Defining fascia is a challenge. Experts have agreed that it’s difficult to define, while agreeing to disagree on a definition. There’s even a Fascial Nomenclature Committee tasked by the Fascia Research Society to shed light on the ambiguity! Should definitions be black or white? Perhaps, gray is the right answer? Let’s take a closer look without getting stuck on the minutia. But wait, isn’t the minutia what we should be looking at? Yep, that’s how this article is going to go.
How time changes all things (the evolution of the definition of fascia):
- Crooke in 1651 – A membranous tendon (qtd. Adstrum 2017)
- Hall in 1788 – A membranous part (qtd. Adstrum 2017)
- Goldman 1824 – A distinct section of strong fibrous tissue, and membranous tissue enveloping organs (qtd Adstrum 2017)
- Ellis 1840 – A distinct superficial or deep layer of connective tissue
- Gray 1858 – A distinct aponeurotic or fibro-areolar type of connective tissue
- Still 1899 – A global connective tissue system
- FCAT 1998 – A sheath, sheet, or other dissectable mass of connective tissue
- Findley & Schleip 2007 – The soft tissue component of the connective tissue system that permeates the human body forming a whole-body continuous three-dimensional matrix of structural support
The definition of fascia evolved from a membranous tendon, to just about everything you could point to in the human body. The reason for the broadened definition over time, is that as fascia continued to be researched it became evident that it acted more like an interconnected web or matrix, that spread in 3 dimensional fashion throughout human tissue. The dilemma with the broadened definition, is that fascia is left as a generic term without a precise anatomical delineation.
The exploration into fascia is best summarized by a quote from the poet Percy Bysshe Shelley:
“The more we study, the more we discover our ignorance.”
Physicians and therapists who assess and treat the musculoskeletal system, have a keen understanding of how injury or dysfunction in one area of the body, can create negative effects on another area of the body. To them, a broadened definition of fascia as a three-dimensional matrix permeating the human body, makes sense. However, to the anatomist or researcher who must make clear anatomical delineations of different tissues of the body, the broadened termed for fascia is not very helpful.
To remedy the definition issue, two distinct terms with two distinct definitions have been proposed by the Fascial Nomenclature Committee:
- Fascial System – a holistic view of fascia
- Fascia(e) – fascia in a singular sense
The Fascial System:
The fascial system consists of the three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissues that permeate the body. It incorporates elements such as adipose tissue, adventitiae and neurovascular sheaths, aponeuroses, deep and superficial fasciae, epineurium, joint capsules, ligaments, membranes, meninges, myofascial expansions, periostea, retinacula, septa, tendons, visceral fasciae, and all the intramuscular and intermuscular connective tissues including endo-/peri-/epimysium.
The fascial system interpenetrates and surrounds all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment which enables all body systems to operate in an integrated manner.
A fascia is a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs.
It’s clear that fascia and the whole fascial system are an important part of our musculoskeletal system. After all, they provide structure and function. This is an important topic of conversation, not only in sports medicine where soft tissue injuries are common, but in physical pain in general. Changes in the fascia over time are believed to play a significant role in the perpetuation and development of musculoskeletal pain disorders, such as neck pain and lower back pain. Therefore, the health of our fascia over time, is an important part of remaining pain free and active.
Fascia is affected intrinsically by age, weight, gender, disease and extrinsically by sports injuries, overloading the musculoskeletal system, and occupational demands on the body. Knowing that these tissues in our bodies respond to load biologically and physically, stressing the fascia (in a good way) by manual manipulation and exercise, can play a vital role in the repair and maintenance of our fascia.
Adstrum, S., Hedley, G., Schleip, R., Stecco, C., & Yucesoy, C. A. (2017). Defining the fascial system. Journal of Bodywork and Movement Therapies, 21(1), 173-177. doi:10.1016/j.jbmt.2016.11.003
Stecco, C. (2014). Why are there so many discussions about the nomenclature of fasciae? Journal of Bodywork and Movement Therapies, 18(3), 441-442. doi:10.1016/j.jbmt.2014.04.013
Zügel, M., Maganaris, C. N., Wilke, J., Jurkat-Rott, K., Klingler, W., Wearing, S. C., … Hodges, P. W. (2018). Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics. British Journal of Sports Medicine, bjsports-2018-099308. doi:10.1136/bjsports-2018-099308