fascial manipulation and the relationship to fibroblastic activity

FASCIAL MANIPULATION AND FIBROBLASTIC ACTIVITY

Fascia Manipulation

Anatomist90

ANTERIOR NECK MUSCLES

Fascia Manipulation

Anatomist90

RIB CAGE & ABDOMINAL MUSCLES

“The human body must be considered as a functional unit, where every area is in communication with another through the fascial continuum, consequently originating perfect tensegritive equilibrium…  The fibroblasts represent the foundation of the fascial system, a structure of connective tissue that covers and affects every body area… and are an invaluable instrument, essential to the understanding of the therapeutic effects of osteopathic treatment.”

In September of last year, the journal Evidence-Based Complementary and Alternative Medicine carried the Italian study called Understanding Fibroblasts in Order to Comprehend the Osteopathic Treatment of the Fascia.  I am not going to spend a great deal of time on the anatomy of FASCIA, as much of it in this article is quite detailed, not to mention that fact that I have covered much of it on my site.  I am, however, going to talk a bit about a type of cell called Fibroblasts, and their relationship to the tissue known as Fascia. 

Any time you hear the word “blast,” think builder.  In other words, Fibroblasts “build” fibrous tissues. They are a form of metabolically active stem cell that are responsible for building and maintaining the bulk of the body’s framework via excretion of the materials that become COLLAGEN FIBERS, HYLURONIC ACID (HA), Reticular Fibers (fibers that crosslink together into a very fine mesh), a number of different Gellatinous Glycoproteins that make up what is known as the Extracellular Matrix, Elastic Fibers such as Elastin (Elastin can stretch half again it’s own length and then return to normal), along with others.

According to this paper, the whole purpose of Osteopathic Treatment of people with various forms of FASCIAL ADHESIONS is to, “allow the various layers of the connective system to slide over each other.”  Some of the problems they immediately mention as being associated with loss of function in the Fascia (most particularly, the Fibroblasts) include…

  • LOSS OF SENSORY FUNCTION AND PAIN:  The authors state that Fibroblasts, “are a source of nociceptive information as well.”  NOCICEPTION is one of the three types of pain, and my best guess is that CHRONIC PAIN is the best explanation for the fact you are sitting here reading this post at 3 am.
  • LOSS OF PROPRIOCEPTION / MECHANORECEPTION:  It was the same Dr. Chan Gunn — the Canadian Neurologist who determined that Scar Tissue is over 1,000 times more pain sensitive than normal tissue — who also determined that your levels of PROPRIOCEPTION / MECHANORECEPTION are directly and dramatically tied to the function (or loss thereof) of your motor nerves.
  • SUPPORT:  This is so critical that the paper reveals, “The fascial tissue is distributed throughout the entire body, enveloping, interacting with and permeating blood vessels, nerves, viscera, meninges, bones, and muscles, creating various layers at different depths, and forming a tridimensional metabolic and mechanical matrix.”  In other words, Fascia is not only the most abundant tissue in your body, it’s matrix acts as your chief support system, something mentioned earlier (more on the matrix known as the ECM or extracellular matrix).
  • TENSEGRITY:  TENSEGRITY is a unique property of Fascial support.  The authors say that fibroblasts, “play a key role in the transmission of the tension produced by the muscles and in the management of the interstitial fluids.”  If you do nothing else, click the link and watch the short video on tensegrity.
  • CONTRACTION:   Due to the action of Fibroblasts, Fascia is actually able to contract like a muscle.  “All fascial layers contain a variable amount of fibroblasts with the ability to contract, known as myofibroblasts.
  • COMMUNICATION:   If the GUT is a “second brain,” Fascia is the SECOND NERVOUS SYSTEM.  Listen to how cool this communication really is. “Any variation in the form of a cell due to tension enhances a series of metabolic responses that perfectly reflect the nature, direction, and duration of the tension itself. This mechanism is known as mechanotransduction; tension is the “language” of cells. The adaptation of the cells (and consequently their survival and that of all the systems) depends on the cells’ ability to adjust themselves and change their form. In this mechanometabolic scenario, a fibroblast is not a mere passive element. In fact, it not only undergoes a morphological variation due to tensional information, but can also activate itself in order to perceive the tensional level surrounding it, so as to be constantly updated and ready to adapt in real time.  Every fibroblast is potentially aware of the functional state of the one close to it, as well as those distant from it, ensuring the fascial and mechanical continuity.

Fascia’s “communication” abilities are interesting in light of what the STECCOS (Italian Physicians who are possibly the world’s foremost experts on the tissue) have determined about the relationship between the Fascial System and the Acupuncture Meridians.  “A characteristic of the fascia that is supposed to affect the expression of movement is the ability to carry electrical activity. The collagen proteins have semiconductive, piezoelectric, and photoconductive properties, in vitro; therefore, the fascial continuum is theorized to produce and distribute electrical activity through the extracellular matrix. The fascial system is supposed to be electrically activated, similar to some neuronal patterns….”   Plainly stated, “The fascia becomes an organ that can affect an individual’s health.”  None of this is really news to those who have studied it. 

After saying that EPIGENETIC EVENTS affect Fascial health, the authors state that, “The mechanical environment [of Facia] can be directly affected by the fibroblasts, thanks to their ability to control and modulate the extracellular matrix, which indirectly determines the function of the different systems dealing with the fascial continuum. The fibroblasts and the extracellular matrix are closely related to each other through some contact proteins, such as the integrins; the amount of elements composing the extracellular matrix varies depending on tensional information. This relationship can be noxious when there is excessive tension, developing fibrosis, or it can remain functional, increasing the sustainability of the mechanical forces, through a correct viscous and elastic environment.

The authors then mention Fibrosis, which is the same thing that I often refer to as microscopic “SCAR TISSUE” with my patients.  If you really want to understand how certain “Epigenetic Events” (chiefly INFLAMMATION) affect Fascia, you need to read these posts (HERE, HERE, HERE, and HERE).  In case you have not figured it out, CHRONIC INFLAMMATION not only causes sickness and disease, but it causes dysfunction and Chronic Pain as well.  This is probably why some of the most brilliant scientists and physicians of our era are saying that problems in the Fascia are the root of almost every single health issue you can name — not to mention most you can’t (HERE).

The thing you need to remember is that not all Inflammation is bad.  While we certainly do not want “Systemic Inflammation” coursing through our systems, “Local Inflammation” is of critical importance for healing injuries, whether large or minute.  “Multiple cytokines, chemokines, and prostanoids [all of these would be considered to be the chemicals we refer to as “Inflammation,” with a number of others being mentioned later in the paper] are synthesized. The fibroblasts play a significant active role in stimulating inflammatory processes, because they are responsible for a suitable cleaning, repair, and replacement of the elements of the fascial continuum that have been and are affected by traumas resulting from daily use. These fibroblastic characteristics aim to ensure a correct performance in managing the tension, perceived and produced.

Before talking about the various CONTRACTILE LAYERS of Fascia, and after mentioning HA (“Hyaluronic acid acts as a lubricant, and its quantity affects the temperature among the fibroblasts. According to research, some specific fibroblastic cells, called fasciacytes, supposedly produce hyaluronic acid, ensuring an optimal viscous and elastic environment“) and the fact that, “The fibroblasts contain receptors for the growth hormone (GH), and depending on the levels of growth hormone circulating they can secrete insulin-like growth factors (IGFs). The IGF is a molecule characterized by multiple activities, such as facilitating tissue repair and influencing the metabolic environment,” they talk a bit more about pain.

Listen to the way that the Fibroblasts in Fascia are said to modulate pain responses.  “There is a close relationship between the endocannabinoid or endorphin system and the fibroblasts. The cannabinoid receptor or CB1 is mainly housed in the nervous system, but it can be found in the fascial system and in the fibroblasts as well, particularly near the neuromuscular junction. This relationship is believed to better manage any inflammation and pain information originating in the fascial tissue, as the fascia undergoes continuous remodeling during the day.”  This is why SMOKING WEED (cannabis), while probably better than some of the therapies I will mention shortly, is still just covering symptoms without addressing underlying causes.

WHAT ALL OF THIS MEANS IN TERMS OF TREATING
PEOPLE WHO HAVE VARIOUS FASCIAL DYSFUNCTIONS

“The superficial fascia is made up of different layers, whose formation facilitates the sliding of one layer over another.  The osteopathic treatment of the fascia involves several techniques, each aimed at allowing the various layers of the connective system to slide over each other.   From an osteopathic perspective, if the fascia is the philosophy of the body, meaning that each body region is connected to another, osteopathy is the philosophy of medicine, meaning that the entire human body must work in harmony.”

The problem is, according to virtually any source you can find, the average Osteopath does exactly zero manipulation (HERE).  For the most part they are no different than MD’s, with things like EXAMINATIONS, MRI’S, NARCOTICS, MUSCLE RELAXERS, ANTI-INFLAMMATORIES, CORTICOSTEROID INJECTIONS, and ANTIDEPRESSANTS making up their first line of diagnosis and treatment.  Furthermore, no matter who does them, endlessly repeated manipulations are not enough to put the type of mechanical stress needed to “DEFORM” injured or adhesed tissues (deformation of tissue is a response to mechanical strain — HERE).  Follow the link to see why you’ll likely have to do some sort of mechanical traction to solve any number of issues — particularly Chronic Neck Problems.  This is also borne out below.

“The fibroblasts are the foundation of the fascial system. They play a fundamental role in conveying tension and can dynamically affect mechanical tension, rapidly remodeling their cytoskeletons, without turning into myofibroblasts; this mechanism can occur in a few moments, as the result of a physiological change in length sustained by the fascia. When the fascial tissue lengthens, the fibroblasts flatten themselves and expand, increasing their area of action. In this way, the fascia can sustain the tension without difficulty, as the flattening and lengthening of the fibroblasts result in a slighter and more sustainable strain.”

The authors, who still likely follow a model at least somewhat similar to DR. AT STILL, conclude by saying that, “Osteopathic techniques aim to release fascial restrictions, to mobilize tight ligaments, and to drain congested lymphatics. The purpose of these therapies and treatments is to alter the mechanical properties of fascia, such as density, stiffness, and viscosity, so that the fascia can more readily adapt to physical stresses….  In vitro studies demonstrate how the osteopathic techniques can influence the metabolic behavior of fibroblasts, such as proliferation and [local] inflammatory response.  Myofascial release is a widely employed direct manual medicine treatment which utilizes specifically guided mechanical forces to manipulate and reduce myofascial restrictions of various somatic dysfunctions. It is proved that by applying this method, fibroblasts are able to change their orientation and probably their mechanical behavior.

As a Chiropractor with 25 years of experience working with these sorts of problems, I can assure you that reducing the body’s load of Systemic Inflammation (HERE), addressing SUBLUXATIONS (aberrant POSTURE or bones that are either out of place or not moving freely in relation to another) and dealing with Fascial Adhesions through some type of TISSUE REMODELING, is usually a large piece of the puzzle as far as helping people GET THEIR LIVES BACK is concerned.  Also realize that on some level, said treatment might require great intensity in order to stimulate fibroblastic activity (HERE).

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