Underlying mechanisms of neuro-fascial body interactions
Myofascial interactions in pain and dysfunction are gaining more and more popularity as new research continues to demonstrate their clinical relevance. The present study attempted to consolidate the currently available literature on changes that can occur within the fascia, to re-integrate our understanding of the connection between the fascial and neurological system. From an osteopathic perspective, this two part review proposes that manual interventions have several methods of interaction on fascia at the local, segmental and global levels.
Structural changes in the fascia are shown to occur following manual therapy, which suggests palpable changes in the organization and hydration state of the connective tissue. By reducing abnormal crosslinking in the collagen interventions can increase the hydration matrix of the tissue and increase the thickness of the fascial layers.
At the cellular level, various forms of strain (brief, static, dynamic) applied to fascia can alter the communication pathways between cells, resulting in detectable change both in vivo as well as in vitro. Fibroblasts demonstrate remarkable capacity to modulate their own structure and immediate environment based on the forces imposed upon them.
When looking at the neuromuscular interactions, research suggests that Ruffini nerve endings located in deep connective tissue are the most likely involved in myofascial neuromuscular adaptation. Mechanoreceptors mainly concentrated in the transitional areas within the muscular tendinous junctions can be proprioceptively modulated to down regulate efferent muscle tone.
Autonomically, adrenergic fibers located in the fascia can play a major role in vasodilation. Reflexive dilation of the extracellular matrix can then impact the transition from a dense solid state (gel) to fluid (sol) state. During the acute onset of inflammation from manual therapy, the extracellular matrix swells allowing the interstitial fluid pressure (fluid dynamics) to drop. Higher vascular osmotic pressure in turn results in greater fluid flow and nourishment to the treated area.
When investigating the neuro-endocrine system it was found that manual therapy can decrease circulating inflammatory markers and create measurable hormonal changes for days following treatment.
The fascial network represents the only tissue capable of unifying the intracellular and extracellular connections throughout our body. The interactions above are meant to illuminate the complexity of this system, while the authors go further yet into the available literature on fascia. When considering the level of interaction at the local, global and segmental levels listed above, it is apparent that as therapists, we need to consider the necessity for a multidisciplinary approach to tackling all of the factors involved.
> From: Tozzi, J Bodyw Mov Ther (2016) 18(Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the Pubmed summary.