Robert Inesta, DC, L.Ac, CCSP

Have you ever exercised and felt that you were not achieving the results you expected? Or worse, have you developed pain or worsened an already painful condition with exercise that was supposed to help? Have you been told by a trainer or physical therapist that your glutes are not firing or you have poor balance and you just can’t correct the problem?

These are very common issues that I hear about in my practice that can have multiple causes. The first thing to examine is the program itself – what exercises are being done and are they even appropriate for the individual based on their health history and present condition. Very often I see people doing exercises that they should definitely not be doing because they are harmful and will cause injury. Unfortunately I also see many trainers and specialists prescribing these exercises.

The second thing to examine is form – are the exercises being done properly. A good exercise, if done incorrectly, can be a bad exercise. Always be meticulous with form. The purpose of exercise should be to improve our health, whether the goal is increasing strength and endurance, rehabilitating tissue, or correcting movement patterns.

The above are the very obvious reasons and should always be ruled out first. But if the exercises are appropriate and being done with correct form and the issue is still present, there may be another less obvious culprit. This hidden hijacker of a good workout results could be fascial tension.

You may have heard of fascia recently, as it getting much attention due to research, which it deserves. Fascia is connective tissue that literally wraps and connects every structure in the body. To visualize this, imagine removing every organ, muscle and bone. If we were to leave all the fascia intact, we would have a 3D outline of the entire body – a completely continuous web.

Fascia transmits energy and force, in addition to holding everything together. We often think of muscles contracting independently to perform an action. For example, flexing our elbow we attribute to the biceps and brachialis muscles. But in reality, it is much more than that. Tension is created throughout the entire arm and shoulder, into the trunk and down to the hand through fascial connection. Other muscles are also performing at different levels in order to stabilize the arm. So really, everything is working, but at different levels of intensity.

We often think of muscle contraction generating force in the tendons (which attach the muscles to bones) in order to produce a movement. Studies have recently demonstrated that only 70% of the generated force of a muscle contraction is transmitted to the tendons. The other 30% is transmitted outward to the fascia surrounding the muscle by way of attachments along its entire length. Because fascia is completely continuous throughout the body, this force is transmitted to other muscles and structures. This shows that when a muscle acts, it is doing much more than its attributed movement. It is communicating with and working in conjunction with other muscles along a line.

Fascia is also a sensory organ. Another recent discovery is that there are more sensory nerve endings in the fascia than there are in the muscle. These nerve endings provide information to the brain and spinal cord about position, tension/stretch and pressure – a sense of where we are in space and what is happening to keep us there. Keep in mind that most of this is happening without us even realizing it.

Fascia is made up of different layers that need to slide over each other in order for movement to happen, and in order to have accurate information exchange with the nervous system. If there is restriction of this sliding, usually due to a densification of hyaluronic acid, the substance that lubricates the fascial layers, overall movement can become restricted. Muscle activity can become inhibited due to the lack of efficient communication through the nerve endings that live in the altered fascia.

The densifications causing this altered function can be a result of old trauma/injuries, surgeries, scars or repetitive strain. For example, an old ankle sprain that didn’t heal properly may subtly cause dysfunction either locally in the foot/ankle, or above in the knee, hip, pelvis or even in the shoulder on the opposite side of the body. These densifications may be difficult to detect because they are often found in different areas than where the symptoms manifest. In this case it would be helpful to be evaluated by a professional who understands this process to properly determine the dysfunction and correct it.

Fascial Manipulation is a diagnostic and treatment system developed by the Stecco family in Italy. It sees the body as an interconnected network of points along the fascia that make up different motion planes. The points are centers of coordination for underlying muscles. Interestingly, many of these are also acupuncture points. Densification, or dysfunction, in these points can alter the muscle activity. Fascial Manipulation practitioners find these areas of densification and remove them through a very specific, deep massage technique. When normal sliding is restored to these points, or centers of coordination, very often pain is relieved and muscles function much more effectively with less stress. It is worth noting that Fascial Manipulation has the most scientific research behind it than any other manual soft tissue technique.

Freed movement in the fascial planes leads to normal coordination of muscle activation. This can allow workout results to be more consistent with the targeted actions of exercise and desired goals. If you feel you are not getting the most out of your workout and you know you are doing the proper exercises with good form, consider a fascial evaluation.
References:
Day, J.A., Copetti, L., Rucli, G., From clinical experience to a model of the human fascial system. Journal of Bodywork and Movement Therapies (2012) 16, 372-380

Hammer, W., Optimal Muscle contraction requires connective tissue. Dynamic Chiropractic (2012) Vol 30, Issue 19

Hammer, W., Why chronic ankle instability can affect a proximal joint. Dynamic Chiropractic (2015) Vol 33, Issue 12

Schleip, R., Muller, D. G., Training Principles for fascial connective tissues: Scientific foundation and practical applications. Journal of Bodywork and Movement Therapies (2012)

Turina, A., Martinez-Gonzalez, M.A., Stecco, C., The Muscular force transmission system: role of the intramuscular connective tissue. Journal of Bodywork and Movement Therapies (2013) 17, 95-102

Dr. Robert Inesta