Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians

Fascianating! A first look at this connective tissue

    I have slightly neglected a key part of understanding our body's soft tissues in an attempts to focus on muscle and function.  Which tissue am I referring to?  Fascia.  While you may not be familiar with the complex and interesting properties of fascia, you have certainly heard of it in terms of feet: plantar fascia, or the fascia of the thigh: tensor fascia latae.  Fascia is controversial, or as controversial as a soft bodily tissue can be.  Some scientists and researchers completely discredit its ability to affect mobility and muscle movement, whereas others are deeply entrenched in research on how it affects body motion and how it creates structure and form in the body.  I happen to be pro-fascia, if that's possible, and I do believe that certain philosophical tenets of fascia research are incredibly valuable to looking at the whole person in regards to tissue injuries and pain.  (As a reminder, I am neither a doctor nor a scientist, many of whom can more thoroughly explain these concepts.  This is merely my understanding as a musician and movement instructor.) Let's backtrack, though.

If we imagine that the peel is our most outer casing, we can see all of this white fibrous material which gives structure and organization to the fluid within.

If we imagine that the peel is our most outer casing, we can see all of this white fibrous material which gives structure and organization to the fluid within.

What is fascia?  Fascia is the soft tissue component of connective tissue (as opposed to nervous, muscular, and epithelial tissue)- there are many different types and textures of fasciae, from superficial to loose to deep, to fasciae that is interwoven with muscle and encasing organs.  Superficial fasciae surrounds all of our body much like a silk stocking, but tendons, ligaments, and even vertebral discs are considered part of the fascial system.  A great way of understanding this is looking at a grapefruit or an orange (thank you Tom Myers for the image).  The peel is akin to our skin and adipose layer, and when you remove it, there is an abundance of white pith, structural fibers, and casing around pockets of juice, AKA. the fruit.  Without the pith, there would just be a mess of juice inside the peel but with the pith, there is individual encasing and structure for the whole fruit, giving it a fibrous and juicy texture.  Over time, as the fruit ages, the pith and skin become less supple, and one may need to roll the fruit on a surface to restore some fluidity to the juice.  Most types of manual bodywork attempt to restore some of more fluid capacities of our fascial system, as we too are a fluid system (not fluid meaning like a waterbed, but fluid like a hydrated sponge).

Fascia is our body’s aqueous soft tissue scaffolding; It provides the matrix that your muscle cells can grow upon and it also envelopes, penetrates and surrounds all of your joints.
— Jill Miller
When you bisect the orange, you can see the geometric organization of the fibers, as well as the asymmetry and the random bulge in the right.  While we are not divide into segments like this, the structural binding is very similar.

When you bisect the orange, you can see the geometric organization of the fibers, as well as the asymmetry and the random bulge in the right.  While we are not divide into segments like this, the structural binding is very similar.

Why is this relevant?  Well, I have been absolutely guilty of exposing one or two muscles at a time, in conjunction with related bones as a way of demonstrating function and location, whether for blogs or for my yoga and movement classes.  Yet, fascia underpins the entire structure of the body, meaning that no muscle, no movement, and no body part is an island.  While anatomy books may cut out everything but a deltoid to demonstrate certain aspects of its properties, the deltoid is truly part of a web of myofascial structures operating as a team, and in order to assess injury, limitation, and range of motion, one has to look at the whole body.  In addition, when your fascia is restrictive and your muscles are "tight" or perhaps lacking full range of motion (PS. "tightness" is an experience not a technical movement term), there can be an adhesion against the fibers, which can additionally cause discomfort and restriction in the area.

This is an image from Dr Jean-Claude Guimberteau's Strolling Under the Skin, which takes a look at living human fascia!

This is an image from Dr Jean-Claude Guimberteau's Strolling Under the Skin, which takes a look at living human fascia!

As musicians, most of us assume an asymmetrical position to play our instruments (or sing, or type on the computer or drive or write), and our myofascial system adapts in accordance; something called adaptation, and sometimes adaptive shortening.  For example, as a violist, I have less range of motion in one of my shoulders from 24 years of asymmetrical music making, but is it exclusively muscular shortening?  Probably a combination of many different connective tissues adapting to the input I gave it, through the process of mechanotransduction!  While that is perhaps scary to think of, it also means that the body and brain are plastic, and that change is absolutely possible, both fascially and neurologically.

How is this different?  Nowadays, Western medicine is focused on specialists-we have nerve specialists, hand specialists, orthopedic specialists, etc.  The catch, is that if you have nerve entrapment in the elbow, which affects your motion in your hand, you will be sent to all of these different specialists, without taking an integrated viewpoint of the big picture.  (i.e. you have may have nerve entrapment due to your motion patterns, as a result of injury to one shoulder, or to a poor setup in sitting with your instrument, or a compensation pattern, etc. etc.)  It can be incredibly frustrating to be in this situation, especially when no one can diagnose your ailment effectively, or when no one can treat your condition completely.  Many types of holistic practitioners, be they osteopaths, acupuncturists, rolfers, etc, look at the whole picture of the body's wellness as a reflection of one area of sensation.  This is in line with the idea that the whole body is fascially continuous, meaning that distal affects the proximal (issues far away affect nearby), etc.  

Image courtesy of AnatomyTrains.com.  The first image questions the dissect and separate logic of traditional study, and the second explores the more integrated idea of fascial webbing.

Image courtesy of AnatomyTrains.com.  The first image questions the dissect and separate logic of traditional study, and the second explores the more integrated idea of fascial webbing.

I'm still confused.  How does this affect me again?  Many injuries start with the health of our fascia, the hydration level of the tissue, and the ability of the layers of myofascia to slide and glide against each other.  When our fascia is dried out or brittle, we are at higher risk for injury, and our capacity for proprioception, or bodily awareness is diminished. *An article by Tom Myers of Anatomy Trains proposed that there are 10 TIMES more proprioceptors in fascia than in muscles!  As musicians and movers, proprioception is our portal to movement quality, movement efficiency, and increased performance, whether in daily activities, musical activities, or athletic performance.  Your movement choices, or lack thereof affect your fascia profoundly!

Healthy fascia benefits from diverse, varied, and frequent movement, as opposed to brief bouts of intense vigorous exercise.    A bodyworker can also help to expose issues in your myofascial web (myofascial meaning muscle+fascia), whether that be through myofascial release, rolfing, etc. 

Want to know more?  I'll definitely post more on fascia in the future, but some of the leading scholars in fascia are Robert SchleipTom Myers of Anatomy Trains and Gil Hedley of Somanauts.  I also really like Brooke Thomas' blog, The Liberated Body, and her respective Ebook.