Sunday, November 18, 2012

What the heck is Fascia? And what does it have to do with Fitness?

  This is Part One of a three part series based on my Interview with Sue Hitzmann, the founder of the MELT Method.I first met Sue Hitzmann at the TSI Summit back in 2003. I took two workshops with her at that conference, in which I was introduced to advanced concepts on fascia. I was so totally blown away by what Sue had to say, that I went on to take two full weekend workshops with her the following year, in what was the beginnings of the MELT Method. At that time, I was recovering from a pretty severe knee injury and had not only been unable to return to dancing fully, but was still experiencing a lot of pain. At those workshops, I began to recognize the value of bodywork in compliment to traditional exercise-based physical therapy as a method of rehabilitating the body after injury and also as a method for maintaining balance, and preventing future injury. I went to a physical therapist, who Sue introduced me to, who used cranio-sacral therapy with profound effects on my body. I credit the cranio-sacral work with helping me recover from an injury that I had suffered from with little result for over a year, ultimately allowing me to get my dance career back on track. Earlier this year, Sue sat down with me and generously gave a full hour of her time for me to interview her about fascia, the MELT Method and trends in the fitness industry. This series is the product of that interview.

Can you talk about your journey into the world of fascia?  How you first learned about it, what it is and why it’s important.

Fascia – Image from
Well it’s actually not that hard to understand.  I think the problem is understanding thatconnective tissue plays multiple roles in our overall wellness and longevity. For years it was defined as a passive packing material as if it were a non-living, accessory tissue in the body.
Over the last 50 years there’s been advances in connective tissue and fascial research.  See, the majority of connective tissue is called fascia. And just so you know, not all connective tissue is fascia.  But all fascia is connective tissue.  So blood could be considered a connective tissue.  But the difference between blood and fascia is that there’s hemoglobin in it.  And so that’s what defines it as blood. Although bones and even blood can be considered connective tissue, what I talk about is the fascial aspects.
What we’re recognizing about connective tissue is that it’s a seamless, integrated system, not just a support tissue.  The connective tissue is a continuous, 3-dimensional system that supports, protects, and stabilizes all aspects of our body.  So it’s kind of amazing that the most abundant material in the body would be so disregarded for so long.  Very little research focused on this tissue until recently. But fascia’s been discussed from the beginning of anatomical research.  It’s not like as if we didn’t know fascia existed.
Fascia is connective tissue. A complex system that supports, protects and stabilizes all aspects of the body.

My first introduction to fascia was in the early and mid ‘90s doing neuromuscular therapy.  The focus was always on the myofascial layer and how the fascia provided head to toe connection and created tensional support throughout the entire muscle system.  It was about how it supported muscles and enhanced my understanding of dynamic movement.
What I’ve learned about connective tissue over the years, is that connective tissue is in fact a renewable resource. Advancements in technology have allowed us to look at connective tissue on a molecular level.  It’s actually a very active system.  There are many active cellular components in connective tissue.  In the early 2000’s, I met Gil Hedley and did dissections with him and he had this concept of doing a layer by layer approach.  Removing the skin and then looking at the superficial fascia and focused on how things connected rather than defining the parts.  I had never seen the superficial layer as a cohesive system nor did I ever consider it to be important, let alone an active system.
When I said, “What is that?”  He said, “It’s the superficial fascia.”  And I said, “What is it doing there?”  And he said, “That’s the system that supports, protects and stabilizes the body” and my head whipped around and I said, “Did you just call it a system? It’s a tissue, right? I mean, it’s not a system. That would mean there are active elements to it.”  And he smiled at me and said, “Oh my, yes there are very active components in connective tissue. It’s a three dimensional matrix that vibrates, translates, and adapts to your movements, emotions… everything.”  And then there it was, a complete shift for me out of the concept that muscles were the dictator of structural deformities and that the connective tissue played a significant role outside of the myofascial layer.
Connective tissue is made up of about 80 percent water.  And the primary components are collagen and elastin. You could even call the connective tissue system the collagen matrix. And the fluids aren’t just water.  It’s hyaluronic acid, macrophages, proteoglycans, andglycosaminoglycans or what’s considered the “ground substance” of connective tissue.  There’s a lot of fancy terms defining the molecular components in connective tissue, however, what’s most important are the primary cells of connective tissue called fibroblasts.  Fibroblasts are the cells that create all of the fluids and all of the fibers that ultimately define the extra cellular matrix – the system outside of all of our cells.  This  is the connective tissue system. And these fibroblasts are very relevant to not only healing and repair, but also how your immune system operates.
And what my education and my understanding of connective tissue has been, at the forefront of research is that when connective tissue is hydrated, it’s flexible, it’s glidable, it’s resilient, it does its job. It’s able to transport nutrients, and most importantly, waste – but only if it’s hydrated.  So when our connective tissue is dehydrated, it gets very inflexible and what could be considered toxic.  It gets stiff like a dried out sponge.  I would say it’s kind of like if you think of connective tissue as being like billions of bubbles, when it lacks fluid, it sort of loses its buoyancy and the bubbles lose their shape and space.  It inhibits other tissues from gliding easily.  It inhibits muscles, organs, and joints to glide and move around each other.  When this occurs – and it is occurring daily for most of us, the architectural supportiveness of this tissue declines.  There is a term called Tensegrity or Biotensegrity that we use to define this dynamic, whole-body architecture the connective tissue provides. When the tissue is hydrated, it manages tension and compression in a balanced way. When we sit at a desk all day long or do repetitive movements, we strain regions of the architecture so the body has to compensate to sustain balance. If you let the compensation persist, imbalance between tension and compression becomes a body-wide issue.  It deforms, misaligns, and compresses joints.  It causes pain.  And ultimately it accelerates the aging process and gives you all the negative effects you would associate with aging.

You mentioned myofascia as being separate from fascia.  Are they two different things?  Are there multiple kinds of fascia?

No, there’s only one type, connective tissue is connective tissue.  The same exact molecular components are literally present from skin to bone in every definable layer.  It is literally a cohesive collagen matrix, like a 3-dimensional mesh suit. It’s like as if you opened up on orange and as you peeled it back, you saw the white that was still on the orange. That’s the superficial fascia.  And then as you start to try to pull that away, you realize that those fibrous elements are actually piercing the orange itself.  And then when you open the orange, you get the pieces of the orange.  And then when you break that piece apart, you see that inside the orange, there are tiny, little bubbles that make little air pockets, you can break them and “pew” water pulls out.
It is literally a cohesive collagen matrix like a 3-dimensional a mesh suit. It’s like as if you opened up on orange and as you peeled it back, you saw the white that was still on the orange.  And then as you start to try to pull that away, you realize that those fibrous elements are actually piercing the orange itself.  And then when you open the orange, you get the pieces of the orange.  And then when you break that piece apart, you see that inside the orange, there are tiny, little bubbles that make little air pockets, you can break them and “pew” water pulls out.
Fascia – Image from
So the connective tissue system is absolutely cohesive.  It’s absolutely seamless.  And again, the molecular components are 100 percent the same throughout the entire structure of our body.  However, in different areas of the body, connective tissue is formed in different ways where there’s a higher or lower deposit of particular molecules or particular fibers.  Like, for example, just under your skin, in dissection, you can actually see the superficial fascia tends to be thick and very spongy.  It has a lot of fatty tissue in it. It’s very dense.  And then as you go into the next layer, we call that deep fascia.  And the deep fascia is a thinner, more fibrous-y layer.  And then you get into the myofascia layers.  And myofascia is more like a grid.  And myofascia is the term to define at what level of the body you are describing the connective tissue.  So myofascia is the tissue that is both around and within muscles that defines muscle shape and gives each muscle its definition so that we can define it through science.
But, you know, something I love that Tom Myers says is “you can think of the entire body as being one muscle with 700 compartments.”  And instead of thinking of it as 700 unique muscles, you really have just one muscle separated by 700 distinct compartments.  The reality is, the brain doesn’t know about your biceps.  It doesn’t know about your gluteus maximus.  When it signals information for muscle contractility to occur, it’s actually a signal that goes through the entire muscle system through the connective tissue.  In other words, connective tissue provides the gateway for that sensory to motor communication to occur on a neurological level.  It’s actually the support neural structures that allow the information to get through our bodies very fast. The connective tissue is the environment our nerves live in. So accurate muscle contraction isn’t just about nerve impulse, the connective tissue does play a role in it’s accuracy.
Bottom line here is, all fascia is connective tissue.  It’s the same molecular components, but we just define connective tissue in different regions of the body so that we know where we are.  Like we can call it visceral fascia to define the region around organs.  We could call it thoracic fascia to define the region around the lungs or ribs.  We could call it, cranial fascia to talk about the skull.  It’s like any anatomy. We define layers or regions so we know where we are in the body.  But fascia is fascia.  It’s absolutely the same tissue – and it’s everywhere.

People always refer to connective tissue when they’re describing ligaments, which are generally talked about as being not vascular and not able to repair easily.

Right.  And that’s the same thing with tendonous structures.  Like they used to say that, tendons were avascular and that theory held sway for many years.  But as surgeries have gotten more refined, Dr. Jean Claude Guimberteau shows a flexor tendon surgery where they released the garret off of the tendon and the tendon bled, which was completely against the avascular theory.  It really depends upon the extent of damage that occurs.  You know, if you were to tear your Achilles tendon and you literally ruptured it, it snaps like a rubber band and coils itself up into your calve.  That then requires a surgical procedure of somebody going in, fishing it out, and then pulling it back down and reattaching it. But that’s an extreme case.
Many of us strain tissue or sprain ligaments but they do repair without surgery.  Connective tissue’s pretty tough and resilient. It can tear, but actually it resists tearing quite aggressively.

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