"Fascia are a sense organ"

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Fascia is becoming a hot topic - in sport as in medicine. Because the connective tissue sheaths not only give the body stability and elasticity, they also play a central role in movement processes and in the development of pain. Fascia expert Prof. Werner Klingler * on an organ that has long been underestimated.

Prof. Dr. med. Werner Klingler

* Prof. Dr. med. Werner Klingler is the senior physician in charge of neuroanesthesia at the Ulm University Clinic in the Günzburg district hospital and a member of the local interdisciplinary pain center.

Prof. Klingler, whether in medicine or in sport: The topic of fascia seems to be omnipresent at the moment. What exactly is behind this term?

In fact, the exact definition is still a matter of heated debate among experts. But one can imagine a three-dimensional network of collagenous, flat connective tissue structures that runs through the whole body - the fascia tissue. It envelops and stabilizes muscles and organs, connects them with one another and creates tension. When you stretch and stretch, you can feel it yourself.

Connective tissue is an elastically stable, but ultimately passive structure. In the meantime it has been found that the fascia of our body are quite active.

That's right. So far, research has neglected connective tissue. It was overlooked that it has many important functions that go far beyond stabilization and elasticity.

It has only been discovered in recent years that, for example, the fascia that surround the muscles are equipped with many free nerve endings. They can register pressure and tension, temperatures and other physical influences, react to them and pass on the information. Basically, they are an additional sense organ.

A sensory organ that also reports when something is wrong - in the form of pain.

That's right. Often, for example, in the case of back pain, no clear cause can be found, such as a herniated disc that presses on a nerve and that can also be seen in magnetic resonance imaging. And even if there is a change in the pictures, it is not necessarily the origin of the symptoms. In particular, non-specific pain is often myofascial, that is, it emanates from the muscles and fasciae.

How can you imagine that exactly?

The fasciae react to a lack of exercise, but also to improper stress. They thicken and harden and become less elastic. They then no longer slide smoothly and can even constrict nerves and cause pain. In addition, the fasciae release inflammatory substances when injured and report pain via the embedded nerve endings.

But fascia also react to stress.

That's correct. 90 percent of the nerve endings in the fascia that surround our muscles belong to the autonomic nervous system. And that is very sensitive to stress. This explains why, in the case of emotional stress, pain in the back or neck is often more likely to be perceived.

What can you do to loosen sore, hardened fasciae again?

One possibility is special connective tissue techniques, i.e. manual therapies such as special massages. One example among many is the so-called rolfing. This is pretty down to the point: the therapist pushes the hardened tissue in front of him with his elbow or even metal or wooden tools like a kind of icebreaker. And slowly.

That sounds painful.

That actually goes to the pain limit. The idea is that this breaks up “adhesions” in the connective tissue. And also that the fascia tissue, which contains a lot of connective tissue fluid, can be squeezed out by pressure like a sponge. The inflammatory substances present in the tissue should then be transported away with the lymph. Whether this actually works the way one imagines it and which forms of treatment are the best for which complaints still has to be researched.

What else can help?

Mental techniques, such as breathing techniques, can have a considerable influence on the pain perception. They act on the autonomic nervous system, which regulates which pain signals get into the central nervous system and thus into consciousness in general. As already mentioned, fasciae are primarily equipped with nerves from the autonomic nervous system. This is why mental techniques are very effective for muscle fascia pain. So-called micro-movements are also helpful in this context.

And what is that?

The patient concentrates on the painful region and tries to activate it with minimal movements. Often these are areas that you have never consciously approached - it's not that easy, but it often works. The method is called eutonia and is almost meditative, takes breathing into account, all of this can have a positive effect on the pain.

What about warmth - for example baths, fango packs or cherry stone pillows?

If you warm the fascia, they relax and become soft. You can see that very well in the laboratory. Heat therapy is useful for fascia-related complaints, but of course not for acute injuries or inflammations.

What can you do for the fascia to prevent pain from occurring in the first place?

To keep moving! Above all, it is about moving the whole body regularly. Lean back and forth extensively in the morning! Swinging movements and stretches are particularly effective. Squat-stretch jumps before you start jogging also mobilize the fascia. You should also try to move around playfully, like a child in the playground, instead of practicing rigid, monotonous sequences of movements. This is very unusual at first, but it brings a lot.

The subject of fascia is now also en vogue in sport. For example, the so-called Blackrolls, with which everyone should get their fascia loose and supple, are a big hit. Does that really work?

A self-massage with the Blackroll should work in a similar way to physiotherapeutic treatments such as the aforementioned Rolfing. In fact, it has been shown that this stimulates the release of nitric oxide, which promotes blood circulation.

Can you also improve your athletic leadership with the Blackroll?

Studies have so far not found any significant differences in terms of performance. After all, the test persons subjectively felt less signs of fatigue.

However, critical voices warn of possible problems with self-massage with the Blackroll - in particular, there is a fear that the risk of thrombosis could increase or existing inflammation could worsen.

Targeted fascia training, in which one moves actively, is something else. Can that increase performance?

Of course, I cannot give a general assessment of the individual offers, but in principle it is possible. When jogging, for example, they act like a spring: the stronger it is, the greater the power output. It's like tug-of-war: the more people pull and the stronger they are, the greater the tension that can be built up.

And through training, the spring becomes stronger, or the tug of war?

Exactly. A large part of the fascia is created in childhood and adolescence, but it can become stronger. However, you have to make an effort, for example so that the Achilles tendon is strengthened and thus developed into a kind of sports suspension. The decisive factor is the combination of stretching stimulus and the warmth that arises during exertion: Only then are growth factors released that enable the creation of new collagen fibers.

And that makes you more efficient.

Right. Nevertheless, I would like to dampen expectations a bit. It is true that fasciae can contribute to athletic performance - they coordinate movements and make them more effective - but they are just one of many building blocks, for example alongside muscle and endurance training. So fascia training is not a new, effortless miracle method.

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