The world of fascial research is continually flowing and changing, a bit like fascia itself. In doing so it is challenging previously held ideas about the nature of fascia and how this relates to chronic pain.
Thixotropy can’t explain it all
One concept that no longer holds true is that of fascia as a thixotropic substance. Thixotropy is the ability of a substance to change consistency quite dramatically and move from gel to fluid, and gel to more solid matter. Thixotropy is triggered by temperature (heat) and mechanical force (pressure). If you subject a thixotropic substance to a short sharp shock it will immediately resist and harden but if you apply gentle sustained pressure it will “melt” and become fluid. This concept has been used to explain how myofascial release can help to change fascia by releasing restrictions. Thixotropy also helps to explain how fascia in its fluid state gives tissues the viscoelastic properties of yield & bounce as well as slide & glide to enable movement.
However thixotropy alone doesn’t explain why fascia can soften through myofascial release and remain softer as most thixotropic substances return to their more solid state when pressure and heat are removed. In fascia there is clearly something else going on and this can be found in the extracellular matrix (ECM).
ECM is the most fluid form of fascia which bathes all cells carrying nutrients to them and waste from them. ECM consists primarily of a jelly-like goo called ground substance. And this in turn is made up mainly of hyaluronan (HA) molecules. A key property of HA is its ability to bind to itself and to water molecules meaning it is a hydrator of tissues. Hence it may sound familiar due to its popularity in the world of cosmetic face and body cream advertising.
Found body wide HA provides stability in tissues and acts as a water reservoir and lubricant. Plump healthy HA molecules are full of water and allow free body movement. Compressed small HA molecules are dehydrated and lead to more sludgy ECM, tissue adhesions and myofascial pain.
The Importance of Extracellular Matrix
Recent research by Carla Stecco has led to new discoveries about the importance of hyaluronan in fascia. This builds on one of the most thorough examinations of ECM done by Austrian researcher Alfred Pischinger, who was the first scientist to start to research and describe this fascinating substance way back in the 1940s.
Pischinger demonstrated that ECM has a direct two-way connection with the brain and established that all disease and illness derives from a lack of balance in ECM regulation. Healthy HA and ECM are the building blocks to a healthy body. ECM forms an essential part of the immune system barrier keeping our cells healthy. Malfunctions in ECM, due to dehydration for example, are the cause of chronic and systemic diseases, such as rheumatism, fibromyalgia, and even cancer.
Dehydration where water is squeezed out of HA molecules can lead to ECM becoming sticky and waste products and toxins can become trapped instead of passing out of the body. This causes cells to react and inflammation to occur. Over time this can lead to the development of chronic disease and to the apparently sudden onset of allergies. This can all be exacerbated by psychological stresses.
It is the accumulation of imbalances in the ECM that frequently leads to the development of chronic conditions in the over 50s. By this age, our systems reach the limit of their tolerance and illness can be triggered by a stressful event – physical, chemical or emotional.
Myofascial Release and Hyaluronan
The flip side of this is that the release of imbalances within the fascial system, through therapies such as myofascial release, can allow fluidity back into the tissues and offer effective healing for systemic disease and chronic conditions such as pain. Unlike a purely thixotropic substance which returns to its more solid state after release, fascia remains softer and more fluid as progressive release allows the HA molecules to rehydrate.
Research into the importance of HA to myofascial therapies is still in its early days. But there is already a glimmer that Carla Stecco and other researchers are starting to provide a scientific explanation about how and why myofascial release can positively affect fascial health, which is good news for us all, therapists and clients alike.