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The human fascia is a continuous sheet of connective tissue located under the skin that encapsulates every organ and vessel in the human body. It is typically elastic and has an appearance that is similar to a well-knitted sweater. A key component of fascia is collagen; this is what makes it flexible such that it can be easily stretched. It can be categorized either based on its layers (superficial, deep, or visceral), or its purpose (linking, fascicular, compression, or separating).
Layer based classification of fascia
1) Deep fascia
The deep fascia is the thick connective tissue that surrounds muscles, nerves, blood vessels, and bones. It is avascular, meaning that it has no blood supply. It has different names based on its function or the part of the body encapsulated:
- Intermuscular septa: Separates different muscles in the limbs into separate fascial compartments.
- Endomysium: Surrounds each muscle fiber, known as a myocyte
- Perimysium: Groups muscle fibers into bundles known as fascicles
- Epimysium: Encapsulates large groups of muscle
- Periosteum: Surrounds the outer surface of bones
- Perichondrium: Covers the outer surface of cartilages.
- Tunica Externa: Surrounds blood vessels
- Endoneurium: Also known as Henle’s sheath, this surrounds each nerve fiber
- Perineurium: Groups nerve fibers into bundles
- Epineurium: Encapsulates large nerve bundles
2) Superficial fascia
This is loose connective tissue located underneath the skin; it is the lowermost layer of the skin. It acts as a conduit for lymphatic vessels, blood vessels, and nerves. Also, it stores fat and water and serves as padding to cushion and insulate tissues in the body.
3) Visceral fascia
Visceral fascia is also known as the subserous fascia. It encapsulates the internal organs of the abdominal and cardiac cavities. These organs are covered in two layers of fascia namely the parietal layer, also known as the outer layer, and the visceral or inner layer.
Purpose-based classification of fascia
- Linking fascia: This is divided into passive and dynamic types. The dynamic fascia serves primarily to aid with movement and stability such as the thoracolumbar fascia; the passive fascia, in contrast, functions to connect different muscle groups, tissues, or organs.
- Fascicular fascia: This serves to bundles muscles, nerves, or blood vessels together
- Compression fascia: These sheaths entire limbs like a stocking such as the crural fascia in the leg, brachial fascia in the upper arm, antebrachial fascia in the forearm, and fascia lata in the thigh
- Separating fascia: This divides the body into different layers or planes
Functions of the fascia
- Support: Tight encapsulation of the muscles and other organs by the fascia ensure that their integrity is kept intact.
- Protection: The fascia acts as an internal shock absorber that protects internal organs from trauma
- Movement: Muscles are kept separated by the fascia so that they can glide across one another during movement. It also helps with muscle elasticity as the muscles contract and relaxes during movement.
Common disorders of the fascia
1) Plantar fasciitis
Plantar Fasciitis is the inflammation of the plantar fascia located underneath the foot running from the heel to the toes. It presents with a sharp, stabbing pain at the bottom of the injured foot. This pain is worse in the morning upon waking up in the morning and after prolonged periods of sitting, standing, or after exercise. Typically, plantar fasciitis is relieved by rest of the affected foot and over-the-counter analgesics; medical attention may be needed if pain persists.
2) Myofascial pain syndrome
This is pain that occurs in a muscle and its encompassing fascia. Other presenting symptoms may vary depending on the muscle location. It is usually triggered by muscle injury, repetitive muscle movements, and muscle immobility. Treatment is typically conservative and includes over-the-counter analgesics, massage therapy (myofascial release), and muscle stretching
Myofascial release is a technique that is used to treat myofascial pain syndrome. A well-trained therapist locates and gently massages tight trigger points to release tension and pressure, thereby alleviating the pain. This technique has also been used in the management of other conditions such as:
- Chronic headaches: Massage of the trigger points around the head and neck can relieve chronic headaches in some individuals
- Venous insufficiency: In conjunction with other forms of therapy, myofascial release can alleviate the venous pooling and lower leg pain that is associated with venous insufficiency.
Benefits of yoga on the fascia
One of the recommended ways to keep the fascia loose and elastic is by doing regular yoga. The main effect of yoga on the body is to stretch and loosen any tight fascia. Some common yoga techniques that can be practiced that help the fascia include:
- Downward dog
- Child’s pose
- Camel Pose
The fascia is an essential, though underappreciated part of the human body. In recent years, however, researchers and medical professionals have become more aware of the significance of the fascia to an individual’s sense of well being.
Medically reviewed by Dr. Susanne Woloson on 5-01-2020.
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