By Tiffany Cruikshank, LAc, MAOM, E-RYT
Connective tissue has a long history of being overlooked in favor of what seem to be more important features in the body. In medical school cadaver dissections, the connective tissue is carefully extracted and thrown away to reveal the more precious structures and organs, but our low prioritization of it is finally being reconsidered in light of recent research putting fascia and other connective tissue in the spotlight. With so many new studies opening our eyes to the crucial functions of this tissue, the need to reexamine our understanding of it and its potential contributions to our health and quality of life is undeniable.
Fascia, a type of connective tissue, has a broad array of functions, including linking nearby tissues, supporting organs, reducing friction that comes with muscular force, forming compartments that enclose groups of muscles and other structures, separating tissues, investing the tendons (thereby adding to their strength and resilience), creating functional chains of muscles that allow us to move more smoothly and efficiently, and much more. This tissue also contains important immune cells, protective adipose cells, myofibroblasts that assist tissue healing, and a complex communication system to help oversee it all. Another important feature of fascia is that it is a continuous intermeshed system of fibrous tissue that weaves through the body, from head to toe. This interconnected system can be the reason your pain in one area may be influenced by changes in another part of your body, and it is also a big part of how we adapt and respond to stress via a body-wide tension-distributing system. Every year, half the fascial fibers (collagen) are replaced in a healthy body, providing us a powerful intervention point to steer these changes in the tissues at any time.
The term myofascial release refers to any technique that works on the muscles and the fascia. There are many different modalities; however, the most common self-myofascial release (SMFR) techniques usually involve the use of balls or foam rollers. The beauty of SMFR is that it can be done with simple tools and training, making it accessible to the general public. There are numerous articles and studies showing positive outcomes for these modalities. The main limiting factors of these studies are that many of them are small and their methods can vary considerably. Nevertheless, most of them show significant positive outcomes with only minor side effects, which usually involve temporary soreness and/or bruising.
Fibroblasts, cells within the fascia that are responsible for producing the fascial matrix, play a large role in how the tissues remodel over time in response to the demands placed on them. These demands can have relatively positive (as in yoga, stretching, exercise, or myofascial release) or negative (in the case of poor posture, repetitive motions, or injuries) effects on the way the fibroblasts remodel the components of our connective tissue. Myofascial release is thought to both stimulate and regulate fibroblasts; it helps break down excessive connective tissue deposition as well as stimulates them to produce new, more resilient connective tissue. It also enhances hydration of this tissue.
Probably the most well-known uses of SMFR are to increase mobility and relieve pain and injuries. The effects of SMFR on mobility are probably the most commonly studied, with positive but often temporary effects seen. Immobility, repetitive movements, poor posture, and injuries can all cause excessive collagen deposition that leads to fibrosis or adhesions between the tissues, resulting in diminished range of motion and mobility. SMFR helps to reduce and prevent excessive collagen deposition by increasing collagen turnover to keep the tissues strong, elastic, and resilient. This feature is critical both for working with injuries and helping to prevent them. Also, one of the great advantages to using SMFR is that the increases in mobility do not initiate the temporary decrease in muscle power and performance seen with stretching.
A key feature of connective tissue that we are still learning about is its function as a communication system. With six times as many sensory neurons than are found in any other tissue (besides the skin), the fascia is a huge sensory organ important both for proprioception (spatial awareness) and interoception (internal body awareness). One of the often-overlooked benefits of myofascial release is this increase in proprioception, which you feel right away. Try, for instance, rolling out your feet before attempting a challenging balance position, and you can experience this firsthand. Research suggests that increasing proprioception can also decrease pain. What’s even more interesting is the new research pointing to the fascia having its own internal communication system, which functions independently from the nervous system via vibration, crystallinity, and electricity. This suggests an inherent body-wide intelligence within this system.
Within the fascial layers, we also find important immune cells that help to modulate inflammation and tissue healing. Many people think of the fascia as just surrounding the muscles, but this tissue also interweaves through the muscles and surrounds organs, bones, nerves, and blood vessels throughout every part of the body. Since it envelops just about every structure of the body, you can imagine how important the immune function in this protective internal fascial layer is. There is increasing evidence that the physical and mechanical environment of the tissues can influence cell behavior and tumor progression. In fact, some of the newest research on fascia focuses on its effects on cancer and suggests that healthy fascia could be an important component in treatment and prevention.
The hydration of the connective tissue is a key component in its health, influencing communication, adhesions, and immune function. Imagine dry tissues rubbing over each other with every movement. Impaired hydration of the fascia causes increased friction, stimulating the fibroblasts to lay down more collagen cross-links between layers of tissue, eventually leading to adhesions between the layers. You might think drinking more water would solve the problem, and though that may be part of the answer, it doesn’t necessarily equate to connective tissue hydration. Gentle SMFR techniques help to increase the hydration of the connective tissue to decrease adhesions, enhance communication, and facilitate healthy immune function. Think of the connective tissue as being like a fish bowl; not only do you need to add more water, you also need to clean it out from time to time.
There are also other body functions that SMFR influences—the parasympathetic response, the blood and lymph circulation, and possibly many more that may be revealed as the studies continue. In addition, there are mental and emotional implications of the connective tissue system that we don’t fully understand yet. Practitioners may observe this in their clients as an unexpected emotional release that may spontaneously arise with SMFR. The beauty of SMFR is that you don’t need to understand the emotional history of a trauma or injury to let it go; you need only provide the space to allow it to pass.
Studies suggest that receiving SMFR just once or twice a week will yield a more resilient fascial system in six to twenty-four months, so slow and steady wins the race for connective tissue health. As with any healing modalities, it’s important that you consult your doctor before using SMFR and seek the help of someone trained to use it.
Though there is still a lot of research needed to show the extent to which the fascial layer may be involved in many pathologies, there is already more than enough to indicate the need for further inquiry into how the health of this tissue can affect so many interconnected systems. Myofascial release techniques show promising outcomes in enhancing mobility, increasing proprioception, supporting injury prevention, promoting tissue healing, regulating inflammation and immune function, and optimizing tissue resilience. As SMFR has so few side effects, I believe it’s our opportunity to pursue further study to see how we can best use this simple, cost-effective modality that could have a significant impact on pain, inflammation, injuries, tissue health, and possibly pathologies such as cancer. ?
Tiffany Cruikshank, LAc, MAOM, E-RYT, is an internationally recognized expert on myofascial release, yoga, and wellness. Tiffany is the founder of Yoga Medicine, a school that trains yoga teachers to work with healthcare providers, and the founder of the non-profit Yoga Medicine Research Institute. She leads myofascial release trainings for teachers, healthcare providers, coaches, and others throughout the world. Go to www.YogaMedicine.com to find an instructor or training program near you.
Author note: Thanks to the Fascia Research Congress for promoting the work of so many researchers who help bring this information to the public, and many thanks to all the researchers out there doing the work.
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