliche Leistungsfähigkeit. Die propriozeptiven
Wahrnehmungsfähigkeiten können durch Training verbessert werden. Die genauen
zentralen wie peripheren Anpassungsmechanismen sind indes nicht endgültig
geklärt und auch hinsichtlich des optimalen Trainingsumfangs besteht noch weiterer
Forschungsbedarf.
Eine Vielzahl von Rezeptoren, die propriozeptive Informationen liefern, befinden sich
im Fasziensystem. Dieses lässt sich in Schichten einteilen und vor allem die tiefe
Faszie, die die aponeurotische wie die epimysiale Faszie umfasst, ist von Relevanz
für die propriozeptive Wahrnehmung. Die mechanische Beschaffenheit des faszialen
Gewebes trägt maßgeblich dazu bei, inwiefern Propriozeptoren aktiviert werden.
Erste Studien konnten zeigen, dass eine myofasziale Selbstmassage der
Oberschenkelrückseite zu akuten, aber auch überdauernden Verbesserungen der
Wahrnehmung des Hüft- und Kniewinkels führt. Dabei zeigte die Anwendung mit
vibrierenden Hartschaumrollen gegenüber der Anwendung mit nicht vibrierenden
signifikant bessere Ergebnisse.
Es deutet daraufhin, dass durch Training, das auf eine Verbesserung der
mechanischen Eigenschaften des faszialen Bindegewebes abzielt, auch die
propriozeptive Wahrnehmung verbessert werden kann. Da hinsichtlich der Anpassungsmechanismen und des optimalen Trainingsumfangs noch keine Klarheit besteht, sollte zukünftige Forschung prüfen, ob grundsätzlich ein Zusammenhang zwischen der faszialen Gewebeelastizität und propriozeptiven Wahrnehmungsleistungen festzustellen ist. Weiterhin besteht Forschungspotenzial hinsichtlich der Auswirkungen spezifischer Interventionen auf propriozeptive Sinnesmodalitäten an unterschiedlichen Gelenken.
... Presently, the official fascial nomenclature defines fascia as a three-dimensional network that includes all connective tissues that invest or interweave between inner organs and muscles. 1 This usage of the term fascia has the advantage of simplifying communication, but the disadvantage is that all possible connective tissues with different histological composition are lumped together. Therefore, when the fascia of the low back is addressed, one has to specify if the subcutaneous tissue or the intervertebral discs are talked about. ...
The aim of the study was to obtain information on the sensory functions of the thoracolumbar fascia (TLF). The types of nerve fibres present in the TLF were visualized with specific antibodies to neuropeptides and sympathetic fibres. Most data were obtained from the TLF in rats, but some findings from the human fascia are also included. The only receptive nerve ending found was the free nerve ending, i.e. no corpuscular receptors existed in our specimen. An exclusive innervation with free nerve endings speaks for a nociceptive function, but the TLF may also fulfill proprioceptive functions, since many of the free nerve endings have a low mechanical threshold. Most of the fibres could be visualized with antibodies to CGRP [calcitonin gene- related peptide (CGRP)] and SP [substance P (SP)]. The latter ones most likely were nociceptors. The TLF contained a great proportion of postganglionic sympathetic fibres, which may be vasoconstrictors. A comparison between an inflamed and intact fascia showed an increase of the CGRP- and SP-positive fibres in the inflamed TLF. This finding could be one explanation for the low back pain of many patients, since practically all lesions of the fascia are accompanied by a sterile inflammation.
... The Fascia Research Society needs to be acknowledged for financial support in conducting the personal meeting of the FNC. In addition, the following experts need to be acknowledged for their active participation in the FNC meeting at the Fascia Research Congress 2015 in addition to their participation in the previous Delphi process rounds: Sue Adstrum (Stecco and Schleip, 2016;Stecco et al., 2018) A fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs. The fascial system consists of the three-dimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body. ...
... The Fascia Research Society needs to be acknowledged for financial support in conducting the personal meeting of the FNC. In addition, the following experts need to be acknowledged for their active participation in the FNC meeting at the Fascia Research Congress 2015 in addition to their participation in the previous Delphi process rounds: Sue Adstrum (Stecco and Schleip, 2016;Stecco et al., 2018) A fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs. The fascial system consists of the three-dimensional continuum of soft, collagen containing, loose and dense fibrous connective tissues that permeate the body. ...
The term fascia is increasingly used not only by anatomists but also by other professionals and authors in different health‐oriented fields. This goes along with an inconsistent usage of the term, in which many different tissues are included by different authors causing an increasing amount of confusion. The Fascia Research Society acted to address this issue by establishing a Fascia Nomenclature Committee (FNC) with the purpose of clarifying the terminology relating to fascia. This committee conducted an elaborate Delphi process to foster a structured consensus debate among different experts in the field. This process led to two distinct terminology recommendations from the FNC, defining the terms “a fascia” and “the fascial system.” This article reports on the process behind this proposed terminology as well as the implications for inclusion and exclusion of different tissue types to these definitions. Clin. Anat. 32:929–933, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
... Adstrum et al. (2017) & Stecco et al. (2018 ...
Fascia is a generic anatomical term that refers to a variety of the body's soft fibrous connective tissue parts. An expanding interdisciplinary interest in fascia might be accompanied by changes in how fascia is cognized. This study surveys the anatomical portrayal of fascia through history, with the aim of helping contextualize the ways it is now known. A historiographic review of fascia‐related literature written in the English language was undertaken. The anatomical meaning associated with fascia has varied during the 400 years that this term has been incorporated in English‐language medical literature. Fascia has been diversely portrayed as a range of macroscopically discernable body parts, the tissues they are composed of, and a pervasive soft connective tissue network structure. Over the last four centuries, fascia has been described in many ways. Anatomical understanding of fascia has developed over the years and is likely to continue to change with evolving research technologies. Multidisciplinary advances in fascial knowledge could conceivably contribute to improving individual and societal health care. Clin. Anat. 32:862–870, 2019. © 2019 Wiley Periodicals, Inc.
... In an indication of the mainstreaming of fascial anatomy, a series of brief summaries of regional fascial anatomies was published as part of an online reference of biomedical knowledge at Statpearls.com, 2018. A robust and timely discussion of fascia nomenclature was engaged under the auspices of the Fascia Research Society, which convened a Fascial Nomenclature Committee in connection with its 2015 conference (Adstrum et al., 2017;Hedley, 2016;Stecco & Schleip, 2016;Stecco et al., 2018a). Carla Stecco continued to be a leading investigator of fascial anatomy. ...
... It is not necessary to take a hard stand as to what is or is not fascia as the science in the field keeps evolving. As Schleip et al (2012) and subsequent associated papers (Adstrum et al 2016, Stecco et al, 2018 are essentially saying, fascia is what we define it to be. Muscle has muscle cells within its fascial encasement, bone has osteoblasts and osteoclasts within its fascial encasement, cartilage has cartilage cells within its fascial encasement, just as pericardium has heart cells within its fascial encasement, mesentery has digestive cells within its fascial encasement, meninges has neural cells within its fascial encasement, and pleura has lung cells within its fascial encasement. ...
The definition of "fascia" is in flux. Most definitions leave out bone as being part of the fascial system. I argue that bone is ossified fascia and should be thought of as integral to the fascial system.
... In an indication of the mainstreaming of fascial anatomy, a series of brief summaries of regional fascial anatomies was published as part of an online reference of biomedical knowledge at Statpearls.com, 2018. A robust and timely discussion of fascia nomenclature was engaged under the auspices of the Fascia Research Society, which convened a Fascial Nomenclature Committee in connection with its 2015 conference (Adstrum et al., 2017;Hedley, 2016;Stecco & Schleip, 2016;Stecco et al., 2018a). Carla Stecco continued to be a leading investigator of fascial anatomy. ...
Content available: Author Interview and Audio Recording
Defining, the fascial system
- S Adstrum
- G Hedley
- R Schleip
- C Stecco
- C Yukesoy
Adstrum, S., Hedley, G., Schleip, R., Stecco, C., Yukesoy, C., 2017. Defining, the fascial
system. J. Bodyw. Mov. Ther. 21 (1), 137e139. https://doi.org/10.1016/j.jbmt.
2016.11.003.