Monday, September 29, 2008

Fascia & Trigger Points

Fascia is a specialized connective tissue layer surrounding muscles, bones and joints and gives support and protection to the body. It consists of three layers - the superficial fascia, the deep fascia and the subserous fascia. Fascia is one of the 3 types of dense connective tissue (the others being ligaments and tendons) and it extends without interruption from the top of the head to the tip of the toes.
Fascia is usually seen as having a passive role in the body, transmitting mechanical tension, which is generated by muscle activity or external forces. Recently, however some evidence suggests that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics.
Obviously, if this is verified by future research, any changes in the tone or structure of the fascia could have significant implications for athletic movements and performance. This research notwithstanding, the occurrence of trigger points within dense connective tissue sheets is thought to be correlated with subsequent injury.
Trigger points have been defined as areas of muscle that are painful to palpation and are characterized by the presence of taut bands. Tissue can become thick, tough and knoted. They can occur in muscle, the muscle-tendon junctions, bursa, or fat pad. Sometimes, trigger points can be accompanied by inflammation and if they remain long enough, what was once healthy fascia is replaced with inelastic scar tissue.
It has been speculated that trigger points may lead to a variety of sports injuries - from camps to more serious muscle and tendon tears. The theory, which seems plausible, is that trigger points compromise the tissue structure in which they are located, placing a greater strain on other tissues that must compensate for its weakness. These in turn can break down and so the spiral continues.
According to many therapists, trigger points in the fascia can restrict or alter the motion about a joint resulting in a change of normal neural feedback to the central nervous system. Eventually, the neuromuscular system becomes less efficient, leading to premature fatigue, chronic pain and injury and less efficient motor skill performance. An athlete's worst nightmare!
What causes a trigger point to form?
The list of proposed causes includes acute physical trauma, poor posture or movement mechanics, over training, inadequate rest between training sessions and possibly even nutritional factors.
Self myofascial release is a relatively simple technique that athletes can use to alleviate trigger points. Studies have shown myofascial release to be an effective treatment modality for myofascial pain syndrome although most studies have focused on therapist-based rather than self-based treatment.
1. Approximately 80 percent of the main trigger point sites lie on points located on the meridian maps (Wall & Melzack 1990). Indeed, many experts believe that trigger points and acupuncture points are the same phenomenon (Kawakita et. al. 2002).
2. Dr. Langevin and her research colleagues have shown that acupuncture points, and many of acupuncture localized "points" lie directly over areas where there is a fascial cleavage, where sheets of fascia diverge to separate, surround and support different muscle bundles (Langevin et. al. 2001).
3. It seems that the traditional Chinese meridians may, in fact, be fascial pathways.
4. A QUESTION THAT THE RESEARCHERS ARE TRYING TO ANSWAR: This is not too surprising, since we know the fascial network represents one continuum from the internal cranial reciprocal tension membranes to the plantar fascia of the feet.
We know acupuncture points (and it seems the majority of trigger points) are structurally situated in connective tissue, but how does application of a needle or pressure in one part of the fascia translate to distant sites? How does the fascia communicate with other parts of the body?
Researchers from University of Vermont have also shown that connective tissue is a sophisticated communication system, of as yet unknown potential.
Loose' connective tissue forms a network extending throughout the body including subcutaneous and interstitial connective tissues. The existence of a cellular network of fibroblasts within loose connective tissue may have considerable significance as it may support yet unknown body-wide cellular signaling systems. ...
According to Langevin et al’s (2004) findings; Soft tissue fibroblasts form an extensively interconnected cellular network, suggesting they may have important, and so far unsuspected integrative functions at the level of the whole body.

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