What IS this thing called Fascia? I’ve often looked at my relationship and association with the world of fascia and questioned where it’s going and whether it’s the right direction. The move towards a website called Functional Anatomy is me trying to shift slightly the emphasis on fascia and to show that I have more of a view than some might think. But it’s worth trying to explain how I got here in the first place.
I’ve spent the last few years straddling two very different worlds. Running dissection classes in medical schools and rubbing shoulders with traditional anatomical approaches, academic imperatives and learning to keep my views to myself. It didn’t work as I’m still a pariah in these circles, at least in the UK. In this world, fascia is a poorly described connective tissue that is not given much consideration in terms of anatomy, diagnosis function or explanation. The information is there, but not much is made of it and it’s not a part of anatomy that has much of a presence.
The fascination that people for fascia is often derided and laughed at and when in the company of anatomists and those involved in classical anatomy, it’s not an oft talked about subject. “Fascia kittens for everybody!” as one senior Doctor chairing a UK anatomy association happily sneered about the world of fascia.
On the other side of the aisle, I still have a strong interest in the world of complementary medicine. I am principal instructor of a hands on therapy school, have written two books about it, hundreds of articles and lectured all over the world on it. It has been my life for over thirty years and most of the people I would call friends are in this sector in some way shape or form.
In this arena, fascia takes on almost god like properties and is imbued with all kinds of improbable qualities and abilities. People claim everything from it being responsible for it being the cause of mental illness to every pain you’ve ever had being as a result of injury, dysfunction, dehydration or something to it.
Therapies for it and approaches to it abound. The claim to stretch it, hydrate it, release it, move it grow it, or do something to it and with it come tools, books, videos and courses, all with fascia or myofascia on it or near it.
There are international and regional conferences on fascia, Facebook groups, research studies and people that have made their entire living and reputation on this inert connective tissue. Theories become beliefs and beliefs become fact and what once was a great idea and theory, now becomes something factual, even when the evidence doesn’t support it. Don’t get me started on evidence.
Somewhere in the middle of this is some truth and both worlds are guilty of taking extreme stances that are never likely to to reflect a middle ground.
Where to begin?
We have to start by saying that there isn’t a single thing that you can call fascia and what fascia is or isn’t, depends on who you’re talking to. There’s also no real consensus in science or even in the world of fascia itself, so we start from a tricky place. For the moment let’s call fascia, ‘A collagen based, body wide connective tissue that has variable properties.’ It’s pretty neutral, most people will agree, and we can go from there. All fascia is connective tissue, but not all connective tissue is fascia.
Fascia is therefore for me, the connective tissue that joins up the dots. It is in effect, the missing link between the branches of medicine and the disconnected bits of anatomy that litter our anatomical understanding. I once sat on a plane back from the USA and sat next to a heart transplant coming surgeon. I asked him how many of his patients complained of back pain post transplant. “All of them,” was his reply and he admitted to being puzzled by why this was the case. 45 minutes later and some pictures from the laptop and things were a lot clearer. There were connections that he had literally never considered, or more importantly had never seen or been taught as an undergraduate.
It probably won’t have made any difference to his surgery, but this simple bit of information certainly made him a better surgeon. Able to dispense advice and explain why people experienced what they did, enabling them to understand it was normal and that they could get help for it, although probably not from him. His capacity to see the person as a whole and how they presented as part of what he did allowed others to have more confidence in what advice and approaches he took.
I felt that my straddling of these worlds, understanding what his training had been and how he learned anatomy, enabled me to reach out to him and present him, not with an alternative view, but an extended view. He wasn’t wrong or blinkered, he had just not seen some of what there was to see.
All the structures I showed him and all the explanations I gave him were all what is in the body. The bio chemistry surrounding cellular activity in scarring and its effects on connective tissues were simple and basic science, but explained the body wide effects of scarring in a way he hadn’t considered before.
In speaking to therapists ‘on the other side,’ I use the same approach to demonstrate the myriad of connective tissue structures, what they consist of, how they get laid down and what we can (and cannot) do as manual therapists. I explain some of the scientific and physiological realities that have got mixed up in myth: there are no lines in the body, fascia is mainly non cellular and so on.
The straddling of the line isn’t fence sitting by the way and I know full well where I would choose to be if I were forced to make such a choice. I firmly believe that the wisdom, education, science, methodology and understanding of the body is something that both sides of the argument have more in common with than you might at first think. The polarisation of the views is what creates the problem for the populace who are caught in the middle struggling to get the best and safest help they can.
My role is to try and bring the worlds together and tease out this wisdom for the good of those who need our passion and knowledge. Wish me luck!
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