In 1923, Dr. John Goodman wrote about fascia and its importance in the body. He recommended creating a definition of fascia to describe its continuity in the body. However, health professionals paid little attention. The importance of fascia slowly started growing decades later, and the definition of fascia is continually evolving.

The number of peer-reviewed scientific publications on fascia has grown from 10 to 20 per year in the 1960s to over 200 in 2020 (Schleip et al., 2022). The initial thrust of learning was primarily about understanding the structure of the fascia, which resulted in the definition focusing primarily on structure. The most recent globally accepted definition published on the Fascia Research Society website is as follows:

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.

As the interest in and understanding of fascia has grown, more research has turned to function. Sharkey and Flannigan (2023) have suggested a more functional definition of fascia be adopted. Their focus is supporting the practitioners who are concerned (or should be concerned) with fascia in their practice as health and wellness professionals, from surgeons to bodyworkers. The definition they suggest is as follows:

Fascia constitutes a variety of morphologically specialist tissues from liquid to osseous composed of a variety of collagen and elastin fibres embedded in a ground substance constituted by bound water, glycosaminoglycans, and other extracellular matrix molecules on a spectrum of softness (e.g., leptomeninges) to stiffness (e.g., bone). Fascia is crucial in transmitting forces, maintaining posture, regulating fluid balance, and providing sensory feedback. Human Fascia is a continuous and ubiquitous three-dimensional web of pre-tensioned connective tissue permeating and supporting every cell, tissue, and organ of the body, providing structural integrity and tensional balance. Fascia is composed of collagen, elastin, and ground substance and is richly innervated and vascularized. Fascia is not a passive container but a dynamic complex tissue constantly remodeling in response to mechanical and biochemical stimuli, modulating muscle function, bone health, fluidic dynamics, joint stability, posture, pain, interoception and proprioception. Moreover, Fascia plays a crucial role in intercellular communication, emotions, immune defense, and inflammation regulation.

The research and definitions of fascia are catching up to what bodyworkers and therapists of all types who have focused on fascia have understood and wondered about for a very long time, myself included.

My Story

As a new graduate occupational therapist, a senior therapist taught me the Barnes Myofascial Release approach. Our very forward-thinking physiatrist wanted more body-based options for helping clients with pain. The therapist who attended a Barnes workshop became very busy, and I was the only therapist who came forward when she was asking for help due to her exploding caseload. All I wanted to do as a new OTP was help my patients feel better and be more functional, so I learned from her and applied the techniques.

The techniques blew me away. Patients who had not found relief with the standard treatments were getting better and back to the activities they needed and wanted to do. Meanwhile, I was confused. How did these techniques work when I was taught that fascia was unimportant? I started searching the literature to find answers, and they did not exist.

Because the only information I could find was based on our old beliefs about fascia, I was often ridiculed by colleagues. I was ridiculed for doing something not supported by science, and existing science seemed to contradict it! This angered me. Something that works should be explored, not immediately rejected. Science is constantly evolving. The research we do have on much of what we do as therapists and health professionals is lacking, but we do it anyway.

Additionally, one of the three legs of the evidence-based triangle is practitioner experience. Does my experience not count? I’m helping people!

Another leg of evidence-based practice is client values. I’m listening to my clients say they don’t want the drugs. The drugs scare them. What else is available? My colleague and I were trying to give them what they wanted, and it was helping, yet we were still shamed and made fun of behind our backs and sometimes to our faces. We persisted, nevertheless.

Looking for the Evidence

I continued searching for information that would help me understand fascia and why this technique worked. My perpetual curiosity eventually led me to books and scientific articles that satiated my curiosity. The first book I found was Anatomy Trains by Thomas Myers. It was dense and overwhelming. I did not take biochemistry in college, but I wish I had. This information was fascinating, and the supporting research was even more dense! The first edition of this book was printed in 2001, and it is now in its fourth edition!

I have never stopped searching for the latest information and research on fascia. I am continually amazed at how important this body system is and how profoundly it is changing our understanding of the human body.

My Goal

My goal is to share with you the information I have found and how I believe it applies to the profession of occupational therapy. In turn, I hope you will discover even more ways to apply this information to practice and help the clients we know need us.

Learning Objectives:

After the completion of Integrating Fascia Science into Occupational Therapy Practice: Elevating Our Understanding of the Human Body and Improving Our Outcomes, learners will be able to:

• Identify and describe the anatomical structures and physiological functions of fascia.
• Explain how fascia contributes to force distribution, coordinated movement, efficient movement, protection, proprioception, interoception, pain perception, and immune system function.
• Implement skills in observing and assessing the condition of the fascia and understand the implications of fascial tension.
• Develop skills in explaining fascia and its interrelationship with other body systems to communicate with patients and other health providers.
• Apply professional and self-care techniques within the occupational therapy scope of practice, focusing on fascial health and wellness and supporting functional outcomes.
  

How to Consume This Course

We recognize this course is huge. Ten hours of CE time is a bit commitment and a lot of content to digest.

We suggest:

• One or two modules at a time. Give yourself time to think and digest. The science doesn't tell us exactly what to do. We must use our critical thinking to determine how the science applies to each person, problem and practice setting.
• Take the course in order or as laid out. There are sections that reference preceding sections. This is not critical but may be helpful to you.
• If you feel at all overwhelmed by the volume and density of the content, this is probably excitement! There have been so many ways this content has influenced my practice and I'm sure it will yours too.

If you have any issues or concerns as you move through the course, please feel free to contact us at: [email protected].

We are happy to help!

References:

Myers, T. W. (2021). Anatomy trains: Myofascial Meridians for manual therapists and Movement Professionals. Elsevier.

Schleip, Robert; Stecco, Carla; Driscoll, Mark; Huijing, Peter. Fascia: The Tensional Network of the Human Body Expert Consult: Fascia: The Tensional Network of the Human Body - E-Book (p. viii). Elsevier Health Sciences. Kindle Edition.

Sharkey, John, Flannigan Mark. Towards a Paramedical Interdisciplinary Definition of Fascia Supporting Practitioners Offering Fascia-Focused Therapies (Part 1). Int J Anat Appl Physiol. 2023;9(1):218-222.