The Fascial System in Musculoskeletal Function and Myofascial Pain
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SPORTS MEDICINE REHABILITATION (B LIEM AND BJ KRABAK, SECTION EDITORS)
The Fascial System in Musculoskeletal Function and Myofascial Pain Kimia Grace Ganjaei 1 & Jeremiah W. Ray 2,3 & Brandee Waite 2 & Kevin J. Burnham 2,4 Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This article aims to discuss the structure and function of fascial systems and the potential role in myofascial pain syndromes. Recent Findings New terminology differentiates anatomic structure (fascia) and function (fascial system), improving the conceptual framework and communication. Fascia has been shown to be innervated and biologically active and may have roles in nociception, proprioception, and myofascial force transmission. A number of factors may modify the function of fascial tissues through altering stiffness. A new cell type, “fasciacytes,” produces hyaluronic acid, a molecule critical to fascial lubrication. Fascial contribution to myofascial pain syndromes remains unclear, though plausible mechanisms connect them, and direct evidence of fascia-mediated pain exists. Current evidence is limited to support fascia-directed therapies for myofascial pain syndromes. Summary Developing evidence implicates fascial tissue in musculoskeletal function and myofascial pain syndromes. Further investigation into fascial physiology and pathophysiology is needed to translate this knowledge into clinical care. Keywords Fascia . Myofascial . Pain . Proprioception . Function . Mechanotransduction
Introduction The term fascia is commonly used in anatomical descriptions; however, the specific definition has been elusive [1•]. Similarly, fascia is inherent in the concept of myofascial pain, though this nomenclature is often inconsistent, and the associated pathophysiologic understanding remains incomplete [2]. Recent work has provided more concrete terminology and insights into the role(s) that fascia may play in musculoskeletal function and myofascial pain. This review aims to This article is part of the Topical Collection on Sports Medicine Rehabilitation * Kevin J. Burnham [email protected] 1
Internal Medicine Residency, Department of Internal Medicine, UC Davis Health, Sacramento, CA, USA
2
Sports Medicine Section, Department of Physical Medicine and Rehabilitation, UC Davis Health, Sacramento, CA, USA
3
Department of Emergency Medicine, UC Davis Health, Sacramento, CA, USA
4
Division of General Internal Medicine, Geriatrics & Bioethics, Department of Internal Medicine, UC Davis Health, 4860 Y Street, Suite 0400, Sacramento, CA 95817, USA
provide an overview of the terminology, physiology, and pathophysiology of the fascial system and its potential roles in the musculoskeletal function and myofascial pain.
Definition and Terminology Some of the difficulty surrounding fascial terminology may arise from the coexistence of incompletely overlapping meanings for the term fascia. More precise and useful definitions, differentiating between the anatomical term a fascia and
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