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What is fascia?
Fascia (or myofascia) is a network of connecting fibers beneath the skin. It is not muscle and, it is indeed, a body system by itself. It has several purposes: it can attach, stabilize, enclose or separate muscles and internal organs. It looks a little like a very densely woven spider's web. From the top of your head to the tip of your toes, fascia aides you with flexibility, strength and stability. Fascia is very strong and very flexible. In fact, it has a tensile strength of over 2000 pounds. 2
There are three types of fascia:
- Superficial: the lower layer of skin in most areas of the body;
- Visceral: wraps around organs so they are suspended within their cavities; and,
- Deep: surrounds individual muscles or divides groups of muscles into compartments.
What can go wrong with fascia?
Most of the time, we are unaware of fascia, but it becomes noticeable to us when it loses stiffness or becomes too stiff. This can happen after surgery if the fascia has been cut or when healing includes a scar. It also can be felt due to a repetitive movement. As with muscles, it can be pulled and strained. 3
There are several conditions that are injured fascia:
Plantar Fasciitis: One of the most common causes of heel pain. It involves pain and inflammation of a thick band of plantar fascia that runs across the bottom of your foot and connects your heel bone to your toes.The location of plantar fasciitis pain will be further under your arch than under your heel.
Myofascial Pain Syndrome: Defined by the Mayo Clinic as "a chronic pain disorder. ...Pressure on sensitive points in your muscles...causes pain in seemingly unrelated parts of your body. This is called referred pain. Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively." Wikipedia states that Myofascial Pain Syndrome is "characterized by chronic pain in multiple fascial constrictions. It can appear in any body part." Because any muscle or fascia in the body may be affected, this may cause a variety of localized symptoms.
Strains: It is believed that, like muscles, fascia can be pulled and strained. Scar tissue can develop on it. This can sometimes result in pain.
- Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome): A common overuse injury which may cause pain or tenderness in the thigh and knee, most especially just above the knee joint. It is a common cause of lateral knee pain in runners and cyclists.
In humans, the Iliotibial band (often referred to as the IT band) extends from the iliac crest in the pelvis to the tibia near the outside of the knee. Both the tensor fascia lata and the gluteus maximus insert into the IT band.
The band is particularly important during running or walking where it helps to stabilize the knee; it moves from behind the femur to the front of the femur during activity.
When the knee is flexed, the IT band is located behind a bony outcropping of the femur at the knee joint (known as the femoral epicondyle). The IT band moves forward across the condyle when the knee is extended. There is a sac that allows the band to glide smoothly across the condyle, but if inflammation occurs in this area, the increased friction from repeatedly rubbing the iliotibial band across the bony condyle can cause pain, especially along the outside of the knee joint.
Can Fascial Injuries Be Treated?
There are treatments recommended for fascial injuries, but the science for some of them is limited. However, if symptoms are ignored, inflammation may continue and scarring could possibly develop — this in turn could decrease range of motion (if a joint is involved) and increase pain. Activity could be impeded even while healing takes place.
The first line of defense is always rest, as fascial injuries are usually overuse injuries. Using ice may also help. There are many other possible treatments — see your doctor or healthcare provider or check out the many articles on the internet. Since this is not my area of expertise, I will leave treatment options up to the reader. Be aware that some types of treatment are controversial. I recommend, whenever possible, that you choose science-based and well-researched alternatives.
You may also be interested in reading:
- Over-Training: How do you know when you're doing too much?
- Pain During Exercise: Should it hurt when I exercise?
- An article by my son, Paul Ingraham, titled "Does Fascia Matter?" will give you a very detailed, in-depth look at the topic of fascia. Paul is a former registered massage therapist, now a science journalist, mostly writing about pain science. His approach is strictly science-based.
I am a BCRPA-certified fitness instructor in Vancouver, BC. I teach four classes at the West End Community Centre in Vancouver, BC, mostly designed for the older adult. The Inevitable Disclaimer: Everything published here expresses only my opinion, based on my training and research. What you do with the information is entirely your own responsibility. I am not liable for any injury you suffer that seems to be related to anything you read here. Always consult your doctor before beginning an exercise program. For other articles, return to the table of contents.
These three dots behave exactly like a footnote. Click on them and you will get more information about the topic. ↩
Can you stretch fascia? This is the subject of much debate. Some say yes. Some say no. You will find arguments for both on the internet, but if one is looking for sound information, one should focus on science-based results. ↩
This article by my son, Paul Ingraham, titled "Does Fascia Matter?" will give you a very detailed, in-depth look at the topic of fascia. Paul is a former registered massage therapist, now a science journalist, mostly writing about pain science. His approach is strictly science-based. ↩