Fascia (făsh'ē-ə), pl. fas·ci·ae (făsh'ē-ē), adj. fascial (făsh'ē-əl) (from latin: a band) is the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds
muscles, bones, organs, nerves, blood vessels and
other structures. Fascia is an uninterrupted, three-dimensional web of tissue that extends
from head to toe, from front to back, from interior to exterior. It is responsible for maintaining structural integrity; for
providing support and protection; and acts as a shock absorber. Fascia has an essential role in hemodynamic and biochemical processes, and provides the
matrix that allows for intercellular
communication. Fascia functions as the body's first line of defense against pathogenic
agents and infections. After injury, it is the fascia that creates an environment for
tissue repair. [1]
Three layers of the fascia
- Superficial fascia is found in the subcutis in most regions of the body, blending
with the reticular layer of the dermis. [2] It is present on the face, over the upper portion of the
sternocleidomastoid, at the nape of the neck,
and overlying the sternum. [3] It is comprised mainly of loose areolar connective
tissue and adipose and is the layer that primarily determines the shape of a body.
In addition to its subcutaneous presence, this type of fascia surrounds organs and
glands, neurovascular bundles, and is found at many other locations where it fills otherwise
unoccupied space. It serves as a storage medium of fat and water; as a passageway for lymph,
nerve and blood vessels; and as a protective padding to
cushion and insulate. [4]
- Deep fascia is the dense fibrous connective tissue that
interpenetrates and surrounds the muscles, bones, nerves and blood vessels of the body. It provides connection and communication
in the form of aponeuroses, ligaments, tendons, retinacula, joint capsules,
and septa. The deep fasciae envelop all bone (periosteum and
endosteum); cartilage (perichondrium), and blood vessels (tunica externa) and
become specialized in muscles (epimysium, perimysium, and
endomysium) and nerves (epineurium, perineurium, and endoneurium). The high density of collagen fibers is what gives the deep fascia its strength and integrity. The amount of elastin fibers determines how much extensibility and resiliancy it will
have. [5]
The galea aponeurotica and the temporal
fascia
- Visceral Fascia suspends the organs within their cavities and wraps them in layers of connective tissue
membranes. Each of the organs is covered in a double layer of fascia; these layers are
separated by a thin serous membrane. The outermost wall of the organ is known as the
parietal layer, whereas the skin of the organ is known as the visceral layer. The organs have specialized names for their visceral fasciae. In the brain, they are known as
meninges; in the heart they are known as pericardia; in
the lungs, they are known as pleura; and in the abdomen, they are known as
peritonea. [1]
The meninges
Fascial dynamics
Fascia is a highly adaptable tissue. Due to its elastic property, superficial
fascia can stretch to accommodate the deposition of adipose that accompanies both ordinary and prenatal weight gain. After pregnancy and weight loss, the superficial
fascia slowly reverts to its original level of tension.
Visceral fascia is less extensible than superficial fascia. Due to its suspensory role of the organs, it needs to maintain its
tone rather consistently. If it is too lax, it contributes to organ prolapse, yet if it is
hypertonic, it restricts proper organ motility. [1]
Deep fascia is also less extensible than superficial fascia. It is essentially avascular
[2], but is richly innervated with sensory receptors that report the presence of pain
(nociceptors); change in movement (proprioceptors);
change in pressure and vibration (mechanoreceptors); change in the chemical milieu
(chemoreceptors); and fluctuation in temperature (thermoreceptors). [3], [4] Deep fascia is able to respond to sensory input by contracting;
by relaxing; or by adding, reducing, or changing its composition through the process of fascial remodeling. [5]
Deep fascia can contract. What happens during the fight-or-flight response
is an example of rapid fascial contraction . In response to a real or imagined threat to the organism, the body responds with a
temporary increase in the stiffness of the fascia. Bolstered with tensioned fascia, people are able to perform extraordinary
feats of strength and speed under emergency conditions. [6]
How fascia contracts is still not well understood, but appears to involve the activity of myofibroblasts. Myofibroblasts are fascial cells that are created as a response to mechanical stress. In a
two step process, fibroblasts differentiate into proto-myofibroblasts that with continued
mechanical stress, become differentiated myofibroblasts. [7] Fibroblasts cannot contract, but myofibroblasts are able to contract in a smooth muscle-like manner. [8]
The deep fascia can also relax. By monitoring changes in muscular tension, joint position, rate of movement, pressure, and
vibration, mechanoreceptors in the deep fascia are capable of initiating relaxation. Deep fascia can relax rapidly in response to
sudden muscular overload or rapid movements. Golgi tendon organs operate as a
feedback mechanism by causing myofascial relaxation before muscle force becomes so great that tendons might be torn.
Pacinian corpuscles sense changes in pressure and vibration to monitor the rate of
acceleration of movement. They will intiate a sudden relaxatory response if movement
happens too fast. [9] Deep fascia can also relax slowly as
some mechanoreceptors are designed to report changes over a longer period of time. Unlike the Golgi tendon organs, Golgi
receptors report joint position independent of muscle contraction. This helps the body to know where the bones are at any given
moment. Ruffini endings respond to regular stretching and to slow sustained pressure. In
addition to initiating fascial relaxation, they contribute to full-body relaxation by inhibiting sympathetic activity which slows
down heart rate and respiration. [10] [11]
When contraction persists, fascia will respond with the addition of new material. Fibroblasts secrete collagen and other
proteins into the extracellular matrix where they bind to existing proteins, making
the composition thicker and less extensible. Although this potentiates the tensile
strength of the fascia, it can unfortunately restrict the very structures it aims to protect. The pathologies resulting
from fascial restrictions range from a mild decrease in joint range of motion to severe
fascial binding of muscles, nerves and blood vessels, as in compartment syndrome of
the leg. However, if fascial contraction can be interrupted long enough, a reverse form of fascial remodeling occurs. The fascia
will normalize its composition and tone and the extra material that was generated by prolonged contraction will be ingested by
macrophages within the extracellular matrix. [12]
Like mechanoreceptors, chemoreceptors in deep fascia also have the ability to promote fascial relaxation. We tend to think of
relaxation as a good thing, however fascia needs to maintain some degree of tension. This is especially true of ligaments. To
maintain joint integrity, they need to provide adequate tension between bony surfaces. If a ligament is too lax, injury becomes
more likely. Certain chemicals, including hormones, can influence the composition of the
ligaments. An example of this is seen in the menstrual cycle, where hormones are
secreted to create changes in the uterine and pelvic floor
fascia. The hormones are not site-specific, however, and chemoreceptors in other ligaments of the body can be receptive to them
as well. The ligaments of the knee may be one of the areas where this happens, as a significant association between the
ovulatory phase of the menstrual cycle and an increased likelihood for an anterior cruciate ligament injury has been demonstrated. [13] [14]
It has been suggested that manipulation of the fascia by acupuncture needles is
responsible for the physical sensation of qi flowing along meridians in the body.[15]
Fascial pathology
Classification by region
| Fasciae of the Abdominal Viscera |
Buccopharyngeal fascia, Coronary ligament, Falciform ligament,
Fibrous capsule of Glisson, Gastrocolic ligament, Gastrolienal ligament,
Gastrosplenic ligament, Greater omentum,
Hepatocolic ligament, Hepatoduodenal
ligament, Hepatogastric ligament, Hepatorenal ligament, Ileocecal fold, Lesser curvature of the stomach, Lesser omentum,
Ligamentum venosum, Mesentery, Mesoappendix, Periodontal ligament, Peritoneum, Pharyngeal aponeurosis, Round ligament of liver, Sigmoid mesocolon,
Splenorenal ligament, Transverse
mesocolon |
| Fasciae of the Brain and Nervous System |
Arachnoid mater, Denticulate
ligament, Dura mater, Endoneurium,
Epineurium, Meninges, Nerve fascicle, Perineurium, Pia
mater |
| Fasciae of the Ears |
Annular stapedial ligament, Anterior auricular ligament, Anterior
ligament of malleus, Lateral ligament of malleus, Posterior auricular ligament, Posterior
ligament of incus, Superior auricular ligament, Superior ligament of incus, Superior ligament
of malleus, Tectorial membrane (cochlea) |
| Fasciae of the Eyes |
Medial palpebral ligament, Orbital
fascia, Orbital septum, Zonular
fibers |
| Fasciae of the Heart and Blood |
Carotid sheath, Chordae
tendineae, Epicardium, Interventricular
septum, Ligamentum arteriosum, Pericardium, Tunica externa |
| Fasciae of Respiration |
Annular ligaments of trachea, Central tendon of the diaphragm, Crus of diaphragm,
Gastrophrenic ligament, Interarticular
ligament, Lateral arcuate ligament, Left triangular ligament, Medial arcuate
ligament, Median arcuate ligament, Phrenicocolic ligament, Pleura, Right triangular ligament, Suprapleural
membrane |
| Fasciae of the Thyroid |
Cricoarytenoid ligament, Cricopharyngeal ligament, Cricothyroid ligament,
Cricotracheal ligament, Lateral
thyrohyoid ligament, Median thyrohyoid ligament, Thyrohyoid membrane |
| Fasciae of the Urinary Tract and Genitals |
Anal fascia, Anococcygeal raphe,
Cardinal ligament, External spermatic
fascia, Broad ligament of the uterus, Cooper's ligaments, Cremasteric fascia, Duodenorenal ligament, Endopelvic part of
the pelvic fascia, Fascia of Camper, Fascia
of Colles, Fascia of Scarpa, Fundiform
ligament, Inferior ligament of epididymis, Inferior pubic ligament, Internal spermatic
fascia, Lateral pubovesical ligament, Lateral umbilical ligament, Medial pubovesical
ligament, Medial umbilical ligament, Median umbilical ligament, Mesosalpinx, Ovarian ligament, Parametrium, Perineal body, Perineal membrane, Puboprostatic ligament, Pubovesical ligament,
Reflected inguinal ligament, Renal
capsule, Renal fascia, Round ligament of
uterus, Superior fascia of the urogenital diaphragm,
Superior ligament of epididymis, Suspensory ligament of the ovary, Suspensory ligament of the penis, Tunica
albuginea (ovaries), Tunica albuginea (penis), Tunica albuginea (testicles) |
| Fasciae of the Muscles and Bones (general) |
Endomysium, Endosteum, Enthesis, Epimysium, Muscle
fascicle, Nerve fascicle, Perimysium,
Periosteum, Sharpey's fibers |
| Fasciae of the Muscles and Bones of the Head |
Alar ligament, Anterior
atlantoaxial ligament, Anterior atlantooccipital membrane,
Capsule of temporomandibular joint, Cruciform ligament of atlas, Galea aponeurotica,
Ligament of apex dentis, Masseteric
fascia, Posterior atlantoaxial ligament, Posterior atlantooccipital membrane, Pterygospinal ligament, Sphenomandibular
ligament, Tectorial membrane, Temporomandibular ligament, Temporal fascia,
Transverse ligament of the atlas |
| Fasciae of the Muscles and Bones of the Neck |
Buccopharyngeal fascia, Deep cervical fascia, Hyoepiglottic ligament,
Investing layer of deep cervical fascia, Nuchal ligament, Pretrachial fascia, Prevertebral fascia, Stylohyoid ligament,
Stylomandibular ligament, Superficial cervical fascia |
| Fasciae of the Muscles and Bones of the Upper Extremity |
Acromioclavicular ligament, Annular ligaments of fingers, Annular ligament of
radius, Antebrachial fascia, Anterior sternoclavicular ligament, Axillary
fascia, Axillary sheath, Bicipital
aponeurosis, Brachial fascia, Clavipectoral fascia, Collateral ligament of interphalangeal articulations of
hand, Conoid ligament, Coracoacromial
ligament, Coracoclavicular ligament, Coracohumeral ligament, Costoclavicular
ligament,Deep transverse metacarpal ligament,
Deltoid fascia, Dorsal
cuboideonavicular ligament, Dorsal cuneonavicular ligaments,
Dorsal cuneocuboid ligament, Dorsal intercarpal ligament, Dorsal
intercuneiform ligaments, Dorsal radiocarpal ligament,
Dorsal radioulnar ligament, Extensor retinaculum of the hand, Flexor retinaculum of the hand, Glenohumeral
ligaments, Glenoid labrum, Inferior transverse ligament of scapula, Infraspinatous fascia, Interclavicular ligament,
Interosseous cuneocuboid ligament, Interosseous intercarpal ligaments, Interosseous intercuneiform ligaments, Interosseous membrane of the forearm, Lateral intermuscular septum, Medial
intermuscular septum, Oblique cord, Palmar
aponeurosis, Palmar carpal ligament, Palmar carpometacarpal ligament, Palmar
intercarpal ligaments, Palmar metacarpophalangeal ligament,
Palmar radiocarpal ligament, Pectoral
fascia, Pisohamate ligament, Pisometacarpal ligament, Plantar
cuboideonavicular ligament, Plantar cuneocuboid ligament,
Plantar cuneonavicular ligaments, Plantar intercuneiform ligaments, Posterior carpometacarpal ligament, Posterior ligament of elbow, Posterior
sternoclavicular ligament, Radial carpal collateral ligament,
Radial collateral ligament, Radiate carpal ligament, Subscapular
aponeurosis, Superficial transverse ligament of the
fingers, Superior transverse scapular ligament,
Supraspinatous fascia, Transverse
humeral ligament, Trapezoid ligament, Ulnar carpal collateral ligament, Ulnar collateral ligament, Vincula tendina,
Volar radioulnar ligament |
| Fasciae of the Muscles and Bones of the Torso |
Anterior longitudinal ligament, Aponeurosis of the Obliquus externus abdominis, Conjoint tendon, Costotransverse ligament,
Costoxiphoid ligament, Fundiform
ligament, Iliolumbar ligament, Interarticular ligament of the head of the rib, Interarticular sternocostal ligament, Intercrural fibers, Interspinal ligament,
Intertransverse ligament, Lateral costotransverse ligament, Ligamenta
flava, Linea alba, Linea
semilunaris, Lumbocostal ligament, Posterior longitudinal ligament, Radiate
ligament, Radiate sternocostal ligaments, Rectus sheath, Sacrospinous ligament, Superior costotransverse ligament, Supraspinous ligament, Tendinous intersection,
Thoracolumbar fascia |
| Fasciae of the Muscles and Bones of the Pelvis |
Anterior sacrococcygeal ligament, Anterior sacroiliac ligament, Crura of
superficial inguinal ring, Deep crural arch, Deep inguinal ring, Diaphragmatic part of
the pelvic fascia, Fascia of the Obturator internus,
Fascia of the Piriformis, Gluteal
aponeurosis, Iliac fascia, Iliolumbar
ligament, Iliopectineal arch, Iliopectineal fascia, Inferior pubic ligament,
Inguinal ligament, Intercrural fibers,
Interfoveolar ligament, Interosseous sacroiliac ligament, Lacunar
ligament, Obturator membrane, Pectineal
ligament, Posterior sacrococcygeal ligament, Posterior sacroiliac ligament, Reflex inguinal
ligament, Sacrotuberous ligament, Superficial inguinal ring, Superior pubic
ligament, Tendinous arch, Transversalis
fascia |
| Fasciae of the Muscles and Bones of the Lower Extremity |
Achilles tendon, Annular
ligament of femur, Annular ligaments of toes, Anterior cruciate ligament, Anterior
ligament of head of fibula, Anterior ligament of the lateral
malleolus, Anterior meniscofemoral ligament, Anterior talofibular ligament, Arcuate
popliteal ligament, Articular capsule of the knee joint,
Bifurcated ligament, Calcaneocuboid
ligament, Calcaneofibular ligament, Calcaneonavicular ligament, Capsule of hip
joint, Collateral ligament of
interphalangeal articulations of foot, Collateral ligament of metatarsophalangeal articulations,
Coronary ligament of the knee, Deep
crural arch, Fascia lata, Fascia cribrosa,
Femoral sheath, Fibular collateral
ligament, Iliofemoral ligament, Iliotibial tract, Inferior extensor retinaculum
of the foot, Inferior transverse ligament
of the tibiofibular syndesmosis, Interosseous cuneometatarsal
ligaments, Interosseous membrane of the leg, Ischiofemoral ligament, Laciniate ligament,
Ligament of head of femur, Medial
collateral ligament, Oblique popliteal ligament, Patellar ligament, Peroneal retinacula, Plantar fascia, Plantar calcaneocuboid ligament,
Plantar calcaneonavicular ligament, Plantar fascia, Posterior cruciate ligament,
Posterior ligament of head of fibula, Posterior ligament of the lateral malleolus, Posterior meniscofemoral ligament, Posterior talofibular ligament, Pubofemoral
ligament, Round ligament of femur, Short plantar ligament, Spring
ligament, Superior extensor retinaculum of foot,
Tibial collateral ligament, Transverse acetabular ligament, Zona
orbicularis |
[16], [17], [18], [19], [20], [21], [22], [23]
References
- ^ Paoletti, Serge (2006). The
Fasciae: Anatomy, Dysfunction & Treatment. Seattle, WA: Eastland Press, 146-147. ISBN 0-939616-53-X.
- ^ Rolf, Ida P. (1989).
Rolfing. Rochester, VT: Healing Arts Press, 38. ISBN 0-89281-335-0.
- ^ Chaitow, Leon (1988). Soft
Tissue Manipulation. Rochester, VT: Healing Arts Press, 26-28. ISBN 0-89281-276-1.
- ^ Schleip, R. (2003). "Fascial plasticity – a
new neurobiological explanation: Part 1". Journal of Bodywork and Movement Therapies 7 (1): 15-19.
Elsevier.
- ^ Myers, Thomas W. (2002).
Anatomy Trains. London, UK: Churchill Livingstone, 15. ISBN 0-443-06351-6.
- ^ Schleip, R.; Klingler W.; Lehmann-Horn, F.
(2005). "Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence
musculoskeletal dynamics". Medical Hypotheses 65: 274. Elsevier.
- ^ Tomasek, J.; Gabbiani, G.; Hinz, B.;
Chaponnier, C.; Brown, R. (2002). "Myofibroblasts and Mechanoregulation of Connective Tissue Remodelling". Molecular Cell
Biology 3: 350-352. Nature Publishing Group.
- ^ Schleip, R.; Klingler, W.; Lehmann-Horn, F.
(2005). "Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence
musculoskeletal dynamics". Medical Hypotheses 65: 273-277. Elsevier.
- ^ Chaitow, Leon (1988). Soft
Tissue Manipulation. Rochester, VT: Healing Arts Press, 26-27. ISBN 0-89281-276-1.
- ^ Schleip, R. (2003). "Fascial plasticity – a
new neurobiological explanation: Part 1". Journal of Bodywork and Movement Therapies 7 (1): 11-19.
Elsevier.
- ^ Schleip, R. (2003). "Fascial plasticity –
a new neurobiological explanation: Part 2". Journal of Bodywork and Movement Therapies 7 (2): 104-116.
Elsevier.
- ^ Paoletti, Serge (2006).
The Fasciae: Anatomy, Dysfunction & Treatment. Seattle, WA: Eastland Press, 138, 147-149. ISBN
0-939616-53-X.
- ^ Wojtys, E.; Huston, L.; Lindenfeld, T.;
Hewett, T.; Greenfield M.L. (1998). "Association Between the Menstrual Cycle and Anterior Cruciate Ligament Injuries in Female
Athletes". American Journal of Sports Medicine 26: 614-619. American Orthopaedic Society for Sports
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