http://en.wikipedia.org/wiki/Fascia
http://www.fasciaresearch.com/

So one thing I've had a hard time reconciling in my physical rehab is some personal experiences with my knowledge of skeletal muscles. For example, at Christmas I sat around with family and didn't do much, and after a day of that I felt like my knee pain was back to the degree it was several months previous and I as a whole, felt very oddly stiff, sort of like being constrained by a straightjacket or something. Two days later I went swimming, and the movement resolved that and made me feel much more "loose" and pain free again. Yet from a skeletal muscle perspective I can find little to explain this, and it has bore out in numerous other situations for me as well. Another example: places of stiffness/tension that are relieved with a sensation of heat after massage or movement. Which doesn't make much sense from a muscle perspective... ischemia would be noticeable and there should be a lactic acid burn in there somewhere as well. Yet this corresponds nicely with histamine and fascia. Or how massage of the upper quad and glute areas quickly and reliably relieves my knee pain which seems to correlate with noticeable ITB tightness-- before learning that little trick, I had difficulty walking more than 5 minutes without incurring knee pain in the wake of my injuries.

So, one thing lead to another, and I was researching the concept of "myofascial knots"... hippie bullshit, or is it actually relevant? Turns out the fascia is a layer of connective tissue that runs under the skin, and around most muscles and organs. It has muscle-like properties in that it can contract and relax, and has been shown to be involved in the biomechanics of movement and stuff like lower back pain. No, it's not going to bench press a car, but the strength of fascia appears to be very relevant.

But where fascia differs from muscle is in its adaptability. It can change composition very quickly, to be either fundamentally stiffer or allow for a greater range of motion. And its composition and the direction its fibers are in is also relevant-- if stressed in too many directions too quickly, or allowed to be sedentary and underused for too long, the fibers can essentially form a laminate with restricted strength and motion.

In muscle, epinephrine enhances contraction... acetylcholine enhances relaxation. In fascia, EPI/ACh have no effect, and instead histamine enhances contraction, and nitric oxide / estrogen enhance relaxation.

In muscle, microtears and their subsequent repairs enhance strength. In fascia, stretching along a certain axis of movement enhances strength in that axis.

In muscle, quick movements require very fast fiber recruitment and contraction. In fascia, very fast movements relax it and let the muscle do the work. Another nifty tidbit is they contract in response to a real or perceived threat / stress -- sort of like a minor layer of armor under the skin.

Additionally, the fascia respond unusually well (relative to muscle) to mechanical movement. It may be that massage then works primarily on the fascia, and indirectly on muscles, by relaxing the fascia, allowing for plastic changes in its elasticity, and thereby releasing the muscle from its "straightjacket" (a study I read actually used that term, which was very interesting as that was what came to mind in regards to my personal experience before learning all this shit). Other theories also suggest involvement in acupuncture.

All interesting stuff. But where it gets more complex is in how it plays in tandem with muscles in regards to injury. If the muscle is injured, through some mechanism (histamine?) my understanding is the fascia contracts around it to support the muscle while it heals. One study on lower back pain suggested if that output signal from the muscle was "corrupted" (though I'm uncertain as to what they meant by that, or by what mechanism), this would in turn lead to aberrant behavior in the fascia possibly making some sort of evil pain-filled feedback loop between the muscle and fascia. And this may also be why the effects of massage can be so temporary-- whatever triggered the fascia to contract (injury?) is still generating that signal, so after temporary release it'll go back to that contracted state.

So assuming the injury to the muscle (or whatever) gets healed, it may be possible this made the fascia be contracted too long, at which point the composition changed to be more rigid and less flexible. And that can be a problem in that the restricted range of motion and lack of fascia contraction in larger coordinated movements incur further injury and pain. So, as the Wiki article notes, interrupting the contraction long enough then allows it to revert to its normal state.

Which probably just seems like a giant ad for yoga or something; "lengthen and strengthen" indeed. Anyway, I can't guarantee everything I assembled above is perfectly accurate (especially my speculation) but perhaps it might be relevant to some of you.

My even more extreme speculation is that like facial expression and emotion, fascia throughout the body directly affect the body and mind in a two way process. For example, with facial expressions, if you're sad, you make a sad a face characterized by specific muscle activation. Yet if you manually activate those same muscles the limbic system, in its infinite stupidity, actually starts to generate the emotion of sadness, even if you weren't sad to begin with. On a bright note, that works for forced smiling as well. So, if the fascia respond and contact to pain, injury, and possible threats, then perhaps contracted fascia (due to posture, injury, etc) also enhance the perception of pain or anxiety / threat scanning. In fact, the Ruffini ending is supposed to be able to inhibit sympathetic nervous system activity and responds to the skin sensation of being relaxed / stretched. From an evolutionary perspective this makes sense, as you'd want to be extra vigilant if you were injured and healing and therefore weakened-- getting twitchy in that state and not getting eaten by a roving bear (which are godless, rampaging killing machines as you well know) is an advantageous trait that could be passed on. But that's enough theoretical masturbation for now.

As an analogy, what kept popping into my mind was the T-X's liquid metal mimetic skin from Terminator 3. Which I'm sure is even worse of an analogy than a "series of tubes" for the internet and makes ScottL cry in his sleep. But if that wasn't a good excuse for a mental image of Kristanna Lokken, I don't know what is.

just get this.

http://www.amazon.com/Trigger-Point-Therap...1882&sr=8-1

I'm familiar with that and find trigger point techniques to be effective, but most of the time that relief is temporary. Hence, my desire to understand the mechanisms better.

i'd be interested to see what you find out. i get them pretty bad sometimes and technique and nutrition to keep them minimized would be great. mixing up my max effort lifts with some high rep stuff is one thing that seems to help, fwiw.

however, i think expecting lasting relief without a longterm consistent dedication to tissue work is unreasonable. it can take a long time to fix things, even with someone working on you that is an expert like an ART practitioner. and if anything, the book will save you a lot of time wih your rehabilitation efforts. it's like a Haynes or Chilton manual for your muscular aches and pains.

oh, and about Davies. massaging trigger points is not the only effective mechanism to release them. lidocaine injections, cold spray and stretch, and even accupuncture can work. at least for the muscular TrPs. scar tissue and sticky fascia, i think you're just going to have to work some of that out by being more active and stretching, but the massage probably works it, too.

Yeah, basically all this with the fascia comes down to being more active and stretching as you say. I'd like to try to understand more the links between injury and healing with regards to muscle and fascia, and how the healing mechanisms go terribly wrong. Unfortunately, there's a paucity of data on this, so ... be more active and stretch, eh?

stretch, stretch and stretch.

I also feel that many yoga poses are great for fascial stretching.

DoogCrapp really advocated deep stretches in his routines, and it was all about the fascia.

you can't stretch myofascial knots, the same way you can't stretch the knot on a rubber band.

good info frange. looking at things in a systematic sort of way instead of cellular indeed will do you good. look also for fascia and ROS generation if interested in some cool stuff.

nice post!

Have you ever tried foam rolling (self-myofascial release)? I'been doing it for th past couple years, and I believe it's been quite beneficial with regards to injuries, and strength gains.

So what's a "myofascial knot", anyway? According to Wikipedia, biopsies show the tissue is normal, there doesn't appear to be aberrant electrical activity, and the latest theory is sympathetically-driven creation of muscle spindles, which I can't really agree with... and that doesn't reference the fascia anyway, so I'm not sure why it's called "myofascial".

I don't doubt the existence of trigger points, I'm just having difficulty understanding the mechanics. They seem to be A) hard / more dense than normal and B) usually resolve quickly with light massage, which to me makes it seem A) related to contraction/increased tone and B) temporary.

I don't buy it's ischemia because the muscle will fail in that state, it cannot operate off lactic acid for very long. Unless it's a zombie muscle or something.

I don't buy it's a scar because they resolve/reverse so quickly, and scar tissue does not.

I don't buy it's due to structural changes in the muscle spindles or wtfever because it reverses quickly and the muscle cannot change composition that quickly.

I don't buy that the sympathetic nervous system is to blame, because mine are greatly attenuated with sympathetic stimulation, and worsened without it.

So I can only conclude from what I know that it has to be due to contraction in a small point, probably the fascia as I don't think a very long muscle can contract at a specific point only, and there has to be a cause for why this occurs-- my assumption is damage or pain to that region, and thus the fascia contracts to help support it.

However, if that is true, then that means the pain sensation is from the fascia. So then, releasing the fascia relieves the pain, but if the pain is due to the fascia being contracted too long, couldn't this actually be negative-long term if the release of the fascia puts increased stress and thus increases damage to the very structures its contraction is supporting?

I don't know. But if the biopsies of muscle are normal they certainly cannot be "knots".



Yeah, I have a foam roller and it helps.

a friend of mine who is a personal trainer got a certificate through st louis university on physiology. He had to cut up cadavers. One of the coolest things he say was adhesions of the fascia. I'll have to ask him more about it but basically he says that the strands can literally adhere together over time or something.

I think the last line is where you have it worng. scar tissue resolve quicker than you think, and the reverse is true for trigger points. while relief is immediate it has to do with the release of pain.

I belive the trigger point is like scar tissue, sort of fascial crosslinking or crosswiring that should not be there.

i'm not exactly sure what's going on with trigger points, either. maybe it's just a localized positive feedback loop. maybe the contraction causes a shortage of blood flow, resulting in something like rigor mortis. pumping blood through the site with massage breaks the loop. but lidocaine injection works, too, so i assume that means the nerves are involved in maintaining the contraction. that acupuncture works might also suggest nerve firing is involved.

as for the fascia, the stuff i've read about that suggests that when muscles become inactive (say from Trigger points, injuries, or just simply inactivity) the fascia adhere to each other. although that problem may begin with a TrP, it doesn't have to begin that way and is a separate problem.

I don't think scar tissue can resolve almost instantly with massage or lidocaine though. Like Proton Soup says, that implies something involving nerves if a local anesthetic is effective at clearing the TrP.

The fascia certainly can get disarrayed and form a laminate but I think that's going to take a couple days minimum to change, rather than something instant with massage or lidocaine.

I do not think trigger point resolve instantly; this is not case IME, and I have worked my own and took care of other people's TP. the pain from massaging them is firing up local nerve junctures for negative feedback and releases BE and thus you get release of former pain sensations. they are not released that soon.

tehre are varoius schools on thesubect. I've met with Dr Michael Leahy who invented ART several times - getting both treated and disscussed science. according to him, any where from several minutes to several sessions can break up the scar tissue (which is what he mentions TP to be made off)

http://www.pubmedcentral.nih.gov/articlere...bmedid=12638663

empirically this is obvious bull - trigger points don't stretch and stretching does not resolve them.

i'm sure Simon and Travell know that. their work is most of the basis for Clair Davies' book. massage, spray and stretch, and procaine injection are some of the techniques they used.

Im pretty sure Ach stimulates muscle contraction rather than faciliates relaxation.....

Hmm

I notice PEA can aggravate the tightness and uncomforatble feeling in my left trap.

I had a cheap massage with this chinese dude recently and he absolutely ripped apart my back. 95% of the time the massage was uncomfortable...but I kept with it thinking that all those dastardly adhesions I had developed due to poor posture were being needfully worked on. 2 days later I am still uncomfortable in the area and slightly more loose. I notice that having my back in warm water eases the tight-not fully released feeling.

I was thinking about using digestive enzymes as that was mentioned before for better scar healing.. I was hoping that the worked upon tissue would be better addressed with some supplements to help it along.

As I note that PEA aggravates it, there seems to be some transmitter modulation of the sensations and not just purely a bunch of adhesed tissue.

Another thing I think I have noticed in the past is if I have come from eating a highly acidic diet which increases the feeling of tightness, and then ate a large salad with so called basic foods, including lemon juice, then the degree of uncomfortableness attenuates. I am pretty sure that addressing the acidic diet with Ca and MG citrates did not do the trick, or I may have been using too little an amount of citrate.

hmmm so has anyone learnt more about the issue and adopted a certain successful regime?

Just IME, one session of 'cross-frictions' cleared up my chronic achilles tendon troubles/calf troubles. No amount of stretching, NSAID, ice, rest, blah, blah, blah seems to resolve adhesions/scar tissue/trigger points - whatever you call them.

The Trigger Point Therapy Workbook is very helpful.

Having used a variety of buffers, and more recently, loads of spinach - the effect is not quite the same. Timing might be an issue, as the spinach was part of an otherwise acidic meal while the buffers were spaced far from the refeed.

As someone who works both with trigger points and functional rehab for soft tissue injuries on a daily basis, on MRI I have seen fascia and scar tissue in some cases double in as little as 48 hours (such as in cases of repeated trauma). I can also attest that this same tissue secondary to inflammation can be resolved if the appropriate techniques are utilized. However, there are many many techniques which in the right hands can be effective. So I think it's a case of technique personally.