The Evidence

As a student learning anatomy in my occupational therapy program, I did not learn anything about fascia other than that it is a packing material inside the body. We were instructed to throw this tough and dense material in the bucket below the dissection table. We cut the fascia away to see what was deemed more important. As a result, fascia was not on my radar screen as a new therapist. I'm sure many of you had a similar experience.

Just a few months into my first job as a new therapist, over 30 years ago, I searched high and low for anything that would tell me why the myofascial techniques I was learning worked so well with the clients I was treating. I could not find anything on the emerging internet or at the local university library. Little did I know that fascia research had already begun, but the work was taking place far away from the United States.

Today, over 200 peer-reviewed publications are being produced annually about fascia (Schleip, 2022). Even more exciting is that much of this is taking place in the United States. Helene Langevin, the current (2022) director of the National Center for Complementary and Integrative Health, a branch of the National Institute of Health, has placed her focus on fascia. Her research on fascia has led her to further support studying fascia-focused techniques for managing pain.

The National Institute of Health started the Helping to End Addiction Long-term or HEAL Initiative and held a workshop in 2020 specifically to explore myofascial pain, including how to better evaluate, research, and treat myofascial pain. Researchers and clinicians from around the world specializing in the study of fascia and the treatment of fascia-related pain collaborated to create a plan that resulted in funding several fascia-related studies in the United States.

The research to understand the fascial system is expanding rapidly around the world. I aim to provide the best available evidence relevant to occupational therapy practice to support your learning in this course!

Who is Paying Attention to Fascia?

Unfortunately, the healthcare system in the United States is not paying much attention. Change is slow. Experts say it takes an average of 17 years for new information to fully integrate into traditional healthcare practice (Morris, 2011). So, my goal is to move that along. Occupational therapy practitioners are passionate about helping people and are often eager to learn what they can to make a difference.

Who is paying attention, and what can we learn from them?

Athletics

The world of athletics is on board with understanding fascia and how it can improve performance. This is where healthcare can learn a lot! Coaches and athletes are learning how to move better to prevent injury and heal faster. They are learning how to train not just their muscles but their fascia as well. These concepts translate well to rehabilitation and wellness. Fascia in Sport and Movement, pictured below, is an 872-page monster text loaded with high-quality research.

Beauty

The beauty industry is capitalizing on the growing interest in fascia to sell new products and services that target fascia. Unfortunately, some of the techniques the industry promotes are actually very dangerous and not evidence-based.

Yoga

The term fascia is being used quite a bit in the yoga world. Many fascia researchers are supporting yoga as a way to keep fascia healthy. Yoga Online University has teamed up with leading researchers like Rober Schleip and Thomas Myers to educate yoga instructors about the importance of fascia.

The Bottom Line

Why have these industries jumped on the fascia bandwagon? Money, of course. When big money is involved, new ideas are more readily accepted and tried out, and if they seem to work, they become a new normal. The bottom line is also healthier when high-paid athletes are injured less and perform better. When the beauty and yoga industries can sell more services, products and classes with new ideas, the bottom line improves.

It is unclear how fascia will change the bottom line in healthcare. I will hypothesize that understanding fascia will help reduce the reliance on pain medications, improve recovery in the rehabilitation process, improve surgical outcomes, improve mental health services, and reduce overall visits to the doctor. This sounds good, but is it good for the bottom line in healthcare? That depends entirely on who you ask.

Body Systems

As occupational therapy practitioners, we must understand the body systems at various depths. This knowledge informs our evaluation process and how we design our interventions. This knowledge helps us educate our clients and keep them safe. As practitioners, we know it is important to keep up with new knowledge about the different body systems to stay current with changes in how we understand the human body and how to best treat clients with various concerns.

Fascia is a body system. Current research takes the understanding of this system one step further and has labeled the fascia as the environment of all the other body systems.

• The Muscular System
• The Skeletal System
• The Circulatory System
• The Respiratory System
• The Nervous System
• The Lymphatic System
• The Digestive System
• The Immune System
• The Reproductive System

As described in the definition below, fascia surrounds and supports everything in the body. For example, imagine a nerve running through the arm. The fascia is responsible for holding this nerve in place yet must allow for the perfect amount of glide to allow for proper health and function of the nerve and movement of the arm. This is incredibly complex!

In September of 2022, I attended the International Fascia Research Congress in Montreal, Quebec, Canada. I attended a full-day preconference session titled Treating Common Myofascial Pain Complaints using Site Specific Fascia Tuning Pegs presented by John Sharkey, a clinical anatomist from Ireland. In this session, John described how difficult it was to determine where to cut when doing a dissection because it was difficult to see where the fascia stopped and another structure began.

The Formal Definition of Fascia

The fascial system is a network of connective tissue described by Schleip et al. (2022) as a 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 (p.702).

This definition is a mouthful! Concerning occupational therapy practitioners, I believe the most important aspect of the definition is the last sentence. It even contains our favorite word, function! Our fascia supports not only the function of all our other body systems but also the everyday function that gives life meaning.

Fascia Wellness

Fascia is found in people (and animals) of all ages and can be influenced positively or negatively at any age.

In this course, you will learn about the anatomy and functions of the fascial system and what influences the fascial system negatively and positively. Below are several areas that influence the health of fascia. All are domains of concern for the occupational therapy practitioner.

• Lifestyle choices 
• Exercise choices
• History of physical and emotional trauma
• History of injuries
• History of surgeries
• Posture choices and patterns 
• Movement choices and patterns
• Stress, anxiety, and mental health
• Nutrition and hydration
• Disease processes

Fascia wellness should concern all healthcare practitioners in all areas of specialties. Since the fascia is the environment of all our body systems, the health of the fascia influences every other system. Fascia is already being identified as the culprit in pain of unknown cause. I suspect that fascia will be identified as the culprit in many other health issues that are currently a mystery to our healthcare system.

The term Fascia Wellness is not a term that is found in the literature. It is a term I use in my practice. I teach my clients that if they improve the health of their fascia, all the other body systems have a better chance of functioning well, leading to overall better health and quality of life. This is why my logo is what it is.

References:

Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180