The Web of Life
by Andrew Hefferman
Just beneath your skin lies a complex network of connective tissue called fascia. It helps you move well, stand straight and play hard. Keeping it healthy might be one of the fastest – and most overlooked – ways to improve your health and fitness.
There’s a good chance you’ve never heard of fascia: the stretchy, mesh-like substance that interweaves through and around your musculature, surrounds and supports your organs, and shrink-wraps your entire internal structure like a second skin.
But if you were able to peek beneath your epidermis, you’d probably be surprised to see that this messy, elastic white stuff — made of collagen fibers, and similar to the material that makes up your ligaments and tendons — is virtually everywhere.
Unlike muscles and bones, though, fascia has historically been given so little attention by therapists, trainers and other fitness pros that it’s not even on the standard gym-wall anatomy chart.
“From an anatomical perspective, fascia is often seen as ‘the gunk you cut through to get to the good stuff,’” says corrective exercise specialist Anthony Carey, MA, owner of Function First in San Diego, Calif., and a leading fascia expert.
In recent years, however, some forward-thinking trainers and therapists have begun to recognize that this seemingly inconsequential webbing plays a far more important role in everyday functioning than was once believed.
Building on ideas outlined by anatomy teacher and bodyworker Thomas Myers in his book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists (Churchill Livingstone, 2009), these therapists have begun to devise ways to improve the quality and elasticity of the fascia directly through bodywork, stretches and targeted exercises.
Among these novel methods are Kinesis Myofascial Integration (KMI) — an approach to Rolfing developed by Myers — and Fascial Stretch Therapy (FST), founded by the husband and wife stretch-therapy team of Chris and Ann Frederick. These methods can significantly enhance the benefits of a stretching and strength program, making you stand taller, run faster and play harder. At the same time, fascial work often provides relief from chronic back and joint pain where many more conventional, muscle-based stretching and massage methods fail.
“Everybody needs to start incorporating the fascia into their conception of the musculoskeletal system,” says Myers. To his way of thinking, however, that may mean a fairly substantial shift in the way we think about how we’re made and how we move.
So if you still think “the foot bone’s connected to the ankle bone,” get ready to expand your thinking.
Facing the Fascia
Anatomy textbooks will tell you that the musculoskeletal system consists of thousands of separate parts: a couple hundred bones held together by more than 600 muscles and a near-countless number of ligaments and tendons. But Myers and Carey both assert that these divisions are largely artificial, created not by nature but by an anatomist’s scalpel.
“The fascia links the entire muscular system, not just muscle to bone but muscle to muscle, along with all the structures in the body, like organs, ligaments and tendons,” says Carey. “Whether you’re exercising or treating pain, it doesn’t make sense to treat it like a machine with separate parts because of this head-to-toe continuity.”
Seen from this perspective, Myers contends, “You don’t have 600-some-odd muscles, as we’ve always been taught: You have a single muscle with 600-odd stopping points, all linked by the fascial web.”
Far from the haphazard mesh that the first anatomists perceived, this fascial network is now described by researchers as sensitive, dynamic and extraordinarily adaptable. “There are 10 times as many more nerve endings in your fascia as there are in your muscles,” says Myers, making fascia far more susceptible to pain and sensation in general than your muscles are. “Most sports injuries are in fact failures of fascial structures, not muscle tissue.
“We say ‘muscles attach to bones,’” he continues, “but muscle can’t attach to anything. It’s formless, like hamburger. It’s the fascia that goes over and around and through your muscles that organizes that tissue into linear pulling machines.” When you perform a biceps curl, for example, the fascia of the biceps muscle shortens, tugging on your tendons and drawing your hand closer to your shoulder. And when you perform a quick, athletic movement — a layup in basketball, for instance — it’s the whip-fast elastic action of the fascia in your legs that transfers the force of those contracting muscles into the floor and launches you off the hardwood.
Through decades of experience as a bodyworker and an extensive study of anatomy, Myers began to notice that the fascial webbing appeared to be organized into distinct meridians, or “trains” — dense bands connecting multiple muscles and spanning multiple joints, tacked down at numerous bony “stations” along the way. If you were to think of the entire fascial network as a suit of clothing, these “anatomy trains” would be a series of elastic straps, suspenders and seams that give it structure and shape. Myers has found about a dozen of these fascial superhighways, which seem especially effective in understanding human movement and treating pain and dysfunction. Some run the length of your body, head to toe; others spiral the torso, shoot over the top of your head, and run down the middle of your back.
Like guy-wires on a well-rigged boat, a balanced, harmonious tension among these myofascial meridians helps support fluid, effortless movement. Too much chronic tension or slack in key meridians can, however, lead to poor posture and pain — and not always in the places you expect. Trace the fascial lines through the muscles and across the skeleton, and it’s possible to see, for instance, how shoulder pain might be caused by dysfunction in your opposite ankle, or how “tight hamstrings” might actually be caused by tension in the soles of the feet.
According to Myers’s model, it is through these myofascial lines, moreso than through individual muscles, that the body adapts to and reinforces alignment and movement. Says Carey, “Fascia adapts to every move you make — good, bad or indifferent.” Over time, a competitive rower, for example, might develop thicker fascia in her back and shoulders to support the repetitive movement of pulling oars. The fascia in the front of the rib cage of your typical desk jockey, on the other hand, may become thick and short to reinforce a habitually caved-in posture. And injuries, even minor ones, often result in fascial “patches” in the muscles that can cause restricted motion, leading to compensations in gait and movement. These might remain long after the injury itself has healed.
“Injured or poorly adapted fascia can start to act like glue, binding to muscles, other fascia, even your ligaments,” says Carey. In a sense, your entire individual life history — exercise habits, injuries, common sitting and sleeping positions — is written in your fascia.
Depending on these and other behavioral factors, fascial adhesions can subtly accrue over years and decades, leading to movement inhibition and sometimes chronic pain.
“Certain things in our bodies become tight, certain things become weak, and before you know it, our joints and limbs begin to make subtle twists and turns, making us a human game of Jenga,” jokes Sue Falsone, vice president of physical therapy at Athletes Performance and Team Sports in Phoenix.
The Tangled Web
So, think you might have a few kinks in your fascia? In a sense, if you’re already exercising and stretching regularly, you’re ahead of the game. “Muscles and fascia are so interwoven that you can’t affect one without affecting the other,” says Falsone.
Nevertheless, standard, static stretching and muscle-isolating exercises, while beneficial in some ways, often have little effect on deeply ingrained fascial tension, especially if, like most people, you spend a large portion of your day sitting down.
“If we spend months, years, even decades sitting at a desk and think that a few hours in the gym per week are going to undo all that, we’re probably fooling ourselves,” says Carey. Stretching a muscle with bound-up or poorly adapted fascia is a bit like trying to stretch a knotted bungee cord: You’ll get much better results if you get the knots out first.
Some of the best methods for untying these knots take a therapeutic approach, in which a practitioner works with an athlete or client on a massage-style table. Other methods have the client participate more actively, moving and stretching him- or herself in fascia-friendly patterns.
“Table work helps a client find more pliability and elasticity throughout the body,” says Carey. “Exercises help the client integrate the new range into their daily lives.” (For suggested exercises, see the Anatomy Trains at Work sidebar.)
Although KMI and FST are among the first treatments to fully integrate Myers’s anatomy-trains concept into their methodology, other treatments have had measurable impact on the suppleness of the fascia, including active release therapy, resistance flexibility and strength training, and even self-myofascial release with foam rollers and other implements. As Myers’s research gains wider recognition, it’s likely that massage therapists, bodyworkers and trainers in other fields — from yoga to Feldenkrais — may well begin to emphasize fascial relationships in their teachings as well. (For more on Feldenkrais, read “The Feldenkrais Fix.”)
Myers’s KMI approach, which builds on the Structural Integration model developed by Ida Rolf (of Rolfing fame), takes the form of about 12 structured, progressive hands-on sessions with a KMI-certified practitioner. (Find one in your area at www.anatomytrains.com/kmi/practitioners.)
Initially, the practitioner takes photos and makes detailed observations about the client’s carriage and posture, noting especially where his or her fascial meridians appear shortened or contracted. From that point, each session focuses on a specific area of the body, starting with more superficial muscles, working gradually inward toward the core as the sequence progresses, and, finally, incorporating fully integrated movement.
Throughout the treatment, the practitioner manually works out the fibrotic knots and scarring in the fascial tissues, restoring balance among the meridians by applying direct, sometimes fairly intense, pressure directly along the affected fascial lines. Although treatment can be painful at times, the results often feel terrific. Many people report marked improvements in everyday activities like sitting and standing, and even more impressive strides in active pursuits.
Forty-seven-year-old Nancy Di Benedetti, from Calgary, Alberta, began her KMI treatments with therapist Nadine Samila with the goal of touching her toes. “After the first session I was already walking differently. And after 12 sessions not only was I able to touch my toes, but I actually started skiing again,” she says.
Chris and Ann Frederick bring to bear many of Myers’s principles in their Fascial Stretch Therapy (FST) system, which takes an unusually gentle approach to athletic flexibility training. “When you stretch too quickly or intensely, as many athletes do, the muscles go into a protective mode, contracting and resisting,” says Ann. “To get around these protective mechanisms, you’ve got to romance — not attack — the nervous system for optimal results. If the client is in a relaxed, calm state, his or her muscles and connective tissue will be much more responsive to the work. So you can’t yank on a muscle or deliberately push past a person’s comfort zone.”
In practice, FST can be almost dancelike, as the practitioner slowly and rhythmically moves the client’s limbs in a series of slowly expanding arcs.
These gentle, oscillating movements can elicit a soothing, parasympathetic response from the client’s nervous system, much like rocking in a chair or swinging in a hammock. “I never push the joints to their limits. I just gently test the boundaries of what’s possible for them at that moment,” says Carey. “A rhythmic tempo lowers apprehension, allowing the trainer to get past resistance in the fascia and into the muscles themselves.”
This calm state also primes the client for learning new movement patterns, while at the same time, the broad, multidimensional movements stretch the entire fascial fabric in ways that conventional, single-plane stretching and many other types of therapy don’t.
“I once worked on an insurance executive who had knee pain from years of high school and college athletics. His doctors were at a loss because the joints themselves seemed fine,” says Chris Frederick. “Through soft-tissue work and some well-chosen stretches, I was able to create space in his hip joints and relax the tension in his hip flexors, which took the pressure off his knees. And the pain he had had for 10 years was gone.”
Frederick emphasizes that treating the whole person — rather than a single symptom or a single part of the body — can often mean paying attention to issues farther up and down the various meridian lines from the site of pain or dysfunction: “Where there’s pain,” he says, “ain’t usually where the problem is.”
DIY Anatomy Trains
Although working with a qualified therapist is the best way to deal with acute problems in the fascia, smart exercise choices involving the fascia can also help address some imbalances.
One very effective option is to focus on full-body movements like Olympic lifts (and their regressions) and medicine-ball throws. Working with implements like battling ropes, Indian clubs and kettlebells, rather than trying to build or work different body parts in isolation, can also be helpful. Many of these movements require a dynamic transfer of force from the ground, through the body, and out through the arms or hands, in a pattern that simulates a wave. Done correctly, these wavelike motions parallel the sequential, muscle-to-muscle transfer of force that occurs along the fascial meridians just below the skin. As a result, they help reinforce healthy, integrated relationships among the myofascial meridians.
You can approach flexibility training with a similar mindset: Rather than stretching one muscle group at a time, think about stretching an entire plane of the body at once, and of long movements that extend and spiral the body head to toe.
Myers recommends stretching in multiple planes, adding rotation of the feet to a toe-touching stretch, for example, in order to more fully stretch the fascia across the hamstrings, calves and lower back. The asanas in yoga and the gentle oscillations of Feldenkrais are good examples of fascia-releasing work that helps enhance flexibility. (For more specific exercise and stretching choices, see the “Anatomy Trains at Work,” sidebar.)
For greater suppleness throughout the fascial network, Myers also encourages people to incorporate bouncing of some kind in their workouts: skipping rope, jogging, jumping on a trampoline. “You lose elasticity in your fascia as you age. Kids exemplify that bouncy elasticity in their fascia, and bouncing helps you hold on to what you have.”
Variety, however, may be your best safeguard against tightness and adhesions in the fascia, notes Myers: “If there’s one thing I could say to people who wanted to get fit or stay fit, it would be ‘Stop repeating yourself!’”
Repetitive physical action — including forms of exercise like running or cycling — can leave its mark on the fascia, unnaturally tightening certain areas and eventually leaving you more susceptible to injury. The take-home lesson? Mix things up. Hike or cycle on uneven terrain, switch strength-training exercises frequently, and seek out new ways to move, through dance, sports, martial arts or other activities.
For some time now, progressive fitness professionals have been emphasizing integrated forms of exercise, from dynamic flexibility work to full-body strength training to outdoor exercise and Eastern-style movement. In a sense, the anatomy-trains model represents the anatomical basis for this approach: Just as the fascia links the muscles together in interconnected chains, so integrated exercise and movement link the muscles functionally, through dynamic, coordinated movement patterns.
In all likelihood, the more we can shift our perspective to see the body that way — as a whole system working together — the healthier we’ll be.
Andrew Heffernan, CSCS, is a contributing editor at Experience Life.
New ways to gain flexibility, improve performance, and protect against injuries.
By Beth Dreher
Watch a group of elite runners warming up and you won't see any of them bending over trying to reach their toes. Instead, you'll see athletes moving their bodies to improve their range of motion, increase flexibility, and guard against injury. "Stretching has progressed to a more functional, dynamic method," says physical therapist Chris Frederick, codirector of the Stretch to Win Institute in Tempe, Arizona. "It helps runners of all levels perform better."
You may be familiar with dynamic warmup moves like butt kicks and high-knee marches. But physical therapists and trainers have developed other ways to stretch your body in a more functional way. Consider the upsides and downsides of these three new methods to decide which works best for you.
FASCIAL STRETCH THERAPY
Unlike stretching that attempts to isolate and stretch specific muscles, fascial stretch therapy (FST) targets fascia, the connective tissue found in, around, and between joints. To stretch the fascia, a certified FST therapist gently pulls then moves the legs, arms, spine, and neck in a smooth motion at various angles to remove pressure between joints, release joint-lubricating synovial fluid, and improve flexibility of muscles. "The function of muscles cannot be separated from the movement of fascia," says Frederick, who has worked with Olympic gold-medal sprinter Sanya Richards. After an initial session with a therapist, runners can continue this stretch therapy on their own.
UPSIDES: "Runners tell us that after the first FST session they move with more ease and feel stronger and faster," Frederick says. Runners using FST also report increased stride length, less pain and tightness, and faster recovery.
DOWNSIDES: You can't do the initial session on your own. The at-home stretches can take some time to master.
HOW TO: Visit stretchtowin.com to find an FST therapist. A session with a certified FST therapist costs $60 to $200 per hour. Frederick's book, Stretch to Win, and DVD, Flexibility for Sports Performance, also offer FST instruction.
Muscle & Performance,
This modern, movement-based approach to flexibility can drastically improve overall athleticism while also boosting strength and size potential.
By Eric Velazquez, NSCA-CPT, and Karla Dial
Stretching is one of those things that everyone knows is good for them but no one wants to invest the time in actually doing it. But when asked to explain its value, Chris Frederick, a physical therapist, fascial stretch specialist and co-author of the book Stretch to Win: Flexibility for Improved Speed, Power, and Agility, immediately offers a unique insight: “Research reviews have shown that stretching does not prevent injury. It does nothing for alleviating delayed onset muscle soreness. Stretching before activity can decrease power in the vertical jump.”
Not exactly the answer you’d expect from someone who in 1999 co-founded the Stretch to Win Institute. The catch is that the research he’s quoting all references static stretching, which, for all of the above reasons, has essentially been discarded by modern sports-medicine professionals. Still, there’s a movement afoot to bring stretching out of the Dark Ages, and Frederick is at the forefront.
Recognizing that current literature on stretching is still “a long way off from giving us exact parameters and indications as to the proper dosage in intensity, duration and frequency of when, how and what to stretch,” Frederick and his wife, Ann, developed and trademarked a parallel and superior brand of movement-based stretching called Fascial Stretch Therapy or FST. In the process, they’ve carved out a tiny but critically important niche in the world of sports performance and training. “We have become specialists in this important aspect of strength, conditioning and rehab,” Frederick says.
FST: Stretching, Enhanced
FST differs greatly from the kinds of stretching that most athletes are familiar with. “With Fascial Stretch Therapy, the focus is not the isolated muscle,” Frederick says. “It’s the fascial connections along a certain path. If you stretch the hip flexors, there’s a whole connection in the line that connects the front of the hip up to the chest and down to the knee. FST involves whole-body movement patterns because the 600 muscles in the body all came from one when we developed. It’s like we’re one muscle divided into 600 compartments.”
According to Frederick, fascia, the tissue that encases muscle, is ultimately just as important as, if not more than, actual muscle tissue. Without fascia, he says, muscle is “just hamburger.”
“Fascia is what gives muscle its shape. If you have a muscle pull, you heal from it, but sometimes that fascia thickens right where you pulled it, unless you do something about it,” Frederick says.
Even if you’re not an avid stretcher, you’re probably at least moderately familiar with static stretching and dynamic stretching, the two most widely, if inappropriately implemented (according to Frederick), methods out there. “Static stretching, or holding a particular stretch for an extended period, is the furthest from our philosophy of how to gain flexibility,” he says. “I have many clients who have tried static stretching for years, hit a plateau and never seemed to make further gains. Plus, most athletes and clients are bored by static stretching and hate doing it.”
Dynamic stretching, a method of using low-impact activity to prep muscle and connective tissue for more intense work, is only moderately more endorsed by Frederick: “Dynamic stretching is complementary. Although generically, it lacks solid guidelines in how to vary it for better, more individualized training.”
FST, on the other hand, is highly customizable based on an individual’s needs, and the benefits of putting it into practice make it worth learning. “For starters, it’s based on science,” Frederick says. “Ann did a videographic analysis in 1997 for her thesis at Arizona State University that showed a 36 to 52 percent increase in cold range of motion. The system has evolved, of course. We get up to a 100 to 200 percent increase now. And more recent research shows that active stretching techniques, such as PNF (proprioceptive neuromuscular facilitation), can actually reduce the severity of DOMS.”
The Fredericks have anecdotal evidence of FST’s benefits, too. “Ann was working on the ASU Sun Devils [football] team when they went to the Rose Bowl in 1997,” Frederick reports. “Injuries went down 45 percent just from her stretching them. Then she went to the 1996 Olympics with the men’s wrestling team. They beat the Russians for the first time and gave her credit for keeping them injury-free.”
Also among FST’s heavy-hitting endorsers are Olympic sprinter Sanya Richards-Ross and former NFL quarterback Donovan McNabb. These elite athletes have seen how Fascial Stretch Therapy can lead to better production, but it’s also about comfort. “Traditional stretching hurts,” Frederick says. “Athletes can grit their teeth and clench their jaws, but they don’t really like it when it hurts a lot. They can handle the pain of weight training, but they can’t take the stretching pain. FST is pain-free. You develop a tolerance to stress on your body — your muscle and connective tissues get stronger. If you start out pain-free, you don’t expect it, so you relax. That’s the secret to our results. This gets the heart rate down, relaxes you and takes your body to places you never thought it’d go.”
This pre-habilitative approach may sound attractive to payday athletes, but what can it do for you, the dedicated gym rat? The increased range of motion precipitated by adopting FST, Frederick says, can produce greater gains in strength, improved balance, faster recovery times and better overall muscle function. “If your hip flexors are tight, it shuts down your glutes, which leads to back and hamstring problems,” he says. “Keeping your hip flexors open helps you get better range of motion on squats and deadlifts, therefore recruiting more total muscle fibers and ultimately leading to more hypertrophy. And that’s just one example.”