Fascia, Pain and Corrective Exercise

A recent study has found that individuals with recurrent lower back pain have 25% thicker fascia in the lower back area than those with no pain. This was also reproduced in the neck area where increased fascial thickness of the scalenes (front of neck) was found in those with neck pain. Also it has been seen in the Achilles tendon as well.

thoracolumbar-fascia-xl

Your first question is what is fascia? Fascia is basically connective tissues that encapsulates the muscles, supports organs and transmit movement of the bones in the body allowing movement to occur. Fascia is in effect the clear, cling filmy substance that on a piece of chicken seems to wrap the main muscle tissue (preparing and cooking chicken is after all an anatomy lesson). For effective movement to occur the muscles must be able to glide past each other. If there is not clear movement then there may be a lack of proprioception, poor coordination of muscle function and possibly pain. Fascia is reactive to stress- place more stress on it and it will start to build up. This is not necessarily a bad thing as it will enhance the tensile strength of the body. However, excessive build ups clearly cause pain.

From a training perspective this highlights two things:

1. Fascial thickness is related to pain. Training on it’s own does not correct fascial thickness. The main way to remove these tightness’s is to increase the body temperature of these areas of fascial thickness. The major way of doing this is by deep tissue, high friction massage.

2.Postural issues related to fascia thickness that cause pain need to be helped by reducing the amount of cumulative stress to the thickened area. This may be termed corrective exercise as it highlights that the tissue is overworked and therefore surrounding and supporting muscles and tissue needs to be picking up the slack.

You typically see this in individuals with forward head position developing shoulder and neck pain as well as in those with flatter back postures. You can also sometimes see what is called a Dowagers hump develop on the upper back as a protective mechanism. What happens here is that the neck is in a forward position and as the muscles of the upper back try to hold on to the head extra stress to that area means that as a protective mechanism the body lays down more tissue to provide stability. Interestingly you can sometimes see this on the Achilles tendon where as a protective mechanism the body will lay down more tissue if the joint is under excessive stress. Sometimes this is seen as a bit of a lump next to the heel.

You can tend to see poor movement in a lot of things, knee alignment in particular can be affected by tight fascia down the outside of the thighs. This doesn’t mean just pain in the knee- it can also relate to lower back and hip issues. No amount of cueing or form adjustment will really help if structurally the tightness’s are caused by excessive tissue. In this case a more holistic approach of soft tissue work and strength exercise will be key.

In summary, what to do if you know posture is poor and painful even on occasion. Strength train in an organised fashion to correct any strength imbalances and restore tissue quality by deep tissue massage.

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