Dlonthenet close The Functional Role of Fascia in Posture and Movement: Part I By Evan Osar, D.C. Date Released : 20 May 2014 Developing and maintaining control of posture and movement is a necessary requirement for optimal performance while minimizing compensatory patterns that potentially lead to injury. Although optimal performance is often attributed primarily to the muscle system, recent evidence has suggested that the intricate relationship between the nervous, muscular, and fascial systems is vital in developing and maintaining control of posture and movement. Part 1 of this article will explore the functional role of fascia, highlighting its relationship to the deep and superficial myofascial systems. This information provides a framework for specific training of the deep and superficial myofascial systems that will be presented in the second installment. Learning Objectives: 1, Understand the functional role of the fascial system and its relationship to the muscular system, 2. Define how integration of the deep and superficial myofascial systems contribute to developing and maintaining efficient posture and movement. 3. Recognize the signs of compensatory postural and movement strategies that occur with imbalances of the deep and superficial myofascial systems Introduction Living life to the fullest of one’s ability requires optimal control over both posture (static positioning) and movement (dynamic positioning). Static and dynamic control of posture and movement relies upon the connective tissue system —muscles, tendons, ligaments, joint capsules; in addition to bones, blood vessels, adipose tissue, and nerves — to maintain structural integrity of body position, When viewed in their isolated form, the connective tissue structures can appear independent of each other. However, what connects and unifies the entire connective tissue system is the extremely complex and integrative tissue known as fascia. While largely ignored and overlooked as simply another static connective tissue, recent research into the fascial system has highlighted its vast role in both overall health as well as its involvement in the postural and movement system. This article will briefly address some of the exciting research surrounding the dynamic fascial system focusing on its role in achieving and maintaining postural alignment and the development of efficient movement. Understanding the dynamic function of the fascial system and how it contributes to httsi/wmw.ptonthenet.com/content/artcloprintaspx?p= "Article D=Mzg3MSBWUnISTBTSNDUsVaUmxEdHdqZWZBPTO= 6syi7/2020 PT on the Net ‘maintaining optimal posture and movement strategies will lay the framework for developing a comprehensive training program that integrates the function of the myofascial systems into traditional functional exercise. Functions of the Fascial System As indicated in the introduction, the fascial system is integrated into every single system within the body. While it serves multiple roles in virtually every systemic function, there are three distinct attributes of the fascial system as it relates to posture and movement. 1, Myofascial linkages: While the fascial system is literally invested into every system and structure, specific lines of fascia connect the skeletal muscles thereby creating continuous myofascial (muscles and their investing fascia) linkages throughout the body. Several of these distinct linkages have been identified, including the myofascial lines deseribed in Anatomy Trains (Myers, 2011), myofascial slings (Lee, 2011), and myofascial chains (Paoletti, 2002). These myofascial linkages specifically connect regions of the body and are responsible for maintaining posture, controlling body position, and for producing smooth and coordinated movement. Additionally, through these series of myofascial chains, fascia can transmit, redirect, and/or dampen force throughout the body. While the muscles are the drivers, fascia appropriately directs these forces throughout the body. For example, through the myofascial chains, forces generated through the lower extremity can be transferred through the trunk and delivered into powerful movements of the upper extremity. Similarly, these myofascial chains act as the body’s break system by decelerating forward momentum while bending, walking, running, throwing, kicking, or twisting. 2. Tensegrity: A term coined by Buckminster Fuller, tensegrity describes a structure containing alternating regions of tension and rigidity that maintain optimal alignment and integrity of the structure. Thus, a structure that possesses tensegrity is both adaptable and resilient to deformation. The human body is an example of this tensegrity model where the myofascial system serves as the tension generator and connects to rigid levers (bones). When functioning optimally, the myofascial system works to virtually suspend the body in the upright position while maintaining "tension and integrity" within the system. More specifically, tensegrity enables the maintenance of erect posture and smooth, coordinated movement. Maintaining erect posture and smooth, coordinated movement under a relative minimal energy expenditure and without compensation is the hallmark of an efficient strategy. ‘When tensegrity is compromised secondary to injury, inflammation, development of muscle imbalances, etc., the nervous system compensates by significantly increasing muscle activity to help maintain posture and movement control. These compensations lead to inefficient strategies and are a direct cause of postural alterations and movement dysfunction. This concept will be discussed in further detail below. Additionally, it is worth noting that a complex fascial network maintains suspension and thereby optimal function of the viscera (organs) contained within the thoracic, abdominal, and pelvic cavities. Fascial restrictions (adhesions and/or scar tissue) of the visceral system - common after surgery, trauma, and/or inflammation - have been shown to directly contribute to common postural and movement dysfunction (Lee & Lee, 2013; Wetzler, 2014). While specific myofascial release techniques have been shown to be effective in releasing thes restrictions, developing proper alignment and incorporating three-dimensional breathing techniques can also promote improvements in visceral mobility while restoring optimal postural and movement patterns (Lee & Lee, 2013; Osar, 2014). These alignment and breathing techniques will be described below. 3. Sensory organs: Through sensory and contractile elements, fascia has a direct influence over posture and ‘movement. Fascia has been shown to contain sensory organs suggesting it is important in detecting and relaying information back to the central nervous system about body position and movement (Chaitow et al., 2012). The presence of myofibrils, contractile elements located within the fascia, enables fascia the ability to respond to different regions of tension and muscular pull by either dampening or redirecting this stress along the different fascial lines (Paoletti, 2002). Being able to sense and direct stresses throughout the fascial system supports optimal posture and movement while reducing the potential for overloading any single region of the body httsi/wmw.ptonthenet.com/content/artcloprintaspx?p= "Article D=Mzg3MSBWUnISTBTSNDUsVaUmxEdHdqZWZBPTO= 216syi7/2020 PT on the Net The preceding section looked at several important functions of fascia and its role in supporting optimal posture and movement. While it functions as an integrative system, there are distinct differences between the muscles and the investing fascia that lie deeper in the body and the muscles and fascia that lie superficially. The next section will expand upon fascia’s role as part of both the deep and superficial myofascial systems, The Superficial and Deep Myofascial Systems The deep myofascial system (DMS) is comprised of the deeper muscles that lie close to the bone and joint surfaces. These muscles are connected through the deeper fascial layers that invest itself not only with the muscles themselves but blend intimately with the ligamentous system including the joint capsules. This enables the DMS the ability to exert specific control over joint position and motion Research has demonstrated that the deep, segmental muscles (attached direetly from bone to the adjoining bone) that make up the DMS (including the transversus abdominus, the multifidi, pelvie floor, and diaphragm) function in a feed forward manner (Richardson et al., 2004). In other words, these muscles contract milliseconds prior to movement to provide joint stabilization. The feed forward function of the DMS functions to create a solid anchor point required to support movement at a distal point within the kinetic chain. The diaphragm is an important muscle of the DMS. Attaching inside the entire thoracic cavity from the xiphoid process, ribs 7-12, and upper lumbar vertebrae, the diaphragm fascially blends with the transversus abdominus, psoas, quadratus lumborum, and multifidi at the thoracolumbar junction. In addition to its role in respiration, the diaphragm functions with the other muscles of the DMS to provide stabilization of the thoracopelvie canister (TPC) - the collective regions of the thorax, lumbar spine, and pelvis (Image 1). Developing and maintaining three- dimensional breathing will be an important strategy for activating the entire DMS and developing the internal pressure that is required to help stabilize the TPC and subsequently restore and/or maintain optimal posture and movement. Image 1: The thoracopelvic pelvic canister and deep myofascial system of the core. Reproduced with permission from Osar and publisher Lotus Publishing, 2013, The superficial myofascial system (SMS), in contrast, consists of the intermediate to superficial muscles. The superficial muscles are fascially connected to form longer chains that generally span multiple joint segments. ‘These myofascial chains are primarily responsible for movement of the trunk and limbs as required for generating higher levels of force production required for throwing a ball, swinging a golf club and running Additionally, these superficial myofascial chains provide the higher levels of trunk and limb stability nec for lifting or required for support when exposed to greater disturbances in the body's center of gravity. The posterior oblique chain is one example of a fascial chain within the SMS (Image 2). Through the thoracolumbar fascia, the latissimus dorsi connects to the contraternal gluteus maximus. The posterior oblique chain is largely responsible for stabilizing the sacroiliac joint during the gait cycle and works with the anterior oblique chain to rotate the trunk and extremities. During bilateral movements such as squatting or deadlifting, the posterior oblique chains provide stability to the trunk, spine, pelvis, and extremities. httsi/wmw.ptonthenet.com/content/artcloprintaspx?p= "Article D=Mzg3MSBWUnISTBTSNDUsVaUmxEdHdqZWZBPTO= 316ayt7/2020 PT on the Net Image 2: The posterior oblique chain. Reproduced with permission from Osar and publisher Lotus Publishing, 2013. ‘Deep myofascial system (DMS) Superficial myofascial system (SMS) Diaphragm, transversus abdominus, Anterior and posterior oblique chains pelvie floor, multifidi, psoas, quadratus lumborum Superficial flexor and extensor chains Lateral chain Above are examples of the deep and superficial myofascial systems of the thoracopelvic canister (core). An important concept to remember is that to have smooth, coordinated, and effortless control of posture and movement, there must be a balance between the DMS and SMS. Synergy between the deep and superficial myofascial systems allows for proper alignment and centering of the joints, three-dimensional breathing, and optimal levels of postural and movement control required for accomplishing functional activity. Dysfunction of the Deep and Superficial Fascial Systems As discussed above, when balance is achieved between the deep and superficial myofascial systems, posture and ‘movement will be smooth, coordinated, and efficient. In other words, the individual will utilize the exact right amount of effort to successfully complete their functional tasks or activities. However, when an imbalance develops between the systems, there is increased likelihood for developing compensatory postural and/or ‘movement strategies. For example, research has shown that individuals with chronic low back pain (CLBP) tend to over-recruit their spinal musculature to a greater degree and also have a harder time relaxing their muscles after activation as compared to control subjects without pain (Jacobs et al., 2011). Additionally, there tends to be thickening of the thoracolumbar fascia in individuals with CLBP as compared to individuals without pain (Chaitow et al., 2012), ‘These alterations in muscle activity and tissue remodeling are common issues in clients that present with a history of chronic tightness and/or pain, as well as individuals who experience challenges in performing at a high Ievel without compensation. The following case is a common representation of many individuals that present to health and fitness professionals with a history of CLBP. Case Study: A38 year-old male presented with a history of CLBP and stiffness while sitting and standing. However, he did not experience any pain while walking short distances or when playing soccer one time per week. He reported no history of acute injury, surgery, and was not taking any medications. ‘On postural evaluation, significant resting tone was noted in his thoracolumbar erectors (Image 3). He reported that he did not work out with weights and/or perform manual labor. Why does an individual who has a sedentary hntps:/wnw ptonthenet.com/contentaticleprint azpx?p=18Articll0-=Meg3MSBWUnISTIBTSNDUAqUmxEdHdgZWZBPTO= a6syi7/2020 PT on the Net job and does not perform resistance exercise have such developed rector spinae? The answer can be found in observing the postural strategy he is using for sitting, standing, and transitioning weight from ‘one leg to the next. Images 3 (left) and 4 (right) Not only does this individual exhibit increased erector spinae tone in standing, note the extreme inerease in activity of the erector spinae as he stands on one leg (Image 4). He over-recruits (also referred to as myofascial “ gripping") his SMS to perform a simple task of standing on one leg. He has compensated for a non-optimal strategy and his erector spinae and overlying thoracolumbar fascia have simply adapted by becoming over- developed and hypertonic. As part of this compensatory strategy he is unable to fully relax his muscles while at rest and thus uses a high-level strategy for performing simple tasks such as sitting, standing, and balancing on one leg. This strategy leads to over-compression of the lumbar spine and hence the development of myofascial, disc, and joint pain. Non-optimal postural and movement strategies are common in many individuals experiencing chronic myofascial tightness, muscle imbalances, and myofascial or joint discomfort. The development of non-optimal strategies is also a common cause of decreased performance in the athletic population, These individuals are compensating for the lack of an efficient deep myofascial control strategy by overusing their SMS for simple everyday tasks. Subsequently, non-optimal strategies lead to inefficiency and compensations, ultimately leading to many of the common postural and movement dysfunctions that often keep individuals from successfully achieving their health and fitness goals. To change these compensatory postural and movement pattems and restore more optimal function, the client must be taught to adopt a more efficient strategy. Simply stretching tight muscles or fascia and strengthening ‘weak muscles is not enough to create long-term changes because this approach does not change the individual's strategy for recruiting their deep and superficial myofascial systems. Understanding how to recruit and integrate the deep and superficial myofascial systems to develop an improved strategy will enable the individual to achieve more optimal postural and movement strategies while minimizing compensations that lead to common. myofascial and degenerative joint issues. Conclusion This article has discussed the functional role of fascia specifically highlighting its contribution to the development of optimal posture and movement. As part of both the deep and superficial, the fascial system connects different regions of the body providing the support, communication, and protection required for ‘maintaining efficient postural and movement strategies. However, when there is inhibition of the deep myofascial system following injury or trauma, the individual will adopt a compensatory strategy and increase activity of the superficial myofascial system. This imbalance alters joint alignment, increases myofascial tone and gripping, and directly contributes to many common postural issues and non-optimal movement patterns. Gradually, these postural issues and non-optimal movement patterns manifest as chronic myofascial restrictions (tightness), joint degeneration, and/or pain. To develop optimal postural and movement control, it is imperative that a training program is designed that restores balance between the deep and superficial myofascial systems. Incorporating the concepts from this section, Part 2 of this article will focus on integrating the deep and superficial myofascial systems into a training program designed to specifically improve functional control of posture and movement. httsi/wmw.ptonthenet.com/content/artcloprintaspx?p= "Article D=Mzg3MSBWUnISTBTSNDUsVaUmxEdHdqZWZBPTO= 56art7/2020 PT on the Net References Chaitow, L., Findley, T.W., Schleip, R. (2012). Fascia Research III. Kiener: Munich. Jacobs, J.V., Henry, S.M., Jones, S.L., Hitt, LR., Bunn, -Y. (2011). A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. Journal of Neurophysiology: 106(5): 2506-2514. Gibbons, 8. (2005). Assessment & Rehabilitation of the Stability Function of the Psoas Major & the Deep Sacral Gluteus Maximus Muscles. Kinetic Control: Ludlow, UK. Holubcova, Z. (2013). Dynamic Neuromuscular Stabilization: Exercise Strategies. Course handouts: Chicago, IL ‘Myers, T.W. (2011). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2" ed. Elsevier: Edinburgh. Lee, D. (2011). The Pelvic Girdle. Fourth ed. Churchill Livingstone: Edinburgh. Lee, D. and Lee, L.J. (2013). Treating the Whole Person with The Integrated Systems Model. Discover Physio Course handouts: Vancouver, CA. Osar, E. (2013). Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. Lotus Publishing: Chinchester, UK. Osar, E. (2014). The Integrative Movement System™. The Integrative Movement Specialist Cettification™ Course handouts: Chicago, IL. Paoletti, S. (2002). The Fascia. Eastland Press Inc.: Seattle, WA. Richardson, C., Hides, J., Hodges, P.W. (2004). Therapeutic Exercise for Lumbopelvic Stabilization: a Motor Control Approach for the Treatment and Prevention of Low Back Pain, 2°4 Edinburgh. ed, Churchill Livingstone: Wetzler, G. (2014). The Listening Connection — Another Step to “Wow”. Discover Physio Course handouts: Vancouver, CA close httsi/wmw.ptonthenet.com/content/artcloprintaspx?p= "Article D=Mzg3MSBWUnISTBTSNDUsVaUmxEdHdqZWZBPTO= 616