fascia in peer review: the latest fascia review

THE LATEST, COOLEST (AND MOST CONTROVERSIAL) STUDIES ON FASCIA

Yoga Fascia


MORE FASCIA AND WHOLE BODY VIBRATION

Besides bone, muscle and tendon, the deep fascia of the vertebrate body comprises a biomechanically unique connective cell and tissue layer with integrative functions to support global and regional strain, tension, and even muscle force during movement and performance control. An estimated 30–40% of the total muscle force and power is likely stored by the fascia and its mainly collagenous 3-dimensional fiber network linked to peculiar viscoelastic extracellular matrix components. With the adherence of muscle and fascia, force is transmitted multi-directionally in both longitudinal and transversal orientation through intramuscular connective tissues (endomysium, perimysium, epimysium), and even further through the deep fascia layers to tendons and their bone insertions.  From the study below
Not only have I dedicated a significant portion of my site to discussing FASCIA (check out my FASCIA SUPER-PAGE with over 170 articles on fascia all neatly systematized and categorized for you), but I’ve been enthralled for quite some time with Whole Body Vibration.  Feel free to take a look at my post titled, WBV: WHY SHAKING YOUR FASCIA HELPS ADDRESS CHRONIC PAIN AND CHRONIC ILLNESS, about the numerous health (and brain) benefits of Whole Body Vibration.

A few weeks ago Frontiers in Physiology published a study by engineers and medical researchers from Germany and China called Effects of Plantar Vibration on Bone and Deep Fascia in a Rat Hindlimb Unloading Model of Disuse, which began with these words; “The deep fascia of the vertebrate body comprises a biomechanically unique connective cell and tissue layer with integrative functions to support global and regional strain, tension, and even muscle force during motion and performance control.”  In light of what we know about fascia in general, and the Thoracolumbar Fascia specifically (HERE and HERE — the second link includes a pair of 7 second videos), these authors are not overstating this tissue’s importance.

In this study, researchers wanted to see what the effects WBV had on the vertebral and leg fascia of rats that had had their hind limbs purposefully “unloaded” (made to be non-weight-bearing).  This unloading was an attempt to mimic bed rest (or space travel), and was achieved by taping the hind legs together, creating a sling-like contraption, which was then attached by some fishing line to a swivel mounted in the roof of the cage.  This allowed the rats to move around on their front legs, but for 21 days their back legs did not touch the ground.  One group of “unloaded” rats was exposed to a customized Whole Body Vibration unit twice a day, while the other was not (the group that was not was put on the WBV device but it was not turned on), with a third group (the control group) having nothing done to it one way or the other.  After three weeks, the rats were “sacrificed” and autopsied.

The testing was extensive, looking not only at the microscopic properties (histology) of the fascia and bone, but actually using a variety of high tech devices to test the mechanical properties of the fascia, along with immunochemistry (INFLAMMATION LEVELS) and bone density. 

  • BONE LOSS AND WBV:  When compared to the control, the unshaken rats lost 10% of the bone density in their lumbar spine, half the bone density in their femurs (upper leg), and a whopping 70% in their tibia (lower leg).  The WBV rats lost about half the bone density of the unshaken rats (27%) in the femur, and none in the tibia.  Not bad. 

 

  • THORACOLUMBAR FASCIA AND WBV:   Although there was not the thickening commonly seen in chronically injured fascia (maybe due to disuse atrophy), there were other signs of dysfunction.  Both of the “weightless hindlimb” groups had increased resistance (less elasticity) — “the lumbar back fascia turned out to become mechanically stiffer following hindlimb unloading.  Plantar vibration was not able to preserve normal mechanical properties of the spinal fascia.”  Also, Collagen I & Collagen III immunoreactivity, and MMP2 immunoreactivity were at least somewhat altered, confirming decreased tissue compliance and diminished tissue remodeling in both of the unloaded / non-weight-bearing groups of rats.

 

  • LEG FASCIA AND WBV:  There was a “decreased crural fascia elasticity” in the non-vibration group, while the vibration group was similar to the control.  And although Collagen III immunoreactivity was similar between the two unloaded limb groups, Collagen I was doubled in the non-vibration unloaded group, showing significantly less tissue compliance.  Overall, “vibration mechano-stimulation in the unloaded vibrated rats showed robust effects by actually preserving close-to-normal mechanical properties in the calf region of the otherwise unloaded rat hindlimb.”  The authors went on to write a short literature review on the subject…..

Fascia tissue layers are likely affected by mechanical stimulation as well as through gene expression and collagen synthesis. Fibroblasts, the major cell type in fascia, are highly adapted to local tissue environment and likely responsive to different mechanical stimulation. Mechanical loading or unloading of connective tissue likely induces expression of several growth factors, some are involved in collagen synthesis and turnover, including transforming growth factor-β, connective tissue growth factor, and insulin-like growth factor. As a very special mechanical stimulation, vibration stimulation in general showed dramatic results in improving muscle tone and therefore increasing muscle strength.

Once again we see the importance of understanding EPIGENETICS (in many ways you can control your genes as much as your genes control you).  We also see that mechanical stimulation is the entity that triggers fibroblastic activity (HERE and HERE), releasing potent anabolic growth factors that help preserve, heal, or even improve the quality of the connective tissues (yes, BONE is considered a connective tissue).

WHAT CAN YOU TAKE AWAY FROM THIS STUDY?  While not perfect, it’s astounding what less than three and a half minutes of vibration, twice a day, was able to accomplish.  With the price of decent WBV machines recently plummeting to around 200 bucks, it’s a fantastic piece to add to any home gym (or senior center) that takes up little floor space, while adding a lot of potential bang for the buck.  I think that WBV could be a valuable tool, as a connective tissue and muscle preserver / builder and potential fall-preventative (HERE), especially for seniors or chronically ill individuals unable to exercise like they want / need.  Although I’m not quite officially a senior, I use mine at least 3-4 times per week (HERE).

IMAGING THORACOLUMBAR FASCIA WITH ULTRASOUND

Speaking of the Thoracolumbar Fascia, a little over a week ago, BMC Musculoskeletal Disorders published a study titled Measuring the Morphological Characteristics of Thoracolumbar Fascia in Ultrasound Images: An Inter-Rater Reliability Study in which the authors (researchers from the University of Kent’s School of Sport and Exercise Sciences) began by saying, “Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor.”  While they’re correct in this assertion, “poorly understood” is actually a huge understatement.  What do I mean? 

Firstly, if you look at my posts on WHAT CAUSES SCIATICA? or WHAT CAUSES BUTT PAIN? you’ll see that numerous issues can lead to similar symptoms.  The same is true of low back pain.  And even thought the medical community and general public has an infatuation with both x-rays and MRI, rarely are they going to provide an adequate answer — what I refer to in my clinic as the “aha moment” (HERE, HERE, or HERE).  And secondly, if you begin to comprehend the three-layered fascial system of the Thoracolumbar Spine (see earlier links), it would make sense why imaging this tissue with the new ultrasound technology could be beneficial (HERE are the videos, it will take less than ten seconds to play them simultaneously side-by-side so you can see for yourself).  Pay attention to some of this study’s CHERRY-PICKED FINDINGS.

A growing body of evidence supports the notion that the thoracolumbar fascia, an anatomical structure consisting of layers of dense connective tissue in the lumbar area of the trunk, is clinically important in people with chronic lower back pain. The thoracolumbar fascia has been shown to play an important role in force transmission between lower limbs and trunk in both cadaver studies and in-vivo research during walking. Subcutaneous fascial bands have been found to mechanically link the skin, subcutaneous layers and deeper muscles.  The architecture of the thoracolumbar fascia is complex, it consists of layers of dense collagenous connective tissue, interspersed with loose connective tissue which allows the dense layers to slide and hence play a role in trunk mobility. The thoracolumbar fascia is continuous with the aponeuroses of major trunk muscles which are instrumental in movement and vertebral control. It has been hypothesised that fibrosis, densification and thickening in the thoracolumbar fascia may be the result of an inflammatory response or soft tissue injury. For instance, a recent animal study demonstrated that an induced soft tissue injury in the lumbar region, when combined with movement restriction, lead to fibrosis, and significant thickening of thoracolumbar fascia. An earlier pioneering ultrasound based human study concluded that the thoracolumbar fascia in people with chronic lower back pain demonstrated 25% greater thickness compared to a matched control group. A follow-up investigation found that thoracolumbar fascia shear strain during passive trunk flexion, was reduced in people with chronic lower back pain by 56%. In both aforementioned studies, Langevin’s research team found significant differences not only in fascial thickness and echogenicity, but also in disorganisation of the architecture of the connective tissues of people with chronic lower back pain.

Here it is folks.  Inflammation is not only the root of sickness, disease, and chronic pain, it always (always) leads to the buildup of scar tissue that the medical community refers to as fibrosis (HERE), which just happens to be America’s leading cause of morbidity (sickness) and mortality (death) HEREDENSIFICATION and THICKENING of fascia is a big deal because it changes its mechano-elastic properties.  This is why physicians and researchers like LANGEVIN mentioned above, are saying that SCAR TISSUE AND FASCIAL ADHESIONS are the root of all sickness and disease (HERE).  And what’s really cool is that these authors concluded that it really does not take specialized training to be able to tell healthy fascia from unhealthy fascia (again, look at the video links and you’ll be able to see the difference yourself).

Medical practitioners agree on different morphological features in ultrasound images of thoracolumbar fascia such as levels of organisation and disorganisation. This agreement is independent of experience in ultrasound image rating. We found that the knowledge gap between musculoskeletal (MSK)-trained radiologists, MSK-trained medical doctors and physiotherapists on the one hand, and clinicians untrained and inexperienced in MSK ultrasound, did not affect the inter-observer agreement.

WHAT CAN YOU TAKE AWAY FROM THIS STUDY?  While technology like this is certainly nice, technology is not typically the solution to people’s problems.  You see it; what are you going to do about it?  Although I sometimes use “high tech” such as LASER THERAPY in my clinic and have for over a decade, good old fashioned low tech TISSUE REMODELING is what typically helps people improve significantly and rapidly.  To see what I’m talking about take a look at our clinic’s results HERE, HERE, or HERE.

FASCIA, YOGA & THE SECOND LAW OF THERMODYNAMICS

The anatomic structures which connect the spine to the lower limbs are considerable. Take biceps femoris or the hamstrings, for example; the force generated by the hamstrings are channelled by the sacrotuberous ligament, which controls longissimus lumborum and latissimus lumborum situated on either side of the lumbar spine. Part of the sacrotuberous ligament then controls the iliocostalis thoracis muscle up to the superior part of the thoracic spine. Two transverse planes (the right hamstrings control part of the muscles connected to the left side of the thorax and vice versa) constitute another direct link between the hamstrings and the superior part of the thoracic spine. Another important linking element consists of gluteus maximus which crosses the medial aspect of the spine to be attached to latissimus dorsi, which controls arm movements. All of these connections form a sort of cross-pyramid of the back, which ensures very strong mechanical integrity from the upper limbs to the lower limbs.  From An Interview with Professor S. Gracovetsky. The Spine Engine: A unified theory of the Spine? in a 1989 issue of the journal, Argos Spine News

The second law of thermodynamics was formulated in the early 1800’s and has to do with something known as entropy.  As defined by Wikipedia, “entropy of an isolated system never decreases. Such systems spontaneously evolve towards thermodynamic equilibrium, the state with maximum entropy. Non-isolated systems may lose entropy, provided their environment’s entropy increases by at least that amount so that the total entropy increases. Entropy is a function of the state of the system, so the change in entropy of a system is determined by its initial and final states.”  Huh?????   Even though I’m a pea-brain when it comes to physics, allow me to simplify this concept a bit.

Entropy has to do with the fact that without putting energy into closed systems, they always fall apart.  In other words, entropy is physical or energetic decay.   And when it comes to entropy, literally everything you can think of is an example.  What happens if you don’t put energy into taking care of your car?  It falls apart.  I talked to a patient just yesterday who is remodeling a ten year old house that was neglected to the point of needing to have tens of thousands of dollars of work done to it.  Left alone, everything falls apart, decays, and if it’s living, it dies.  Unless engergy is put into the system, things always move from greater energy to lesser energy.  Not only is entropy the very nature of the universe, it helps explain one of the reasons I don’t personally believe in evolution (HERE).

About six weeks ago the Journal of Bodywork and Movement Therapies published Yoga, Fascia and the Second Law of Thermodynamics by Dr. Serge Gracovetsky.  Dr. G, whom I’ve previously quoted in a post on the thoracolumbar fascia (HERE), is a true ‘Renaissance Man’.   He holds advanced degrees in nuclear physics and electrical engineering, developing the idea of the TL fascia as a “Spinal Engine” (also the name of his highly-rated book), able to act as the primary driving force of the pelvis during the gait cycle. He worked on preventing neck injuries to pilots during ejections (HERE), he holds numerous patents, has written any number of books and scientific papers, and has lectured extensively around the world.  Although he received his Ph.D in 1970, he still speaks, and if I am not mistaken, is scheduled for the upcoming Fascia Congress in Berlin (November).  Oh; I almost forgot to mention that he is also an accomplished woodwind musician.

Gracovetsky began his short paper by talking about a 17 page manuscript known as The Edwin Smith Papyrus, which is a transcript of an ancient Egyptian text on manual medicine.  Three principles were discussed, the first of which I have mentioned any number of times on my site.  Because so many disease processes / injury processes share COMMON DENOMINATORS, having an exact diagnosis is not needed for treatment to be effective. In other words, EXCELLENT CLINICAL RESULTS do not necessarily mean that, “the diagnosis and/or its underlying philosophy that led to it were correct.”   While this is related to THE PLACEBO EFFECT, it’s a concept that goes well beyond simple placebo.

The result is that good clinical outcomes lead to either “complacency or self-gratification,” which he argues slows down the urge to see why (“including doing nothing“) patients are really getting such excellent results, which he believes is due to the excellent resiliency and ability that human beings have to heal despite or in spite of whatever sort of treatment we may try.  What does this have to do with entropy? 

“And so, the freedom to innovate without the burden of a proof resulted in the development of a plethora of treatment philosophies by many visionaries with the best intentions. Yoga is one of these philosophies/approaches which have done a lot of good to countless individuals. Osteopathy, Chiropractic, Physical therapy, Rolfing, and many others, are also rehabilitation methodologies competing for the same clientele, with similar outcomes.  The Cochrane collaboration, who published many reports on various type of treatments protocols [produced] overall conclusions for Pilates, Chiropractic Physical conditioning, Spinal manipulation for low back pain, etc., that all manual therapies are fairly equal, and only marginally successful.   This means that regardless of the claims made by the various schools of thought operating in the field, it would appear that none of them are better than any other.”

After invoking Darwinistic evolution as a proof for entropy (remember that Darwinistic evolution is a mindless, unintelligent, purely mechanistic / naturalistic process driven solely by CHANCE), he says that when you boil it all down, we are nothing more than, “simple heat machines regulated by the second law of thermodynamics” — an idea that kind of reminds me of what the late Dr. Will Provine used to say.  In my scientific pea-brain, the problem with this way of thinking is two-fold.  Firstly, it is far too “MECHANISTIC” to explain such absurdly complex phenomenon as DNA (which is not only physically complex but is actually made up of information), THE EYE, or consciousness.  And secondly, while energy in the form of heat is great (who relishes being cold?), since when is an organism’s ability to use or create heat powerful enough to drive anything even as remotely complex as what it would take to drive evolution?

The point of his paper is two-fold, with the first being that evolution has driven our skeletal systems to operate at max efficiency.  What specifically makes that possible is FASCIA, by creating enough mechanical advantage that the intensity of muscular contraction “never exceeds 2/3 of the value that would rupture their respective tissues“.  His next point is that since all of these treatments are actually similar versions of the same thing, everyone “should work together to find a patient-dependent therapy that is only related to the patient‘s pathophysiology, rather than some vaguely defined, unproven, philosophical conjecture.”  While I would agree with the part about everyone working together, yoga is not the same as chiropractic is not the same as tissue remodeling. His quote above almost sounds a bit too “EVIDENCE-BASED,” which is one of those oxymoronical concepts that sounds great on the surface, but doesn’t always pan out in the end.  Kind of like the ongoing push by academia for COMMUNISM-BASED HEALTHCARE I discussed not too long ago.

It’s not that EBM is necessarily a bad thing, but always ask your self a question, WHO DECIDES WHAT CONSTITUTES THE EVIDENCE?  As I’ve shown you over and over again, it’s special interests and multi-national corporations.  In other words, those with the deepest pockets control the science.  This starts hitting home once you realize that half of all biomedical research is either HIDDEN OR NOT PUBLISHED (invisible & abandoned) so as to obscure unwanted results, while the other half IS NOT REPRODUCIBLE — the cornerstone of science that makes it, well, scientific.

WHAT CAN YOU TAKE AWAY FROM THIS STUDY?   While I thought Dr. Gracovetsky’s paper was interesting, his earlier work on spinal engines is far more practical.  It addresses some of the concepts of coupled-motion as discovered in the early 1900’s by by Lovett and Fryette, and later made practical by Dr. L. John Faye (Motion Palpation — a technique based on the differences between SEGMENTAL MOTION -VS- SECTIONAL MOTION) back in the 1960’s.  As is always the case, it’s not difficult to find naysayers.   A 2007 issue of the Journal of Orthopedic and Sports Physical Therapy (Does the Evidence Support the Existence of Lumbar Spine Coupled Motion? A Critical Review of the Literature) came to these conclusions.

“We were not able to find evidence of a consistent pattern of coupled  motion  between side-bending  and rotation in the lumbar spine across articles.  This was the case even when considering such  conditions as the age and sex of the subject, position in the sagittal plane, or method of detecting coupled motion. These findings have implications for the application of theories regarding coupled motion to manual therapy practice, as there is no evidence to support the use of coupled motion principles to evaluate or treat patients with low back pain.  Clinicians should, therefore, consider eliminating the use of the concept of coupled motion patterns in their evaluation and intervention for patients with lumbar spine conditions. Rather, clinical decisions regarding the determination of physical therapy interventions for patients with low back pain should focus on more validated examination procedures.”

And what, pray tell, would those “validated examination procedures” be?  Although we all do them, everyone knows that orthopedic tests are largely a joke.  Imaging?  I gave you links in the first section of today’s post showing just how screwy imaging really is when it comes to making definitive diagnosis about almost anything. 

I’m of the opinion that Gracovetsky’s work meshes well with Janda’s ideas about both UPPER CROSSED and LOWER CROSSED syndromes.  And if you are interested, Dr. G has a fascinating lecture that was given exactly thirty years ago (HERE) on the thoracolumbar fascia as a spinal engine.  BTW, if you found today’s post intriguing, help us spread the wealth by liking, sharing, or following on FACEBOOK.  It’s a fantastic way to reach those you love and care about most with excellent (and completely free) information!

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