FASCIAL PHYSIOLOGY
Fascial plasticity – a new neurobiological explanation Part 2

https://doi.org/10.1016/S1360-8592(02)00076-1Get rights and content

Abstract

Part 1 of this two part article showed that immediate fascial responsiveness to manipulation cannot be explained by its mechanical properties alone. Fascia is densely innervated by mechanoreceptors which are responsive to myofascial manipulation. They are intimately connected with the central nervous system and specially with the autonomic nervous system. Part 2 of the article shows how stimulation of these receptors can trigger viscosity changes in the ground substance. The discovery and implications of the existence of fascial smooth muscle cells are of special interest in relation to fibromyalgia, amongst other conditions. An attitudinal shift is suggested, from a mechanical body concept towards a cybernetic model, in which the practitioner's intervention are seen as stimulation for self-regulatory processes within the client's organism. Practical implications of this approach in myofascial manipulation will be explored.

Introduction

Part 1 of this article showed that fascial responsiveness cannot be explained by its mechanical properties alone. Fascia is populated by a dense network of mechanoreceptors. The majority of fascial sensory nerve endings which are stimulated by fascial manipulation are interstitial receptors (type III & IV) which have been shown to induce a change in local vasodilation. The additional group of Pacinian receptors seem to be involved in high-velocity manipulation, while Ruffini endings are mostly stimulated by slow deep pressure techniques, specially if they involve tangential forces, i.e. lateral stretch (Kruger 1987). Stimulation of fascial mechanoreceptors leads to changes in muscle tonus which come primarily from a resetting of the gamma motor system, rather than the more volitional alpha motor coordination. Additionally, stimulation of Ruffini organs as well as of many of the interstitial receptors effects the autonomic nervous system, which can result in a lowering of sympathetic tone, or in changes in local vasodilation. Part 2 of this article will explore further implications and practical applications of this neurobiological orientation.

Section snippets

Mechanoreceptors influence local fluid dynamics

Let us now look at some of the other effects of myofascial work. It is the large group of interstitial receptors that make up the majority of sensory input from myofascial tissue. Their activation triggers the autonomic nervous system to change the local pressure in fascial arterioles and capillaries. Additionally, stimulation of Ruffini endings appears to have a similar effect in terms of a lowering of sympathetic activity (van den Berg & Cabri 1999).

According to Kruger many of the

Changes in hypothalamic tuning

And there is a second autonomic feedback loop. The interstitial mechanoreceptors can trigger an increase in vagal tone which leads towards more trophotropic tuning of the hypothalamus. Based on Gellhorn (1967) this results in global neuromuscular, emotional, cortical and endocrinal changes that are associated with deep and healthy relaxation (see the paragraph ‘Touch research with cats and humans’ in Part 1). This Hypothalamus-Loop- is illustrated in Fig. 2.

Fascia is capable of spontaneous contraction

Yahia and her team in Montreal – after doing the study on the sensory innervation of fascia which was discussed in Part 1 – also conducted a fascinating study on the viscoelastic properties of the lumbodorsal fascia (Yahia et al. 1993). Performing various repeated tests with dynamic and static traction loading on fresh pieces of lumbodorsal fascia from cadavers, their findings supported the well-known force and time-dependent viscoelastic phenomena which have already been described by other

The discovery of fascial smooth muscle cells

A few years later, in 1996, a German anatomy professor, Staubesand published an exciting new paper. He and his Chinese co-worker Li studied the fascia cruris in humans with electron photomicroscopy for several years and found smooth muscle cells embedded within the collagen fibers (Staubesand & Li 1996) (Fig. 3). For a more detailed description of this discovery see Box 1 ‘Fascia is alive!’

Interestingly, this article also reported – similar to Yahia's innervation study – the widespread

Myofibroblasts and tissue contractility

Compared with striated muscle cells, smooth muscle cells offer a more efficient transformation of chemical energy into mechanical strength. It has long been known that fibroblasts often transform into myofibroblasts which contain smooth muscle actin fibers and can therefore actively contract. This happens in pathological situations like Dupuytren's contracture, liver cirrhosis, in rheumatic arthritis and a few other inflammatory processes. Yet it is also a productive element of early wound

Fascial tonus, breathing, and fibromyalgia

Tonus regulation of fascial smooth muscle cells is most likely achieved via the sympathetic nervous system as well as vasoconstrictor substances such as CO2. The discovery of fascial muscle cells therefore opens a doorway for exciting speculations about a direct link between fascial behavior and the pH of the body, which is directly linked to breathing function and CO2 levels. As Chaitow, Bradley and Gilbert showed (Chaitow et al. 2002) there is already a clear link between smooth muscle

How about visceral ligaments?

In visceral osteopathy it is often claimed that gentle manipulation of a visceral ligament can induce an immediate and palpable release within that ligament (Barral & Mercier 1988). Similar concepts have also been suggested for osteopathic work with skeletal ligaments (Barral & Croibier 2000, Crow et al. 2001). Since ligaments can be seen as special arrangements of fascia – often ligaments are nothing but local thickenings within larger fascial sheets – the question arises: how is this

Acupuncture points and fascia

As we learned in Part 1 of this article, an electron photomicroscopy study of the Fascia cruris (Staubesand 1997, Staubesand & Li 1997) showed that there are numerous perforations of the superficial fascia layer that are all characterized by a perforating triad of vein, artery and nerve (Fig. 5). Staubesand could identify that most of the perforating nerves in these triads are unmyelated autonomic nerves.

A study by Heine around the same time also documented the existence of these triad

A dynamic systems approach

The beauty of Kovac's approach lies in his view of the nervous system as ‘a wet tropical jungle’, i.e. in his inclusion of the liquid aspects of the nervous system. Compared to the more mechanically oriented treatment approach of Bauer and Heine, Kovac looks at the body as a cybernetic system in which an intervention is seen as stimulation for complex internal self-regulatory processes.

Cybernetic approaches often work with flow charts as useful simplifications for complex dynamic

From hero technician to a humble midwife

It seems clear that in order to better understand and to use fascial plasticity, we need to include the self-regulatory dynamics of the nervous system. This will include an attitudinal shift in the practitioner. If we are willing to move from a mechanical view of the body towards an inclusion of the neuroendocrine system, we are doing well to prepare our brain (and guts) to think in nonlinear system dynamics. The self-regulatory complexity of the nervous system could be compared with that of a

A different role model

The role of a ‘master technician’ in Table 2 can best be described by the following story: The heating system of a big steam boat was broken and for several days nobody could fix it. Finally, a master technician was called in. He just walked around and looked at everything and finally took out a little hammer from his pocket and hit a little valve, which immediately fixed the problem and the machine started working again. When his bill of $1000 arrived, the captain didn’t want to believe such a

Where to work

Table 3 gives some recommendations for the practical work. Since myofascial work seems to be more focused on softening or release of tight tissues (Rolf 1977, Barnes 1990) rather than on an increase of tonification, it usually includes work on those myofascial tissues which appear as unnecessarily short and tight (see rule 1 in Table 3). Yet if one includes the self-regulatory system dynamics of the client's motor coordination, it is also useful to include work on the antagonists of those

How to work

The basis for rule 7 has been explored in Part 1, same for rule 8 which relates to Gellhorn’ s research on trophotropic and ergotropic tuning states (Gellhorn 1967).

Rule 9 acknowledges the fact that the reticular formation (see Fig. 8) usually filters out all manual input which is interpreted as nonsignificant by the clients central nervous system. An example: while probably sitting and reading this article, the reader's underwear and other pieces of clothes are touching the body, sometimes

Active client participation

If it is true that myofascial manipulation includes the self-regulation dynamics of the client's nervous system, then it makes sense to involve the client more actively in the session. Figure 9 shows a typical example of using active micromovement participation in a sitting client. Refined verbal and tactile guidance from the practitioner serve to facilitate subtle slow motion participations of the client such that the nervous system is more deeply involved in the coordination around a specific

Conclusion

Fascia is alive. Practitioners working with this truly fascinating tissue should understand that it is innervated by four different kinds of mechanoreceptors. Without an inclusion of their responsiveness to various kinds of touch, the immediate tissue release effects in myofascial manipulation cannot be adequately explained. Fascia has been shown to contain smooth muscle cells which seem to be responsible for its ability of active ‘ligament contraction’. There are strong links between fascia

Acknowledgements

The illustrations Fig. 7, Fig. 8 as well as those in Table 1 are by Twyla Weixl, Hiltenspergerstr.60, 80796 Munich/Germany. E-mail: [email protected].

References (0)

Cited by (142)

  • ‘Reflexology: Exploring the mechanism of action’

    2022, Complementary Therapies in Clinical Practice
View all citing articles on Scopus
View full text