4 Disorders You Didn’t Know Are Linked to Fascial Dysfunction
Dr. Edythe Heus
June 18, 2024

There were clinicians who, as early as the early 20th century, recognized just how vital fascia is to our well-being. One of them was Andrew Taylor Still, the father of osteopathic medicine, who wrote in 1910:

“The fascia gives one of, if not the greatest problems to solve as to the part it takes in life and death. It belts each muscle, vein, nerve, and all organs of the body. By its action we live, and by its failure we shrink, or swell, and die.”   

It seems curious, then, that for the greater part of the past 100 years, the fascia has been overlooked by the medical field. It was seen as only a covering, discarded during dissections to examine the ‘more important’ muscles and organs.

Thankfully, the fascia is getting more attention from doctors and researchers, who now acknowledge it as a key to understanding and treating various musculoskeletal disorders. Here are four whose connection to the fascia might surprise you:

1. Diabetic Foot

Most of us are well aware that people with diabetes are more prone to foot issues due to the high levels of sugar in their blood. However, our understanding of how diabetes impacts the foot is incomplete.

It turns out that the fascia is crucial in explaining the far-reaching effects of diabetes on the foot. Excess glucose in the blood causes nonenzymatic glycosylation, a process in which free glucose attaches to collagen proteins. Aside from changing the structure of the fascia, this process also produces advanced glycosylation end-products (AGEs), which promote degeneration.

The plantar fascia (the fascia of the foot) is essential in:

  • organizing the muscles of the foot for optimized movement,
  • supporting local nerves and blood vessels, and
  • absorbing shock during walking and running.

Increased blood sugar hampers all of these functions, which then lead to the many symptoms experienced by individuals with diabetic foot:

  • changes in foot shape and impaired movement,
  • loss of sensation and proprioception (awareness of our body’s positioning in space), and
  • decreased foot cushioning.

2. Frozen Shoulder

Otherwise known as adhesive capsulitis, frozen shoulder is a painful condition restricting movement involving the shoulder joint. At the moment, experts have yet to determine precisely what causes this problem to occur. However, many studies point to fascial dysfunction as an explanation.

Biopsies reveal that patients with frozen shoulder have an increased amount of fibroblasts and myofibroblasts in the affected shoulder capsule. Fibroblasts are cells that help produce fascia, while myofibroblasts help with wound healing.

While they are helpful in the fascia’s normal function, too much of both can cause fibrosis, the thickening and scarring of tissue. Fibrosis hampers the normal gliding of the fascia, which is crucial for smooth and pain-free movement.

Fascial treatment and training help control the proliferation of fibroblasts and myofibroblasts and facilitate the healthy gliding of the fascial layers, curbing the symptoms of frozen shoulder.

The effectiveness of these modalities was observed in a case study of a 38-year-old man with a frozen right shoulder. Prior to treatment, he reported burning pain and was only able to raise his arm to his side by up to 90° and rotate his shoulders up to 70°. After only ten sessions of fascial manipulation and training, his range of motion was restored by 140° and 90°, respectively, and his pain went away.

3. Lymphedema

Lymphedema is a disease arising from blockages in the lymphatic system—the body network responsible for draining waste material from the body and filtering out harmful bacteria. It is characterized by the accumulation of lymphatic fluid in the body, causing swelling in affected areas.

This condition is classified as either genetic or acquired. Genetic or primary lymphedema often co-occurs with vascular diseases, which affect the blood vessels. Meanwhile, acquired lymphedema is believed to stem from cancer or surgery.

What’s often missing in discussions of lymphedema is how the lymphatic system is enveloped and supported by the fascia. The lymphatic system does not have an organ like the heart to pump liquid throughout its network. Instead, it relies on the fascia to push the lymphatic fluid through its vessels.

Some experts suggest that the arrangement of the collagen and elastin fibers in the superficial fascia helps guide lymphatic fluid in the right direction. When this organization is altered, lymphatic drainage is hampered. Stiffness in the fascia also restricts the lymphatic vessels, slowing down the flow of liquid.

Taking the fascia into account, it’s easier to puzzle out why primary lymphedema is commonly seen with vascular problems. Both the lymphatic and vascular systems run through and are enclosed by the superficial fascia.

Furthermore, surgeries often scar the fascia, which causes stiffness and, ultimately, lymphedema. That’s why swelling is all too common among patients recovering from surgery. A study demonstrated that preserving the fascia during lymph node dissection to check for cancer cells lowers the incidence of edema.

4. Hypermobility

A person with hypermobility has the capability to move their joints in a range most other people cannot access. It can manifest in one or many joints in the body.

While most cases of hypermobility are asymptomatic, some present with persistent pain, easy bruising, and chronic fatigue. These comorbidities indicate that a person might have hypermobility spectrum disorder. Other symptoms include:

  • digestive problems
  • poor proprioception
  • autonomic dysfunction (e.g., difficulty regulating temperature, light-headedness from changing postures)
  • poor wound healing

Hypermobility is caused by a genetic abnormality in collagen production. This protein gives structure and strength to our fascia, which in turn supports and shapes our body.

Dysfunction in the fascia explains why, in addition to mobile joints, hypermobility comes with a variety of issues. Our organs are enclosed and supported by visceral fascia. Its laxity due to decreased collagen may cause gastrointestinal problems. Furthermore, the superficial and deep fascia contain the most amount of sensory receptors, which tell us where we are in space. That’s why unhealthy fascia leads to poor proprioception.

Most online resources identify hypermobility as a connective tissue disorder but fail to mention fascia specifically. That means they also overlook fascial training as a viable treatment modality, which has been beneficial for my patients with symptomatic hypermobility.

Keeping Your Fascia Healthy          

Looking at these four seemingly unrelated disorders, it becomes quite clear that there are very few conditions that are unaffected by the fascia. There is even research being conducted to examine the role of fascia in fighting cancer.

As such, we should strive as much as we can to keep the fascia healthy. Manual therapies like Fascial Manipulation® by Luigi Stecco, of which I am a practitioner, have been proven to improve the health of the fascia and alleviate the symptoms arising from its dysfunction.

However, I find that manual therapy alone is not enough—it should also be accompanied by exercise for its results to become more lasting. That’s why I have all my patients do Rev6, the movement program I developed with the health of the fascia in mind.

Training with Rev6 improves the tone of the fascia and gets rid of the densifications that form due to immobility. It has helped my patients eliminate pain and live a more active life. I invite you to explore Rev6 and reap the benefits of fascial training with my free foundations class.

Sources:

Bourne, M., Talkad, A., & Varacallo, M. (2023, August 14). Anatomy, Bony Pelvis and Lower Limb, Foot Fascia. National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK526043/

George, T. & De Jesus, O. (2023, March 12). Physiology, Fascia. National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK568725/

Ghorbanpour, A. (2020). Fascial Treatment in Frozen Shoulder: A Case Report. Journal of Modern Rehabilitation 13(2), 122-127. https://doi.org/10.32598/JMR.13.2.123

Klingler, W., Velders, M., Hoppe, K., Pedro, M., & Schleip, R. (2014). Clinical relevance of fascial tissue and dysfunctions. Current pain and headache reports, 18(8), 439. https://doi.org/10.1007/s11916-014-0439-y

Langevin H. M. (2021). Fascia Mobility, Proprioception, and Myofascial Pain. Life (Basel, Switzerland), 11(7), 668. https://doi.org/10.3390/life11070668

Langevin, H. M., Keely, P., Mao, J., Hodge, L. M., Schleip, R., Deng, G., Hinz, B., Swartz, M. A., de Valois, B. A., Zick, S., & Findley, T. (2016). Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology. Cancer research, 76(21), 6159–6162. https://doi.org/10.1158/0008-5472.CAN-16-0753

Lawton, G., Rasque, H., & Ariyan, S. (2002). Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma. Journal of the American College of Surgeons, 195(3), 339–351. https://doi.org/10.1016/s1072-7515(02)01230-9

Pirri, C., Fede, C., Pirri, N., Petrelli, L., Fan, C., De Caro, R., & Stecco, C. (2021). Diabetic Foot: The Role of Fasciae, a Narrative Review. Biology, 10(8), 759. https://doi.org/10.3390/biology10080759

Sleigh, B. C. & Manna, B. (2023, April 19). Lymphedema. National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK537239/

Stecco, A., Stern, R., Fantoni, I., De Caro, R., & Stecco, C. (2016). Fascial Disorders: Implications for Treatment. PM & R : the journal of injury, function, and rehabilitation, 8(2), 161–168. https://doi.org/10.1016/j.pmrj.2015.06.006

Stecco, C., Driscoll, M., Huijing, P., & Schleip, R. (2021). Fascia: The Tensional Network of the Human Body. Elsevier Health Sciences.

Still A.T. (1910). Osteopathy research and practice. Kirksville. MO.