Fascia: The forgotten connective tissue, and new organ?
An injury often involves the muscles, tendons, ligaments, and bones which are all part of the connective tissues of our bodies. The fascia is also part of the connective tissue but is rarely talked about. It is a sheath of connective tissue under the skin that covers all joints, muscles, tendons, ligaments and visceral organs. There are no orthopedic tests to identify a fascial injury other than pressure points where we think the fascia is tense and irritated. Trauma to the body can replicate the same pain within the fascia that other connective tissue injuries can. Researchers in the past few years have concluded that the fascia, also known as the interstitium has properties that could classify it as a new organ. This was the conclusion of a study in the Journal of Scientific Reports published in March of 2018. The fascia was previously thought as just a wall of dense collagen, but now according to Dr. Neil Theise a professor of pathology at New York University, it’s more like an “open, fluid filled highway”. This was only discovered when a new imaging technique called probe based confocal laser endomicroscopy or pCLE, enabled them to examine living tissues on a microscopic level. Our bodies which are about 60-70% water, has about two thirds of it in the cells and about one third outside the cells in the fluid filled spaces of this interstitium or fascia. Researchers at Mt. Sinai hospital in NYC believe that the fluid filled fascia can act as a portal to deliver lymph to and from organs and unfortunately serve as a transportation highway for metastatic cancerous cell migration. These same researchers believe the fluid filled spaces may also act as a shock absorber to protect tissues during daily functions as well, and that is the connection to many acute and chronic pain syndromes.
This acronym broadly describes a new development in the treatment of pain. It stands for instrument assisted soft tissue mobilization. In recent years there have been different instruments developed by various people to treat soft tissue fascial injuries with these tools. I myself have been using a set of these tools for over ten years. About 20 years ago David Graston first used these tools on himself to treat scar tissue resulting from knee surgery. By using a specially designed tool with an edge he was able to break up scar tissue and adhesions resulting from the surgery. Today, many health care providers like myself are using these tools to address problems within the fascia. Pictured below is an example of what a treatment would look like. I.A.S.T.M. is just a newer version of what Chinese Medicine used for a few thousand years. Traditional Chinese medicine called it gua sha andwould use pieces of jade or a ceramic spoon to scrape the skin, and to raise Chi (life energy). Evidence of this is the red marks and petechia that would arise after a treatment.
For about 5000 years, Chinese medicine have used heated glass bulbs and applied it to the skin to create suction to address many health issues. It was primarily used to raise Chi or energy to an area of stagnation and for pain. Today, the more modern application of cupping is often a hand-held suction device used to address fascial trauma and the suction is used to relieve the injury through decompression. The more modern versions of cupping sets use a suction device without the use of a flame which can be adjusted more easily to the tolerance of the patient. The cups are plastic, not glass so they are safer and easy to clean. Probably no one did more to publicize cupping than the Olympic swimmer Michael Phelps. In the last Olympics he swam to several gold medals with the characteristic bruised circles on his back and shoulders from his cupping treatments.
While the treatments for fascial irritation can look painful, they rarely cause more than slight discomfort. Almost always, reduction in pain and increased range of motion is immediately felt. I have witnessed daily, the relief a treatment of these types has brought to patients. Anything that can be done to avoid the use of prescription pain killers and the side effects from them is worth considering. About two months ago, I took a class on Chinese cupping. The I.A.S.T.M. approach creates a shearing release, while the cupping creates a decompression release to the fascia. Kinesiotaping is a more modern application. There is a time and place for all these approaches including massage. Chinese medicine was describing something different than what western medicine describes for the application of these techniques, but the bottom line is, what worked on humans 5000 years ago still works on modern man today.
J.M. is a 65-year-old woman who woke up in an odd position and had acute lower flank pain on the right side. She had extreme difficulty raising her right arm above her head and was very uncomfortable with her level of pain. I applied 5 cups to her side and stabilized her ribs with Rock Tape, which is another type of Kinesiotape. Just from the cupping her pain was reduced by 80-90%. The bruising that results from the cups should go away in a few days. These three pictures show the results of the treatment.