Fascia is a system of connective tissue that encases our body parts and binds them together. Fascia, made primarily of collagen, can be thought of as a sausage casing for your body’s tissues. It surrounds muscles, nerves, tendons, and ligaments and gives them shape. Fascia also connects your skin to the tissue that is directly beneath it.
The collagen that makes up fascia is organized in a wavy pattern. When pulled, these lines of tissue resist tensile and shear loads, helping to keep your body parts together.
When you injure a body part, healthcare professionals tend to focus solely on that part; an injury to your Achilles tendon usually results in your physician or physical therapist focusing on the tendon. Some of that focus should be on the fascia, as it is woven into all of our body’s systems, holding them together, giving them shape, and allowing pain-free functional movement to occur.
Structure of Fascia
Fascia is made up of collagen, which is the gluey, gooey, cellular matrix that binds tissues together. Specialized cells called fibroblasts produce the collagen that becomes fascia.
There are different types of collagen:
- Type I: Type I collagen makes up 90% of the collagen in your body and surrounds tendons, cartilage, muscles, teeth, and bones.
- Type II: This type of collagen is found in the cartilage in your joints. It is specifically designed to provide cushioning and shock absorption in your joints.
- Type III: This collagen makes up the fascia that surrounds your arteries and visceral organs.
- Type IV: Type IV collagen is located within the layers of your skin.
- Type V: This type of collagen makes up cell membranes, hair, and the human placenta.
All of the different types of collagen are intertwined together, providing support to the structures within your body. You can imagine fascia as an intertwined web of gooey tissue between structures in your body.
Fascia is located all over your body, and while it surrounds all tissues, it can be divided into three distinct types based on location. Types of fascia include:
- Superficial fascia: This type of fascia is associated with your skin.
- Deep fascia: Deep fascia surrounds your bones, nerves, muscles, and arteries and veins.
- Visceral fascia: This fascia surrounds your internal organs.
Fascia may be innervated by nerves and may send pain signals to your brain. Microcapillaries supply blood and nutrients to fascia.
It is easy to understand fascia by comparing it to a sausage casing around tendons, muscles, bones, organs, and joints. Fascia also helps support proper movement and function in your body.
Fascia supports structures in your body. It surrounds tissues and provides shape for muscles, tendons, and joints. But it also can help with functional movement by reducing friction between structures.
Fascia provides moveable wrappings around muscles, tendons, and nerves. Sometimes, bundles of muscles with different lines of pull are contained in one fascial compartment.
One well-known piece of fascia is called the plantar fascia, also known as the plantar aponeurosis. It is located on the bottom of your foot and stretches from your heel bone to your toes. This thick band of fascia supports your medial arch and gives shape to the bottom of your foot. But it also serves a very functional purpose.
When you are walking, the plantar fascia is gently stretched as you are stepping and your toes are about to leave the ground. (Imagine a rubber band stretching from your heel to your toes.) This stretching of the fascia stores energy, and that energy is released as your foot comes up while stepping.
This energy literally puts a spring in your step and allows your foot to be more efficient while walking. The storage and release of energy in the plantar fascia while stepping is known as the windlass mechanism.1
Your iliotibial band is also a large piece of fascia that courses along the length of your outer thigh. It arises from a muscle near your hip called the tensor fascia lata (TFL), and it attaches just below your knee.
When you are stepping, the iliotibial band gets pulled a little, storing a bit of energy that resists rotational forces in your knee. Like the windlass mechanism in your foot, this energy is released as you step, making activities like walking and running more efficient.2
Injury to Fascia
Just like you can injure a muscle or tendon, fascia can also suffer injury. Whenever a muscle or tendon is torn, the fascia around it may also become injured and torn. Sometimes, overuse and overstress to your body can cause injury to the fascia as well.
Symptoms of injury to fascia mimic symptoms of a muscle or tendon strain. These may include:
- Difficulty with motion
- Increased tissue temperature
If you suspect you have injured any tissue in your body, it is important to see your physician right away. They can assess your condition and make a diagnosis. That way you can start on the correct treatment for your condition.
Two common conditions that affect fascia are plantar fasciitis and iliotibial band friction syndrome.
Plantar fasciitis occurs when the fascia in your foot becomes irritated or inflamed. This may cause pain, specifically at the bottom of the heel, difficulty with walking and running, and pain when rising from sitting. Diagnosis is often made by palpation of the heel and bottom of the foot, and treatment centers around decreasing stress via plantar fascia stretching, Achilles tendon stretching, shoe orthotics, and modifying activities.
Iliotibial band friction syndrome (ITBS) occurs when the fascia near your knee becomes irritated due to overuse and abnormal rubbing of the fascia by the outer portion of your knee joint. When this happens, pain, swelling, and difficulty with walking and running may occur.
Diagnosis of ITBS is made by clinical examination and palpation of the area near your knee. Treatment focuses on improving tissue flexibility of the fascia and related muscles and strengthening muscles to ensure proper alignment of your knees while walking and running.
Sometimes fascia compartments can become tight and not allow for normal movement of blood into and out of the compartment. A condition called compartment syndrome occurs when muscles fill with blood during activity, but the fascia covering around the muscles is tight and does not allow the blood to easily exit the muscle compartment.
Compartment syndrome often occurs in the calf muscles of the lower leg. Pain, swelling, firmness of the calf, and often neurological symptoms such as numbness, tingling, and/or burning that occur a few minutes after moderate exercise are hallmarks of the condition.
Any traumatic injury in the body may include injury to the fascia in the area; an Achilles tendon tear likely includes tearing of the fascia surrounding the tendon.
Diagnosing problems with fascia can be difficult. Often diagnostic tests like magnetic resonance imaging (MRI) focuses on larger structures like muscles and tendons and ignores the fascia and collagen coverings around those structures.
Diagnosis of fascial problems is often made by palpation (touching), although this method of diagnosis has been proven to be quite unreliable. Occasionally, diagnostic ultrasound is used to study fascial thickness and elasticity in order to diagnose problems.
Fascia is like any other collagen type tissue in the body. When it becomes torn or injured, it needs appropriate time to heal properly. As it is healing, gentle motion can be started to ensure that the collagen cells are properly aligned.
This is thought to eliminate the build up of scar tissue in the body. (Scar tissue is simply collagen that has not healed properly and is thought of as a tight ball of fascia and tissue.)
Once things have healed, strengthening exercises for muscles and tendons can help improve fascia’s ability to tolerate stresses that are placed upon it during day to day activities.
Components of a rehab program for injured fascia may include:
- Scar tissue massage: This massage technique is used to realign the collagen tissue that makes up fascia, leading to improved flexibility and pain-free movement.
- Stretching and flexibility exercises: Exercises to improve overall flexibility can pull gently on fascia, leading to more freedom of movement and less tightness.
- Myofascial release: This specialized massage technique uses gently pressure motions to guide fascia into the correct position. It is used to release restrictions in the fascia. Myofascial release is often used by specially trained massage therapists or physical therapists.
- Strengthening exercises: Strengthening muscles can help provide your body with appropriate support, and strength training may improve your body’s ability to manage stress that is placed upon it.
- Foam rolling: Some rehab professionals recommend foam rolling to gently stretch and massage muscles and fascia. While this may feel good, there is little evidence that foam rolling offers any greater benefit than stretching and strengthening exercises.3
While rehabbing an injury to fascia, you may use heat to increase blood flow to the injured area and ice to decrease inflammation to the injured tissue. Working closely with a rehab professional like a physical therapist or occupational therapist is recommended to get the best outcome after an injury to fascia.
Most injury to fascia heals within a six to eight week period.
Occasionally chronic inflammation and pain affect fascia. This may cause problems such as painful movement or fibromyalgia. When this occurs, a multi-thronged approach to care may be necessary. This may include massage, exercise, and medication to help ease pain and improve movement.
Modification of activity may be important as well; too much activity may cause a flare-up, while too little activity may lead to tight tissues and atrophy of muscles.