Does this photograph look familiar to you? Chances are high that it may – it features Michael Phelps in his natural habitat, an olympic pool, at the Rio Olympics last year. What may be less familiar are the circular bruises on his right shoulder. These peculiar markings are the result of an alternative medical practice called “cupping.” But what is this trend, what’s the science behind it, and why might it also be relevant for those of us who aren’t Olympic athletes?
As a researcher, I pride myself on trying to remain ahead of the curve, especially when it comes to new findings in health and technology. Fascia has recently attracted my attention as a growing area of research and as an important link to inflammation in autoimmune diseases (1).
A Brief Overview of Fascia
Fascia is the densely-woven, soft tissue layer of the connective tissue system, forming a continuous structure from head to toe. Analogous to yarn in a sweater, fascia surrounds all internal structures and provides support for our entire body.
Fascia enables all of our movements by allowing muscles and organs to glide smoothly by one another. Healthy fascia exists in a relaxed, wavy state and moves without restriction. Fascia may develop adhesions, stickiness, or distortion due to various causes: underlying genetic tendencies, injury, infection, inflammation. Tightness and stiffness, as well as palpable grit, lumps or patches can be triggered or exacerbated by poor form or asymmetry during movement. This causes the fascia to lose pliability, stick to underlying muscles, inhibit blood flow and limit range of motion.
Historically, due to its complex and intricate nature, which has made it difficult to study, fascia has received less attention from the scientific community than other tissues of the musculoskeletal system. However, a growing number of researchers have begun to acknowledge that fascia may influence joint stability and motor coordination as well as musculoskeletal pain and other pathologies.
Chronic Pathologies and Fascia
Given that fascia is highly innervated, containing roughly ten times as many nerve endings as muscles, this connective layer is susceptible to pain and sensation. Research has shown that distortion, inflammation and dysfunction of fascia has been linked to multiple chronic conditions including:
- Chronic Lumbar Backache (2)
- Fibromyalgia (3)
- Dermatomyositis (1)
- Rheumatoid Arthritis (4)
- And others
Luckily, there a growing number of therapies that are being used to alleviate discomfort and symptoms that arise from damaged fascia.
Movement and Physical Therapies
1. Myofascial Release (MFR)
MFR are manual therapeutic techniques used to release fascial restrictions. These therapies are performed by specialists trained in sports medicine or sports injuries, massage therapists, occupational or physical therapists, chiropractors, osteopaths and acupuncturists. There are many MFR techniques, including:
- Cupping, mentioned above, which uses glass cups with vacuum suction to release the fascia deep to where the cup is applied.
- Active Release Therapy (ART), where the operator fixes or pins one end of a limb’s range of motion, and the patient moves the joint through the appropriate range, repeated until the fascial hold is released.
- Trigger Point massage, in which the therapist uses fingers, hands or elbows to deeply press and pin fascial restrictions at known trigger points, causing an increase in pain followed by a sudden release.
- A variation on trigger point work using Graston tools, blunt surgical steel tools that can reach through superficial tissue to break up or loosen adhesions.
- Certain acupuncturists will target trigger points or fascial adhesions with needles, sometimes augmented with electrostimulation, rather than following the traditional Chinese meridians.
- Foam rolling techniques using various cylinders, rubber balls and other tools (even rolling pins!) to massage and release points of fascial restriction. This is one therapy where patients, once taught the techniques, can do much of the work themselves.
In a study published by The International Journal of Therapeutic Massage and Bodywork, researchers analyzed the effects of MFR on a patient with rheumatoid arthritis and collagenous colitis. They saw “improvements in pain, fatigue, gastrointestinal tract function, cervical range of motion, and quality of life following the initial treatment series of six sessions.”(4)
Another method for alleviating symptoms that arise from damaged fascia is stretching.
Dr. Robert Schleip, a leading researcher in the field of fascia and movement therapy, has discovered many stretching techniques that can positively influence connective tissue (5). He believes that applying a variety of different stretching styles is key to a healthy fascia. His variations include a combination of slow passive stretches at different angles as well as more dynamic stretches. Recently, new studios are opening with a sole focus of stretching. You can find a studio like this near you and discuss with them different options for fascial stretching! Or you could try one of the following movement therapies, which incorporate stretches and fascia movements into their practice.
If you’re looking for a movement therapy targeting fascia, then Pilates might be right for you. This system of physical conditioning was developed in the early 20th Century by Joseph Pilates for boxers and ballet dancers, and has become one of the most popular exercise therapies, especially for athletes, musicians, dancers and even older women at risk of osteoporosis. Pilates teaches controlled movements and stretches focused on strengthening the core muscles of the torso (deep spinal and pelvic muscles, abdominals, chest, back and buttocks); some are free form (“Mat Pilates”), others use various machines to provide resistance and guide the range of motion. Many Pilates practices incorporate barre work from ballet, as well as poses and stretches borrowed from yoga. Some specialists target posture, bone strength and scoliosis or asymmetry compensation, as well as injury rehabilitation and prevention. Pilates is suitable for all ages and for beginners as well as elite athletes and dancers.
Dr. Schleip advocates for Pilates as a method to protect against distorted, overly-tense fascia. Bouncing movements preserve elasticity, while broad movements stretch the entire network. The variety of these movements is a good way to support healthy fascia.
Pilates isn’t your cup of tea? You could also try gyrotonic,which has devised exercises that spread movement over as many joints as possible using an apparatus designed for the work. Gyrotonic practitioners believe that slow, sustained movements stretch fascial fibers, while rhythmic pulses promote the flow of blood and lymph fluid through layers of fascia for hydration and nourishment.
The truth is… everyone’s body works differently. One of these methods may be more beneficial to your condition than the others. But the only way you are going to find out is if you start experimenting!
For more information of these movement therapies please visit our mind and body blog here. And don’t forget to let us know what did (or didn’t) work for you!
(1) Noda, Kentaro, et al. “The Fascia Is a Target Organ of Inflammation in Autoimmune Diseases.” ACR Meeting Abstracts. September 2015.
(2) Bordoni, Bruno, and Emiliano Zanier. “Clinical and Symptomatological Reflections: The Fascial System.” Journal of Multidisciplinary Healthcare 7 (2014): 401–411. PMC. Web. 6 Nov. 2017.
(3) Liptan G.L. “Fascia: A missing link in our understanding of the pathology of fibromyalgia”. Journal of Bodywork and Movement Therapies. Pubmed.gov. Jan 2010.
(4) Cubick, Erin E. et al. “Sustained Release Myofascial Release as Treatment for a Patient with Complications of Rheumatoid Arthritis and Collagenous Colitis: A Case Report.” International Journal of Therapeutic Massage & Bodywork 4.3 (2011): 1–9. Print.
(5) Schleip, Robert et al. “Training principles for fascial connective tissues: Scientific foundation and suggested practical applications.” Journal of Bodywork and Movement Therapies. Jan 2013