Fascia and Inflammation
Definition: Inflammation – Inflammation is the body’s attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens – and begin the healing process.
When something harmful or irritating affects a part of our body, there is a biological response to try to remove the harmful stimuli, and to protect that part of the body from further damage. The signs and symptoms of inflammation (swelling, pain, and muscle spasm) 1, specifically acute inflammation, show that the body is trying to heal itself.
Inflammation does not mean infection, even when an infection causes inflammation. Infection is caused by a bacterium, virus or fungus, while inflammation is the body’s response to it. This article refers strictly to inflammation and pain related to the musculoskeletal and fascial systems of the body.
Fascia and Inflammation/Pain
In 2007, Harvard Medical School hosted the First World Fascial Congress, where research was presented that completely changed our understanding of fascia and the role it plays in painful/inflamed conditions. An article in the April 2015 issue of ID Magazine called these discoveries some of the most important of the century.2
Nearly all painful conditions are accompanied by inflammation of the fascia. Fascia is the connective
tissue that is abundant throughout the entire body and covers all nerves, arteries, veins, and internal organs of the body. In other words, fascia is everywhere throughout the human body. If you are wondering what it looks like, picture the thin, white, filmy layer of tissue that covers the muscle of a chicken breast, once the skin has been pulled back.
Fascia is filled with millions of nerve endings and also contains smooth muscle cells, so it can contract if injured or traumatized, and also cause skeletal muscle (like biceps, quads, or upper traps) to tighten (hypertonicity). When there is sufficient trauma or strain to an area (quick unexpected stretch, strain, prolonged bad posture, surgery, direct blow), the smooth muscle in the fascia contracts (tightens), and the nerve endings start producing inflammatory chemicals.3
The inflammatory chemicals make those same nerve endings even more sensitive, so that now it takes only takes a very mild strain to cause more inflammation, muscle spasm, and pain. Most of us function normally every day with a certain level of this “fascial dysfunction” and hardly notice anything more than a degree of “tightness” or “soreness” in a particular area of our body. Usually, the stronger you are, the more of this fascial dysfunction you can “manage.” However, when enough fascial tissue is affected, you will begin to feel pain – and that is usually when you seek help.
Treatment for Inflammation
Health professionals treat pain and inflammation. Traditionally the techniques used have included cold therapy, anti-inflammatory drugs, and acupuncture. 4 Like any form of treatment, there are advantages and disadvantages of these traditional methods.
Cold Therapy – Advantages:
The use of cold (cryotherapy) seems to be more effective for acute pain and the swelling associated with acute inflammation. The Journal of Orthopedic and Sports Physical Therapy5 reviewed the literature on the physiological effects of cold therapy. The conclusions were that the results of the studies reviewed were consistent in describing reductions in musculoskeletal pain, spasm, muscle temperature, and swelling.
Cold Therapy – Disadvantages:
The reductions in pain, swelling, and spasm are usually temporary only, lasting for up to an hour or more, when another cryotherapy treatment is needed. Cryotherapy does not affect the neural mechanism which caused the reaction in the fascial tissue described above. Finally, when cold therapy is used, caution must be used to avoid freezer burn (frostbite).
Anti-inflammatory Drugs – Advantages:
NSAIDs (non-steroidal anti-inflammatory medications) are among the most widely used drugs, starting in infancy for pain and fever, right through to the elderly where they are standards for treating osteoarthritis and other muscle and skeletal conditions. NSAIDs all work in the same way, blocking the cyclooxygenase (COX) enzyme, responsible for the production of prostaglandin messenger substances that cause pain, inflammation and fever.6 NSAIDs usually do a fairly good job of reducing inflammation and pain, but like nearly all medication, there are side-effects and risks.
Anti-inflammatory Drugs – Disadvantages:
Ulcers are the most well-known effect, and hospitalization secondary to gastrointestinal bleeding from NSAIDs is common. Fortunately these side effects can be prevented with drugs like proton pump inhibitors, or PPI drugs (to reduce stomach acid). Unfortunately, the Food and Drug Administration (FDA) has issued a number of broad-based product warnings regarding the long-term use of PPI drugs. The potential interactions have ranged from an alteration of the absorption of vitamins and minerals, metabolic effects on bone density (potentially resulting in fractures), infection risk, and hypersensitivity response with consequent organ damage. 7
Finally, another well-known side effect of long-term use of NSAIDs is cardiovascular disease, as NSAIDs seem to increase the risks of heart attacks and strokes.
Acupuncture – Advantages:
Acupuncture does seem to have a beneficial effect when treating many diseases and painful conditions, and therefore is thought to be useful as a complementary therapy or to replace drug therapy (NSAIDs).
Acupuncture – Disadvantages:
Acupuncture is considered to be relatively safe as a treatment. The effects of acupuncture have been investigated in inflammatory diseases, including asthma, inflammatory bowel disease, rheumatoid arthritis, epicondylitis (tennis elbow), and complex regional pain syndrome, but research studies demonstrating the immediate and sustained effect of acupuncture are missing.
A fourth (4th) treatment option called Fascial Counterstrain has also shown exceptional early promise for the treatment of nearly all painful and inflamed conditions.
Fascial Counterstrain: An Intriguing Treatment Option
One of the many groundbreaking research papers published about fascia in the past decade is one where fascia was subjected to repetitive strain, followed by measuring the level of inflammatory chemicals that the strained fascia produced. All of the samples of strained fascia produced increased levels of inflammatory chemicals. The researchers then shortened some of the samples, decreasing the tension on the strained fascia, and found there to be nearly 50% less inflammation at 24 hours and beyond. The unshortened samples were unchanged, with significantly higher levels of inflammatory chemicals still present in the fascial tissue.
This study helped to lead to the discovery of a treatment that is capable of reversing the production of inflammation and muscle spasm in the body, a treatment called Fascial Counterstrain. A brilliant young physical therapist from Maryland, Brian Tuckey, was paying close attention to the research about fascia, and discovered that strained and inflamed fascia could be “counterstrained” or shortened, thereby “resetting” the neural mechanism that was causing the inflammation and muscle spasm in the first place, resulting in an immediate, significant reduction in pain, inflammation, and muscle spasm, as well as greater pain-free range of motion of the joints affected by the fascial dysfunction.
Practitioners of Fascial Counterstrain (usually specially trained physical therapists), look for very specific “tender points” on the body that tell them which particular fascial structure is involved (kind of like a road map for fascial dysfunction). The physical therapist will then shorten that particular fascial structure manually (with their hands),
until they feel a “ pulsing” at the tender point associated with that fascial structure. This position is then held for 30 seconds, and when the therapist releases the shortened tissue, the nerve endings and smooth muscle in the fascia are “reset,” and the inflammation and spasm stops in that area of fascia. There are nearly 700 fascial “tender points” in the human body, and the number of tender points that need to be treated varies between individuals, depending on the severity of the problem.
Fascial Counterstrain treats the most fundamental aspect of nearly every painful condition. The treatment is fast, gentle, and effective. It allows the body to start to heal, and usually a few simple exercises can help prevent the fascial dysfunction, inflammation, spasm, and pain from returning. Fascial Counterstrain will soon change the way physical therapists treat most painful conditions. Traditional physical therapy (exercise and modalities) does not address the root cause of most painful conditions (fascial dysfunction), and so the results are often less than optimal.
Currently, there are only about 300 trained practitioners of Fascial Counterstrain in the United States, most of them either physical therapists or massage therapists. They can be found by searching Fascial Counterstrain on Google or contacting the Jones Institute at www.jiscs.com and search for a practitioner near you.
Ultimately, the choice in treatment for battling inflammation is yours. However, it is important to be aware and informed of the consequences of prolonged use and side effects of certain treatments.
2) Ideas and Discoveries Magazine April 2015
3) Fascial Strain and Counterstrain, White Paper by Brian Tuckey, PT, OCS, JSCCI
4) The Merck Manual Online http://www.merckmanuals.com/home/fundamentals/rehabilitation/treatment-of-pain-and-inflammation
5) Journal of Orthopedic and sports Physical Therapy http://www.jospt.org/doi/abs/10.2519/jospt.2002.32.10.510
6) Science Based Medicine online https://www.sciencebasedmedicine.org/anti-inflammatory-drugs-a-closer-look-at-the-risks/
7) Medscape Multispecialty online http://www.medscape.com/viewarticle/735672
8) Mediators of Inflammation http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781596/