Fascia: The Collagen That Binds Us Together (2024)

Fascia is a system of connective tissue that encases our body parts and binds them together. Primarily of collagen, fascia can be thought of as a sausage casing for your body's tissues. It surrounds muscles, nerves, tendons, and ligaments and gives them shape. Fascia also connects your skin to the tissue that is directly beneath it.

The collagen that makes up fascia is organized in a wavy pattern. When pulled, these lines of tissue resist tensile and shear loads, helping to keep your body parts together.

In this article, learn about the structure and function of fascia, fascia pain, and how it is treated.

Fascia: The Collagen That Binds Us Together (1)

Structure of Fascia

Fascia is made of collagen, the gluey, gooey cellular matrix that binds tissues together. Specialized cells called fibroblasts produce the collagen that becomes fascia.

Among the layers of fascia is a liquid called hyaluronan, also known as hyaluronic acid. Hyaluronan is important in controlling inflammation, cell growth, and cell migration.

There are different types of collagen:

Type I: Type I collagen makes up 90% of the collagen in your body and surrounds tendons, cartilage, muscles, teeth, and bones.
Type II: This type of collagen is found in the cartilage in your joints. It is specifically designed to provide cushioning and shock absorption in your joints.
Type III: This collagen makes up the fascia that surrounds your arteries and visceral organs.
Type IV: Type IV collagen is located within the layers of your skin.
Type V: This type of collagen comprises cell membranes, hair, and the human placenta.

All the different types of collagen are intertwined, providing support to the structures within your body. Imagine fascia as an intertwined web of gooey tissue between structures in your body.

Types of Fascia

Fascia is located all over your body, and while it surrounds all tissues, it can be divided into three distinct types based on location. Types of fascia include:

Superficial fascia: This type of fascia is associated with your skin.
Deep fascia: Deep fascia surrounds your bones, nerves, muscles, arteries, and veins.
Visceral fascia: This fascia surrounds your internal organs.
Parietal fascia: Parietal fascia is present in the pelvis and lines the walls of the body cavity.

Fascia may be innervated by nerves and send pain signals to your brain. Microcapillaries supply blood and nutrients to the fascia.

It is easy to understand fascia by comparing it to a sausage casing around tendons, muscles, bones, organs, and joints. Fascia also helps support proper movement and function in your body.

What Does Fascia Do?

The fascia supports structures in the body. It surrounds tissues and provides shape for muscles, tendons, and joints. However, it can also help with functional movement by reducing friction between structures.

Fascia provides moveable wrappings around muscles, tendons, and nerves. Sometimes, bundles of muscles with different lines of pull are contained in one fascial compartment.

Plantar Fascia

One well-known piece of fascia is called the plantar fascia, also known as the plantar aponeurosis. It is located on the bottom of your foot and stretches from your heel bone to your toes. This thick fascia band supports your medial arch and gives shape to the bottom of your foot. But it also serves a very functional purpose.

When you are walking, the plantar fascia is gently stretched as you step, and your toes are about to leave the ground. (Imagine a rubber band stretching from your heel to your toes.) This fascia stretching stores energy, which is released as your foot comes up while stepping.

This energy puts a spring in your step and makes your foot more efficient while walking. The storage and release of energy in the plantar fascia while stepping is known as the windlass mechanism.

Iliotibial Band

Your iliotibial band is also a large piece of fascia that courses along the length of your outer thigh. It arises from a muscle near your hip called the tensor fascia lata (TFL), which attaches just below your knee.

When you step, the iliotibial band gets pulled a little, storing energy that resists rotational forces in your knee. Like the windlass mechanism in your foot, this energy is released as you step, making activities like walking and running more efficient.

Fascia Pain

Fascial pain is one of the most common reasons for muscle pain. This is partly because the fascia is rich in nerves that can transmit pain signals to the brain. Some potential reasons for fascia pain include injury, poor ergonomics, and tightness in fascia caused by lack of movement.

One cause of fascial pain is a lack of adequate hyaluronan. Hyaluronan lubricates fascia and joints, and when not enough is produced, it can lead to pain and stiffness caused by fascial adhesions. An inactive lifestyle, injuries, age, and obesity can all lead to fascial adhesions.

While fascia pain is common, researchers know there is a lot about fascial pain that it has yet to learn. Initiatives are underway to understand more about the function and dysfunction of the fascia.

What Are the Symptoms of Tight Fascia?

When fascia cannot stretch as much, you might experience symptoms of tight fascia. Symptoms include:

Reduced range of motion
Spasms
Tense, painful knots
Pain that worsens with specific movements or postures
Tenderness

Injury to Fascia

Just like you can injure a muscle or tendon, fascia can also suffer injury. Whenever a muscle or tendon is torn, the fascia around it may also become injured and torn. Sometimes, overuse and overstress of your body can also cause injury to the fascia.

Symptoms of injury to fascia mimic symptoms of a muscle or tendon strain. These may include:

Conditions That Affect Fascia

Two common conditions that affect fascia are plantar fasciitis and iliotibial band friction syndrome.

Plantar Fasciitis

Plantar fasciitis occurs when the fascia in your foot becomes irritated or inflamed. This may cause pain, specifically at the bottom of the heel, difficulty with walking and running, and pain when rising from sitting.

Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome (ITBS) occurs when the fascia near your knee becomes irritated due to overuse and abnormal rubbing of the fascia by the outer portion of your knee joint. Pain, swelling, and difficulty with walking and running may occur when this happens.

Compartment Syndrome

Sometimes, fascia compartments can become tight and not allow normal blood movement into and out of the compartment. Compartment syndrome occurs when muscles fill with blood during activity, but the fascia covering the muscles is tight and does not allow the blood to exit the muscle compartment easily.

Compartment syndrome often occurs in the calf muscles of the lower leg. Pain, swelling, firmness of the calf, and often neurological symptoms such as numbness, tingling, and/or burning that occur a few minutes after moderate exercise are hallmarks of the condition.

Any traumatic injury in the body may include injury to the fascia in the area; an Achilles tendon tear likely includes tearing of the fascia surrounding the tendon.

Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a chronic pain disorder of the fascia, muscles, or other soft tissue. Researchers are still determining the exact causes of MPS, which can be aggravated by cold, fatigue, and overuse of muscles.

MPS pain is usually dull, aching, and localized to a specific region. People with MPS usually have muscular trigger points, which are hard nodules within a muscle group that are tender to external pressure.

Diagnosis

Diagnosing problems with fascia can be difficult. Often, diagnostic tests like magnetic resonance imaging (MRI) focus on larger structures like muscles and tendons and ignore the fascia and collagen coverings around those structures.

The diagnosis of fascial problems is often made by palpation (touching), although this method has been proven to be quite unreliable. Occasionally, diagnostic ultrasound is used to study fascial thickness and elasticity to diagnose problems.

Diagnosis of plantar fasciitis is often made by palpation of the heel and bottom of the foot. Diagnosis of ITBS is made by clinical examination and palpation of the area near your knee.

Treatment

Fascia is like any other collagen-type tissue in the body. It needs appropriate time to heal properly when it becomes torn or injured. As it is healing, gentle motion can be started to ensure the collagen cells are properly aligned.

This is thought to eliminate the build-up of scar tissue in the body. (Scar tissue is simply collagen that has not healed properly and is thought of as a tight ball of fascia and tissue.)

The treatment of plantar fasciitis centers around decreasing stress via plantar fascia stretching, Achilles tendon stretching, shoe orthotics, and modifying activities. The treatment of ITBS focuses on improving the tissue flexibility of the fascia and related muscles and strengthening muscles to ensure proper alignment of your knees while walking and running.

Once it has healed, strengthening exercises for muscles and tendons can help improve the fascia's ability to tolerate stresses placed upon it during daily activities.

Components of a rehab program for injured fascia may include:

Scar tissue massage: This technique is used to realign the collagen tissue that makes up fascia, improving flexibility and pain-free movement.
Stretching and flexibility exercises: Exercises to improve overall flexibility can pull gently on the fascia, leading to more freedom of movement and less tightness.
Myofascial release: This specialized massage technique uses gentle pressure motions to guide the fascia into the correct position and release restrictions in the fascia. It is often used by specially trained massage therapists or physical therapists.
Strengthening exercises: Strengthening muscles can help provide your body with appropriate support, and strength training may improve your body's ability to manage stress.
Foam rolling: Some rehab professionals recommend foam rolling to stretch gently and massage muscles and fascia. While this may feel good, there is little evidence that foam rolling offers more significant benefits than stretching and strengthening exercises.

While rehabbing an injury to the fascia, you may use heat to increase blood flow to the injured area and ice to decrease inflammation of the injured tissue. Working closely with a rehab professional like a physical or occupational therapist is recommended to get the best outcome after an injury to the fascia.

Most injury to fascia heals within six to eight weeks period.

Occasionally, chronic inflammation and pain affect fascia, causing problems such as painful movement or fibromyalgia. When this occurs, a multi-thronged approach to care may be necessary. This may include massage, exercise, and medication to help ease pain and improve movement.

Modification of activity may also be important; too much activity may cause a flare-up, while too little activity may lead to tight tissues and muscle atrophy.

How to Keep Fascia Healthy

Keeping fascia healthy can help improve physical performance, reduce pain, increase blood flow, improve fitness recovery, and make your body feel better overall.

The following are some ways to relieve tight fascia and maintain its health:

Exercise
Staying hydrated
Stretching
Foam rolling
Heat and cold therapy
Yoga
Physical therapy
Acupuncture
Massage therapy

A modality called "fascia blasting" involves manipulating the fascia with a tool with plastic teeth in a scrubbing motion with a skin lubricant like massage oil. While some people feel results from fascia blasting, there are not robust scientific studies that support its use. If you do engage in fascia blasting, make sure to start gently and for a short duration (one minute) to prevent bruising and see how your body reacts.

Summary

Fascia is the collagen of stringy stuff that surrounds the tissues in your body. It encases nerves, muscles, tendons, joints, and bones. Fascia seems like a very passive material, but some areas of your body have thick bands of fascia that store energy when stretched. This energy is then used to improve efficiency when moving.

An injury to a muscle or tendon may also cause injury to the fascia around it, but do not fret; fascia can heal and return to its previous function within a short period.