Fascial Densification: What It Is, How It Affects You, and How You Can Treat It
Dr. Edythe Heus
March 21, 2024

Whenever you feel pain and tightness in your body, what do you attribute it to?

Like most of my patients, you must be thinking your overworked muscles, arthritic joints, or aging body are to blame.

Upon investigation, my patients’ theories are often proven wrong. Most of the time, an underlying condition causes their symptoms.

It’s called fascial densification.

This painful condition also causes a whole host of issues, such as movement aberrations, nerve entrapment, circulatory restriction, and autonomic dysfunction.

Thankfully, this alteration of the fascia is reversible. Make sure to read until the end to find out how you can remodel your fascia back to a healthy state!

What is the fascia’s structure and function?

Before we begin diving into fascial densification, we need first to establish a good understanding of the fascia.

The fascia is an interconnected web of collagenous protein and elastin fibers. It was previously thought to have only mechanical functions in the body—to enclose, attach, and separate muscles and internal organs.

However, emerging research demonstrates that the fascia is also involved in metabolism and communication within the body. According to the Foundation of Osteopathic Research and Clinical Endorsement (FORCE) scholars, the fascia is…

“…the result of the evolution of the perfect synergy among different tissues, liquids, and solids, capable of supporting, dividing, penetrating, feeding, and connecting [all the parts of the body]. The continuum constantly transmits and receives mechano-metabolic information that can influence the shape and function of the entire body.”

Depending on its location, the fascia can be classified into four categories:

  • Superficial (directly under the skin),
  • Deep (surrounding bones, muscles, nerves, and blood vessels),
  • Visceral (further classified into investing and insertional, these surround organs such as the lungs and heart and attaching them to the parietal fascia), and
  • Parietal (lining the body’s cavities such as the pelvic, thoracic, and cranial cavities).

Deep fasciae occur in two to three layers of fiber bundles arranged like waves. Each layer is separated by loose connective tissue containing fasciacytes. This specialized cell produces hyaluronic acid (HA), which acts as a lubricant for the fascia to glide over one another.

What is fascial densification and what causes it to happen?

Fascial densification happens when the HA that is supposed to lubricate the deep fascial layers becomes adhesive.

This change happens when the structure and concentration of HA molecules are altered. Short and long-chain HA molecules get tangled into complex nets, becoming more viscous. This increased viscosity hinders the fascial layers from gliding smoothly over one another.

A couple of reasons can trigger this process.

First is immobility. One factor that encourages HA production and turnover is movement. When sedentary, the HA already occurring in our loose connective tissue fails to be recycled, increasing its concentration. This build-up of HA leads to densification.

Second is inflammation. When our bodies are wounded, our fasciacytes produce more HA to promote healing and protect our cells. This process has the unwanted consequence, however, of promoting dysfunction in the fascia.

Third is stress. HA becomes more viscous due to mechanical, pH, or temperature changes, and dehydration. Stressors include lactic acid build-up from strenuous exercise and colder temperatures.

What are the effects of densified fascia?

The superficial and deep fascia are the sites of many sensory receptors, namely:

  • nociceptors (pain),
  • proprioceptors (body position and movement),
  • mechanoreceptors (touch, pressure, vibration, and sound), and
  • thermoreceptors (temperature).

Being richly innervated with these receptors makes the fascia essential fo many functions. Among many other responsibilities, the fascia transmits muscle force and aids in proprioception and motor and postural control.

It thus comes as no surprise that dysfunction in the fascia results in a variety of issues, such as:

Pain

Healthy deep fascia easily slides over one another. When this gliding motion is hampered due to densification, tension in the fascia occurs, leading to pain.

A study that looked at the shear strain of the thoracolumbar fascia demonstrates this effect. Shear strain is a measure of the fascia’s gliding motion. The researchers found that those with chronic lower back pain had approximately 20% less shear strain than those without.

Aside from causing tension, densification also activates the nociceptors in the fascia, contributing to pain.

Muscle Stiffness and Reduced Range of Motion

The deep fascial layers not only glide over one another but also over the muscles they enclose. This movement is crucial in the transmission of force between the muscles.

Reduced force transmission due to densified fascia leads to muscle stiffness and reduced range of motion. Studies have shown that individuals suffering from muscle stiffness do indeed have a higher concentration of HA than normal controls.

Nerve Entrapment

If you can recall, the deep fascia not only surrounds muscles and bones but also blood vessels and nerves. When the environment surrounding the nerves changes, nerve entrapment can happen.

One such alteration is fascial densification. Other than certain tunnel syndromes, most types of entrapment are caused by compression by the fascia and other connective tissue.

Common types of nerve entrapment include sciatica and sural nerve entrapment, which can cause numbness and pain in the lower extremities.

How is fascial densification treated?

Due to the properties of HA, it is possible to reverse densification in the fascia. As you may recall, HA becomes more viscous because of changes in temperature, pH, and mechanical pressure. Thus, it stands to reason that HA can return to a less viscous state in the same fashion.

The HA superstructures in the loose connective tissue break down in temperatures hotter than 40°C. This explains why physical therapies that use heat have anecdotally been found to relieve myofascial pain.

Injecting hyaluronidase, an enzyme that breaks down HA, can also be a viable solution to fascial densification. Small clinical trials have shown that patients with post-stroke muscle stiffness presented with less stiffness after the injection.

Fascial Manipulation®, developed by Luigi Stecco and his children Carla and Antonio, is a manual therapy specifically targeting fascial densifications. Many studies have confirmed its effectiveness in reducing pain and densification thickness.

Treating and Avoiding Densified Fascia with Exercise

If you don’t have access to the treatment methods mentioned above, the good news is there is a way for you to do it yourself.

Armed with decades of clinical experience and a deep understanding of the fascia, I created exercises and sequences specifically to restore the fascia to its optimal state. The result is Rev6.

Remember how both immobility and overuse promote densification? Rev6 sits at the very middle of the spectrum. Our exercises involve fluid, efficient, and dynamic movement—promoting turnover of HA without building up lactic acid.

Rev6 will also reveal where in your body your fascia is densified, and reduce that densification over time. With each workout, you will feel your body getting stronger, more responsive, and more resilient to stressors. Even I get surprised at how potent Rev6 is at treating densifications—my patients and students are living proof. If you would like to experience the transformative effect of Rev6 yourself, here is where you can get started.

Source:

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Bordoni, B., Mahabadi, N., & Varacallo, M. (2022, July 18). Anatomy, Fascia. National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493232/

Gatt, A., Agarwal, S., & Zito, P. M. (2022, July 25). Anatomy, Fascia Layers. National Center for Biotechnology Information Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK526038/

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