Adventures in the
Jungle
of the Neuro-Myofascial Net
by Robert Schleip
First
published in: ROLF LINES, Vol 26, No.5, p.35-37 (1998)
This is part 2 of a series focusing on the
intricate network connecting fascia and the neuromuscular coordination system.
Part 1 focused on the function of interstitial muscle receptors as well as new
research on neural gravity receptors within fascia1. Future
continuations of this series are planned, dealing with e.g. thixotropy,
short-term fascial plasticity, and internal body representations. The following
quote by the founder of osteopathy underlines the fundamental quest of this
series:2
"The soul of man with all the streams
of pure living water
seems to dwell in the fascia of his body.
When you deal with the fascia,
you deal and do business with the branch
offices of the brain,
and under the general corporation law, the
same as the brain itself,
and why not treat it with the same degree
of respect."
Andew Taylor Still, Philosophy of Osteopathy, 1899
An
Interview with Prof. Dr. med. J. Staubesand
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Fig.1: Prof. Dr.med. J.Staubesand
R.S.: Professor Staubesand, you have made some interesting research
findings about fascia. It seems to me that these findings could have some
importance for manual therapists working with connective tissue. Could you
briefly describe what your findings are?
Prof.S.: We did some electron photomicrograph studies of the Fascia
Cruris, which is the connective tissue covering the lower leg in humans. Rather
surprisingly we found isolated smooth muscle cells within the fascia.
Additionally we found some intrafascial nerve fibers and sensory nerve endings
which have not been reported previously.
Let's start with the smooth muscle cells you found in fascia. Do you
think they have any functional significance?
That is indeed possible, although at this time one cannot say for sure.
There are all kinds of transitional stages between smooth muscle cells on the
one hand and fibroblasts - from which smooth muscle cells generally originate -
on the other hand. Some authors therefore even speak of `myofibroblasts'. It
seems that fibroblasts are generally able to differentiate into smooth muscle
cells. Another factor is that because of the microscopically thin layers of
tissue that we examined in our electron photomicrographic studies, we are not
yet able to say anything about the relative 3-dimensional density of those
smooth muscle cells within fascia. Yet it appears likely that these smooth
muscle cells are there for a functional reason. Based on our findings it seems
quite possible that the body is able to regulate a fascial `Vorspannung'
(pre-tension) via those smooth muscle cells, in order adjust to different
muscular tonus demands. This function would also explain the amazingly
widespread presence of autonomic nerves and capillaries which we found in
fascia.
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Now, such an active regulation of the fascial tonus appears to me to
shift our picture of fascia dramatically. The fascial tonus is then much more
intimately connected with the nervous system and especially the autonomic
nervous system.
Yes. It is true that such a function puts fascia into a very different
picture than in the past, where it was believed that fascia would only adjust
passively to short term changes in tensional demands. In the past, medical
science regarded fascia mostly as something of secondary importance, and one
can say that fascia has been mostly neglected in its function. Medical students
were trained not to respect fascia, by learning to chop it away in their
dissections as a very first thing, in order to study the functionally important
elements of the body. Yet this new picture of fascia as an actively adapting
organ and the widespread existence of various intrafascial neural receptors,
puts fascia into a much higher functional importance.
So let's talk about these intrafascial nerves. What kind of nerve supply
did you find in the fascial sheets that you studied? Are these sympathetic
fibers?
This we can't say with certainty. Further studies are necessary to
clarify this question. Yet what we can say is that there are myelinated, as
well as unmyelinated nerve fibers in fascia. The myelinated axons are generally
regarded as sensory. The unmyelinated nerve fibers could have motor functions
as the efferent nerves of the autonomic nervous system to the smooth muscle
fibers, or they could also serve other autonomic nervous system functions.
Based on studies from Heppelman and others3 about pain receptors in the joint capsule
of the knee in cats and because of striking similarities between the observed structures
of humans and cats, we can assume that there are also pain receptors in the
fascial tissues that we examined in humans.
In our studies we found that what had previously been described as
perforations of the superficial fascial layer by the venae perforantes, are
regularly created by a triad of vein, artery and nerve. And these perforations
are quite numerous. For example in we humans there are about 150 such triade
perforations in each leg.
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This sounds to me as if you could be talking now about the same fascial
perforation points as Prof. Hartmut Heine4. What I understood is that Heine
showed recently that the locations of the traditional Chinese acupuncture
points - or to be more precise: at least 82% of those points - are
topographical identical with fascial perforation points in which the
superficial fascia is perforated by a triad of vein, artery and nerve. Do you
see a correspondence between your described fascial perforation points and
those acupuncture points or - and this is perhaps a different question - a
correspondence between your perforation points and what has been described as
myofascial Trigger points?
I have yet to read Prof. Heine's research about acupuncture points
myself. So I can't say anything about it. The same applies to trigger points:
it is quite possible that they do relate to some of our anatomical findings.
Yet we don't have enough data at this point to say so definitely.
In your publications you also mentioned a possible relevance for the
understanding and treatment of fibromyalgia. Could you explain this?
With fibromyalgia the main understanding has been that the pain
receptors would be in the muscle tissue. Yet now we know that there are many
sensory receptors, including pain receptors in fascia, which points our
attention in fibromyalgia, as well as many other kinds of soft tissue pain
syndromes, to a much higher value of therapeutic interventions in the fascia
itself.
What would you suggest could be the most important relevance of all
those findings in your recent research for us as manual therapists?
I believe that the most important aspect of our findings for your work
is in regards to the innervation of fascia. The receptors that we found in the
lower leg fascia in humans could be responsible for several types of myofascial
pain sensations. If you could influence these fascial receptors with your
manipulation this could be of significant importance.
Another and more specific aspect is the innervation and direct
connection of fascia with the autonomic nervous system. It now appears that the
fascial tonus might be influenced and regulated by the state of the autonomic
nervous system. Plus - and this aspect should have ramifications for your work
- any intervention in the fascial system might have an effect on the autonomic
nervous system in general and upon all the organs which are directly effected
from the autonomic nervous system. To put it more simply: any intervention on
fascia is also an intervention on the autonomics.
Prof. Staubesand, to complete this brief interview: where, and in what
setting have your studies been done? And where have they been published so far?
I am now Emeritus Professor of Anatomy at the Anatomical Institute of
the Albert-Ludwigs-University of Freiburg, Germany. Together with my co-worker
Dr. Yi Li, from China I have mostly concentrated my work there in the last
decade or so on the microstructural analysis of the fascia of the lower leg. We
have published these studies in numerous scientific journals since about 1984.
Those specific and newer findings that we talked about today have been
published so far in `Manuelle Medizin' 5 Vol.34, as well as in `Phlebologie'
Vol.26. Both are professional medical journals with full text versions in
German and their abstracts written in English.
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 Fig.5 Intrafascial
smooth muscle cell found in Fascia Cruris |
"This is pure unadulterated notion,
but I think it is the mesodermal systems
that give access to control of the
autonomic functions of the body."
Ida P. Rolf
