Fascia and Tensegrity: It's All Connected

Anyone that has worked with a manual therapist has undoubtedly heard the phase, "it's all connected." You're having back pain?...lets stretch your hips. Your shoulder hurts?...we need to strengthen your neck. Hopefully, if you've heard this you've also discovered there is some truth to that. However, like most of the buzzwords that I post about, it's not very well understood and poorly explained.

In school we learn anatomy very early on as it is critical to evaluation, diagnosis, and treatment. Traditional anatomy does a good job of separating body structures for simpler understanding but does a poor job of teaching the concept of connectivity. We're taught that muscles attach to tendons, tendons attach to bones, ligaments connect bones and skin covers it all. This example structures the body as more of a mechanical robot than a functioning organism. Again, this isn't meant to discredit the purpose of anatomy. My first piece of advice to anyone planning to work in a manual therapy field is to learn your anatomy. Once you have a working knowledge of anatomy, it's time to start putting the pieces together.   

The most influential resource that helped me put this together is a book titled, Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists by Thomas Myers. Myers creates an analogy consisting of tracks and stations to describe the interconnectivity of the body. Central to the anatomy trains analogy is fascia. Facia is the connective tissue that connects EVERYTHING! Anyone that has prepared a meal with raw meat knows all about fascia. (I apologize for the somewhat crude example using food to teach about the human body but the tissues are relatively the same and provides a great reference.) Fascia is the somewhat sticky sheet like film that surrounds the layers of tissue.

Examples of some of Myers' anatomy trains

The important thing to understand is that the fascia doesn't necessarily start or stop at any place, it blends into the anatomical structures that are formally taught. For example, fascia runs through the fibers of muscle and converges to form the tendons. There is not a specific line where fascia stops and the tendon starts, rather the facia is a continual web of connective tissue running through the body. Fascia is similar to skin in that it doesn't start or stop. When someone says, "it's all connected" fascia is that connection. 

Although important to understand the structure of fascia, understanding the function is where the connectivity comes together. There is an idea in physics called tensegrity. Tensegrity is the combination of the word tension and integrity. It is literally integrity through tension. Tensegrity allows structures to absorb and respond to external stimulus by absorbing and distributing force to hold it's shape. 

Example of a tensegrity model

The fascial system in the body forms a tensegrity model which allows the body to both absorb external forces and utilize internal forces for movement. Consider an athlete doing a simple jump. The athlete first loads the system by slightly squatting down. In physics this is called potential energy. The athlete then releases the potential energy into the jump. On the landing, the body then absorbs the decelerative force to control the landing. The tensegrity model of the body is able to absorb and store the energy and transfer that into motion. 

As a manual therapist, I believe I can manipulate the fascial system to improve movement. This is where soft tissue treatments come into play. Massage, "scraping", "cupping" etc. are used to try to manipulate the fascial system to provide better balance to the tensegrity system to allow for better function. As always, it is important to understand that this is a theory of movement and treatment and not necessarily fact. There are other theories as to why soft tissue treatments work or if they really work at all. 

To better understand this theory, let's look at an example. An issue I commonly see in overhead throwing athletes is a forward shoulder position. This can be difficult for non-throwing athletes but especially challenging for athletes that have to use a full ROM in their shoulder. If the forward rolled shoulder position is a result of a fascial restriction, the athlete may have shoulder or elbow pain especially in the portion of the motion where that tissue is stretched out. In this scenario, I might complete manual therapy along the entire fascial line of the arm to try to create better balance and a more complete ROM.

Forward shoulder position compared to the ROM needed for throwing

As always, it is important to understand that this is a theory of movement and treatment and not necessarily fact. There are other theories as to why soft tissue treatments work or if they really work at all. The important thing to understand is that fascia is a vital tissue in the body that is responsible for the connection of muscles and segments of the body. Fascia is crucial to motion and movement. That's all for now...from the training room.