thickened fascia: what, where, why, when, and how to solve

 WHAT “THICKENED” FASCIA REALLY TELLS YOU

Fascia Densification

“In some places the fascia is thinner than nylon pantyhose, but in other places, such as the Iliotibial band on the outside of the leg, it can be much thicker.  All the nerves and blood vessels run through the fascia. Therefore, if the connective tissue is tight, the associated tissues will have poor nutrient exchange. This exacerbates any painful situation because toxic metabolic waste products build up which will further aggravate pain receptors. This creates a vicious cycle by creating more muscle tension, leading to further thickening and hardening of the fascia, which will further limit mobility.”  Holistic Physical Therapist Russell Ditchfield (he does TOM MEYERS work) from an article on his site called What is Fascia?

“Because of injury, illness, stress, aging and repetitive use, this tissue will shorten, thicken become more unyielding and twist according to the pattern of strain to which the body is subjected.  As the fascia thickens and hardens where chronic tension is present, the fibers begin to solidify creating structure that no longer feel like soft tissue but rather tendons or ligaments. In addition to hardening tissues, severe pain begins to arise and blood and lymph now fight to get through to the blocked area causing poor circulation and nutrition. In situations such as these, exercise can exacerbate the areas due to blood and lymph being unable to circulate and flush out old fluids.”  From Ron Thompson’s article, More About Fascia.  Thompson, of the Tampa area, trained with Ida Rolf and has been treating patients for half a century.

And your wise men don’t know how it feels…  To be thick…  As a brick.”  Jethro Tull from 1972’s Thick as a Brick

Many people come to my clinic, get treated, GET GREAT RESULTS, and never take things to the next level.  In other words, most never modify their inflammation levels by changing their lifestyles or diets. This is unfortunate because at least briefly, I mention the importance of this to everyone I that I treat with Tissue Remodeling, as well as giving them THIS HANDOUT with THIS ARTICLE circled (THIS ONE also) for them to read.  I also frequently mention doing an ELIMINATION DIET in order to empower people to start addressing any diet-based inflammation that may be present.  Why is addressing inflammation such a big deal?  Because the end result of inflammation is always the same thing — fibrosis (HERE) — America’s leading cause of death (HERE).

Please remember that even though you frequently see them together, used in the same sentence, swelling and inflammation are not synonymous terms.  INFLAMMATION is the collective name given to a large group of the body’s chemical messengers; messengers that sometimes attract swelling to them.  What’s important to grasp here is that not only is inflammation a normal part of your immune system response, without it your body cannot heal damaged cells or tissues.  However….

When there is too much inflammation present, not just locally but even more critically, SYSTEMICALLY, the healing process will be hindered.  Significantly hindered.  Many people are aware that “itis” is the medical term for inflammation, but I’m not sure that they realize that the biggest portion of sickness and disease (according to current research about 85-90%) is not, as you have been led to believe, due to your particular genetic makeup (genetics), but is instead predicated on whether or not you are triggering these so-called “bad” genes to do “bad” things by living a “bad” lifestyle and eating “bad” foods (EPIGENETICS).

One of the problems with fibrosis is that it is thicker than normal tissue — in most cases much thicker — a fact I have shown you previously (HERE).  The problem with abnormal or pathological thickened connective tissues is that they hinder function.  A simple way to think about it is that as long as everything else is equal, a thin piece of elastic is going to be stretchier than a thick piece.  The key is to have enough thickness so that the tissue is strong enough to resist being pulled apart, but not so much thickness that it looses elasticity.  Because FASCIA is so naturally thin anyway, the differences between thick and thin, as you’ll soon see, are often subtle.

Historically, these differences in normal fascia and fibrotic fascia could not be measured because MRI, contrary to what millions of people have been led to believe, does a poor job of imaging fascia, particularly at the microscopic levels needed to show the “adhesions” responsible for TETHERED RANGES OF MOTION.  What is being used to visualize some of these restrictions besides Tissue Remodeling?  Although ultrasound technology is still not to the point where it is going to show everything that desperate and hurting people hope it will, it has improved dramatically, to the point where FASCIAL ADHESIONS of heavy fascia (such as that of the Thoracolumbar Fascia) and TRIGGER POINTS can be imaged (HERE).

And while the newest of this newer technology (sonoelastography) was verified just a couple of weeks ago in the Journal of Chiropractic Medicine (Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome), a good overview of the technique can be found in the abstract of a 2012 issue of the Journal of Medical Ultrasound (Musculoskeletal Sonoelastography: A Focused Review of its Diagnostic Applications for Evaluating Tendons and Fascia).

“Sonoelastography is a diagnostic ultrasound technique that provides a noninvasive means of estimating soft tissue elasticity and stiffness. It is based on the principle that the compression of soft tissue produces strain that is greater in tissues that are softer and more elastic than in harder, more rigid tissues. Pathological and healthy tissues can present with similar echogenicity and morphology on conventional ultrasound. However, alterations in tissue elasticity often occur with degeneration or other pathological changes that involve the soft tissues.”

If you have ever BUTCHERED ANYTHING, you’ve seen fascia.  It’s the super tough cellophane-like membrane that covers virtually all the tissues in your body (it has different names according to which specific tissue), but is most commonly associated with being the covering of MUSCLES.  When this tissue is injured, it thickens, hindering it’s ability to slide and glide on whatever tissue, nerve, blood vessel, or muscle it covers.  The end result is not only pain and restricted motion, but the LOSS OF PROPRIOCEPTION that an increasing number of elite researchers believe could be the cause of all sickness and disease (see link). 

  • Back in 2012, one of the world’s leaders in soft tissue problems, Dr. Warren Hammer, showed in an article for D.C. (Fascial Thickening Is Responsible for Musculoskeletal Pain) that a number of studies have proved that fascia thickens in response to mechanical or biochemical insults, and that this thickened fascia adversely affects numerous tissues, causing “abnormal proprioception, incoordination of muscle function, and pain.”  It also leads to degenerative changes of said joints.

 

  • In an article by DR. HELENE LANGEVIN that I previously mentioned in my post on FASCIA & AUTOIMMUNE DISEASES; she states in What Role Does Fascia Play in Rheumatic Diseases? that “Recent studies describing thickening and decreased mobility of the thoracolumbar fascia in patients with chronic back pain suggest the presence of inflammation and/or fibrosis.”  How much did the tissue thicken?  If you take a look at my numerous posts on the THORACOLUMBAR FASCIA (including some of her work), you’ll see that it thickened by about 25%.

 

  • Because I’ve dabbled a bit with fascia work on horses (HERE), this piece caught my eye.  Listen to these cherry-picked sentences from a 2014 Facebook post on Dr. Kerry Ridgway’s (DVM) page.  Ridgway runs the Institute for Equine Therapeutic Options in Aiken SC and says,  “Fascial thickening has been held responsible for chronic pain in both the neck and lower back It is therefore probable that if spindle cells are embedded in thickened, densified fascia, its ability to be stretched would be affected and normal spindle cell feedback to the CNS would be altered.

 

  • Less than a month ago, Amanda Oswald of England’s Pain Care Clinics, wrote an article for her blog called An Introduction to Fascia in which she said of fascial thickening, “Fascial thickening in the wrong places can lead to restrictions which change posture and balance, reroute tensional forces and overload pain sensitive structures. It is these restrictions that can lead to many of the common chronic pain conditions that baffle the medical profession as they are unable to find an attributable structural cause. This is often because even thickened restricted fascia cannot be identified using common diagnostic tests such as MRI scans. And even if it was identified, many medical professionals have not yet been trained to understand the significance of the fascia they are identifying. The reason lies back in their student days when dissected fascia was stripped away as being medically insignificant.”  My anatomy class at KSU was one of the only undergrad programs in the US to use cadavers, and Logan had a brand new, state of the art dissection lab.  I can vouch for the veracity of the last sentence of the quote above.

 

  • Leon Chaitow has been in practice as an osteopath / naturopath since 1960.   He has lectured worldwide, authored over 70 books (including Fascia; The Tensional Network of the Human Body that he co-authored with Drs. Schleip, Findley, and Huijing, as well as Fascial Dysfunction: Manual Therapy Approaches) and is widely considered one of the world’s foremost experts on the subject.  A few years ago he wrote an article called What Happens When Fascia Stops Sliding….? in which he stated “Ultrasound imaging suggested that there was a thickening of the loose connective tissue relating to key cervical muscles in individuals with chronic neck pain.  Following treatment (Fascia Manipulation or a combination of massage, electrotherapy and laser) symptomatic improvement was noted – along with reduction in the previously noted thickening – with the FM approach producing more lasting benefits.”  He went on to talk at length about the role of HA in this phenomenon.

AREAS, DISEASES, AND COMMON HEALTH ISSUES ASSOCIATED WITH PAIN RELATED TO THICKENED FASCIA

Although thickened fascia in the form of Fascial Adhesions can occur virtually anywhere (when I say anywhere, I literally mean anywhere), there are certain places where it is more common than others.

  • BOTTOM OF THE FOOT:  No anatomical area has had more research on thickened fascia than the bottom of the foot — the plantar fasica.  Although this is typically referred to as “FASCIITIS,” it seems that in similar fashion to what we see with TENDINITIS / TENDINOSIS, this term is not as accurate as it could be (remember that “itis” indicates inflammation).  The website of an Australian podiatry clinic (Podantics) explains this in an article called What is the Difference Between Plantar Fasciitis and Plantar Fasciosis?  “One is an inflamed plantar fascia, the other is a degenerated plantar fascia.  After some time of injury and re-injury, the plantar fascia can begin to deteriorate (plantar fasciosis), which is represented by a disorganisation and fragmentation of the collagen fibers and death of surrounding cellular tissue. The collagen fibers are separated by a myxoid substance, a semi-solid gel intermixed with waste products, which thickens the fascia, decreases cohesion between the fibres and further decreases it’s strength. The initial increase of oxygen, nutrients and cells to the injured area during the inflammatory process is replaced by a decrease in small blood vessels and a lack of oxygen, nutrients and growth factors.”  There are, in fact, numerous studies attesting to this very thing.

 

  • THE PALM OF THE HAND:  Known as DUPUYTREN’S CONTRACTURE or Dupuytren’s Disease, Northwest Orthopedic Associates in Spokane WA had this to say about Dupuytren’s on their website, “This condition is a thickening of the fascia on the palm of the hand. This thickened fascia can form lumps or nodules under the skin, or long thick cords of tissue that extend from the palm to the fingers. Often, this thickened tissue contracts.”  And while these surgeons let their readers know that the people who get this problem tend to be older males of Scandanavian or European decent, they also listed a host of epigenetic factors that trigger the thickening — including diabetes.  Speaking of diabetes…

 

  • THOSE WITH DIABETES:  I RECENTLY WROTE A POST on what sugar diabetes does to connective tissues (as you may have already guessed, it thickens them).   Since then I found a very cool study that shows a correlation between the thickness of the fascia on the bottom of the foot (the Plantar Fascia) and the amount of tissue glycation taking place in collagen-based connective tissues by measuring something called advanced glycation endproducts or AGES.  The study (Plantar Fascia Thickness, A Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes) in an ADA journal Diabetes Care, concluded that, “In patients with diabetes, hyperglycemia-mediated synthesis of new collagen and accumulation of glycation products accelerate age-related changes to the skin, connective tissue, and joints, including decreased elasticity, increased collagen cross-linking, and loss of enzymatic digestibility of the extracellular matrix. AGE residues in skin collagen are associated with severity of hyperglycemia as well as the presence of long-term complications. Limited joint mobility of the interphalangeal joints in the hands is also associated with increased risk of retinopathy [blindness] and nephropathy [kidney failure].  Plantar fascia thickening is a significant predictor of the subsequent development of complications in type 1 diabetes, suggesting that glycation and oxidation of collagen in soft tissues may be independent risk factors for microvascular complications.

 

  • SHOULDER FASCIA:  A Dutch publication, The Journal of Medicine, published a letter to the editor titled Ultrasound Imaging of Shoulder Fasciitis Due to Polymyalgia RheumaticaPOLYMYALGIA RHEUMATICA is an autoimmune disease that among other things, attacks connective tissues.  “Fascia and soft tissues, which are rich in collagen, receptors of pain, and capable of significant distention, may be targets of autoimmune inflammatory diseases, causing morning stiffness, swelling, severe pain and limitation in movement.”  The point of the study was that ultrasound technology could image the thickened fascia in the affected shoulder(s).  A similar study, this one from Muscle & Nerve (Increased Fascial Thickness of the Deltoid Muscle in Dermatomyositis and Polymyositis: An Ultrasound Study) found an almost identical scenario when looking at diseases in the “MYOSITIS” family.

 

  • ABDOMINAL FASCIA:   Although I’ve previously written about Scar Tissue in the ABDOMINAL WALL -VS- ABDOMINAL CAVITY, the biggest and baddest problem associated with abdominal wall thickening would be CANCER and a wide array of tumors (many malignant, but not all).  I also found any number of studies indicating other problems that can cause thickening of the abdominal fascia — COPD, ENDOMETRIOSIS, hernia repairs, hematomas and ABDOMINAL MUSCLE TEARS, CHRONIC LOW GRADE INFECTIONS, IBD, along with dozens of others.  Dr. Morton Meyer’s book Dynamic Radiology of the Abdomen: Normal and Pathologic Anatomy stated that, “The normal thickness of the fascial planes is 1-2 mm thickness on CT.   A fascia that is focally thickened or greater than 2-3 mm width is usually abnormal.”  Just bear in mind that CT is not worth a flip for finding run of the mill FASCIAL ADHESIONS.

 

  • PELVIC FASCIA:  When I talk about Pelvic Fascia, I am typically referring to the fascia around the pelvis (PIRIFORMIS, CUTANEOUS NERVE ENTRAPMENT, HIP FLEXORS, GROIN, and/or TFL / ITB).  Although there are tons of articles and studies on pelvic fascia, these are typically in reference to either cancer or PELVIC FLOOR PAIN (or HERE).  California’s Pelvic Health and Rehabilitation Centers had a great article on this topic called Sitting on Painful Fascia: Connective Tissue and Pelvic Pain.  “Fascia has become quite the buzzword for treating everything from chronic neck pain, ACL repair surgery, plantar fasciitis, and yes—even pelvic floor dysfunction. Superficial and deep fascia act as padding and covering for protection of delicate structures such as nerves, blood vessels, muscles and bones. The composure of a layered system allows for sliding mechanisms, as multiple sheaths separated by a unique fluid primarily composed of hyaluronic acid; and it is also considered a part of our nervous system.  When thickening, or densification, occurs at a particular point in the connective tissue of the shoulder, the calf muscle, or the groin, where vital layers of connective tissue must glide, a pain response is usually created as the tissue pulls and rubs irregularly. The fascia uses a sliding structure to enable smooth movement; the fluid-like substance between layers contains hyaluronic acid is found to be more viscous is denser points of fascia—it begins to act more like honey, with the layers sticking together, creating faulty movement and faulty messages back to the spinal cord and brain.”  The authors go on to talk about what it takes to RESTORE PROPRIOCPTIVE POWER to fouled fascia.  And yes, fascia is a second nervous system (HERE).

 

  • CONGENITAL THICKENING OF FASCIA:  Discovered in 1970, Congenital Fascial Dystrophy (Stiff Skin Syndrome) is just that, a non-inflammatory thickening of the fascia that can lead to some serious problems.  But fortunately, it’s rare.  What’s far more common are the various diseases that fall under an autoimmune category collectively referred to as “SCLERODERMA” — the abnormal growth and thickening of various connective tissues, and frequently associated with, or giving sufferers the impression of, being in the skin.  Scleroderma can be severe enough to actually affect not only the musculoskeletal system, but one’s organs as well.  Bear in mind that most autoimmune diseases, while certainly having a genetic component, are far more affected by EPIGENETIC FACTORS than the average doctor lets on.  In other words, you may not be able to “cure” the stuff, but by golly, in most cases you can keep it in check (more to come momentarily).  And while it might not totally fit here, this is as good a place as any to mention LIPEDEMA.

HOW TO EFFECTIVELY DEAL WITH YOUR THICKENED FASCIA

Remember the study that Chaitow mentioned earlier?  He showed that according to ultrasound measurements of fascial thickness, various forms of fascial manipulation and bodywork were being objectively proven effective at decreasing the thickness of densified fascia.  Just understand that “bodywork” encompasses a lot of ground, as there are literally hundreds of different techniques (he was specifically talking about the Steccos’ “Fascial Manipulation”.  While I certainly believe that underlying mechanical issues must be addressed using things like TISSUE REMODELING, WBV, STRETCHING, YOGA, GROUNDING, TRACTION (or HERE), ACUPUNCTURE, CHIROPRACTIC, etc, etc, etc, I also feel that in many cases, this approach is missing the boat — or at the very least, missing a huge part of the boat; especially concerning chronic, long-term problems.  What do I mean?

Firstly, because 99% of the problems we discussed today share a common denominator (INFLAMMATION), you have no choice but to address it if you truly want to get better.  While changing your diet is the lowest of the low-hanging reparative fruit, there are numerous underlying problems that can potentially drive inflammation (HERE; important since most disease processes share several universal characteristics).  Secondly, for many of you, BRAIN FUNCTION will need to be addressed as well.  This is because a significant amount of CHRONIC PAIN (TYPE III PAIN) is not caused by tissue damage, but instead by ABNORMAL BRAIN LOOPS that have been “learned” by repetition.  In similar fashion to the way you learn to do anything, do it enough and you tend to get good at it.  Unfortunately, pain can work the same way.

So, although there is no way that every person will be able to solve every health issue they struggle with on their own, the cool thing is that they can improve most of them. In fact, I’ll go out on a limb and suggest that when it comes to CHRONIC DEGENERATIVE INFLAMMATORY DISEASES (including AUTOIMMUNITY), not only can people usually do better on their own than they could using standard medical fare (i.e. PRESCRIPTION), getting out of the box and attacking your problem yourself is the only way that most of you will have a prayer at solving, not just ‘improving’ your problem (the topic of an upcoming post — on FUNCTIONAL MEDICINE).  If you want to see a “Big Picture” approach to improving / solving your health problems, HERE IS ONE that has the potential to help the majority of you pull yourselves out of the pit that is your health.

I certainly hope that today’s post was helpful for someone out there struggling to cope with their chronic issues.  If you feel this information needs to be shared, by all means share it.  The best way to reach those you love and care about most?  Try liking, sharing, or following on FACEBOOK.
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