Fascia: the key to back pain?
Back pain? “You need fascia training,” blogger colleague Annett said to me a few months ago. “I have no idea what that is,” I said. Annett knew. She was enthusiastic. I was skeptical but interested. I know fascia from my studies as connective tissue strands, preferably of the “coarse” variety. After that I didn’t hear the word again until all of a sudden the fascia classes popped up in all kinds of fitness studios. Sporty hypes are not my thing. I stayed away.
Fascia: Unimagined importance in pain
After the discussion with Annett – she is a biologist like me – I wanted to know more about it. What do fasciae have to do with back pain? Are they the key to freedom from pain? An impression that has occasionally emerged recently. The magazine Geo, for example, devoted a cover story to connective tissue in February 2015 and raved about its “undreamt-of importance for health and well-being” – especially in relation to chronic (often recurring or permanent) pain.
What is the state of science? I asked one of the internationally best known researchers about this topic: Dr. Werner Klingler dedicates himself to gaining knowledge about the fascia at the district hospital in Günzburg and treats patients on a daily basis who have had problems with their backs for many years.
Sometimes, he says, he is amazed at the hype about “fasciae” and “fascia training” that comes from gyms in particular. In an interview with Healthandthecity, he explains what everyone – whether athletic or not – can do themselves to avoid (back) pain.
Here is the interview:
Mr. Klingler, a lack of exercise is considered to be the main cause of back pain. It causes weak muscles, muscular imbalances, muscle tension and, as a result, pain – according to the popular theory. Now reports are increasing that the fasciae are to blame for the pain, and targeted training and special fascia therapies bring healing. What is it?
Klingler: Only a small part of back pain can be traced back to a single cause – a pinched nerve, for example. Many factors play a role, especially with chronic back pain. Including bad posture, lack of exercise, stress or obesity. All of this affects the muscles – and the fasciae. That is why the therapy for persistent pain also includes work on the fascia, but mostly as part of a comprehensive treatment concept. Treating the fascia only: This would not help most of our patients.
What do patients with severe chronic back pain really need?
Klingler : The patients who come to us have piles of reports with them. X-rays, and, and, and. You have been in pain for a long time and have had many different therapies. What they lack is a holistic view that records, brings together and evaluates all possible influencing factors and adapts the treatment accordingly. With us, these back pain patients fill out long questionnaires. In addition to the physical examination, we create a profile of how you are mentally. We record your lifestyle and do a complementary medical evaluation. In this way we create an image that includes the whole person.
So dealing with the fascia alone is not enough to understand and treat back pain. But what part do they have now?
Klingler: In the fascia there are many receptors with connections to so-called wide dynamic range neurons in the spinal cord. This allows a wide variety of stimuli to be registered, for example in response to pressure or vibrations and with every movement. But they also transmit pain signals to the brain when something is wrong in the fine network of fascia tissue. In the lower back, for example, there is a large layer of connective tissue between muscles and skin, the lumbar fascia. A small amount of inflammation in this area can cause pain. This is particularly problematic because the interconnection of the nerves involved is rearranged very quickly. As a result, the area becomes more sensitive to pain until at some point it hurts for no cause. A so-called pain memory has arisen.
What can be wrong in the fascia tissue? Physiotherapists often speak of adhesions. What is happening there?
Klingler: We fascia researchers are still in the middle of the learning process with this question. What we can observe is the following: Movement causes a pull on the collagen fibers in the fascia. Controlled by the water content in the tissue, they align, and weak connections are formed – via hydrogen bonds – between strands that are close together. This creates orderly but very flexible networks. The connective tissue and the underlying muscles can slide smoothly. If there is no movement, a jumble of differently oriented connective tissue fibers grows. This restricts freedom of movement. For example, if a leg is in a cast for some time, this disorder can be detected in the fascia tissue.
How does it cause pain?
Klingler: Everyday movements can produce the finest cracks in glued fasciae. Tiny injuries that pain sensors jump on. Since fascia and muscles are closely interwoven, this can presumably also lead to tension and pain in the muscles.
Can such tangles be removed again?
Klingler: Yes, at least very often. The following applies: the earlier, the better, and fascia therapy comes into play. It is based on slow, pushing movements that are apparently particularly good for the connective tissue. We are gradually beginning to understand at the molecular level how this works. Among other things, it is related to the hydrogen bonds already mentioned. Training on a fascia roll also starts with pain memory: Rolling hurts. But afterwards the pain subsides because the deep movement suppresses the transmission of pain to the brain. On the conscious level, the patient experiences that pain can also improve again.
Of course, it’s even better not to get any back pain in the first place. What do you advise? What is the best way to prevent it?
Klingler: If you lack movement, every additional step counts. Cycling, dancing, gardening: everything is profitable. But there are also many people who are athletic and fit. Nevertheless, they can do a lot more for their backs by adding variety to their often worn-out sequences of movements.
Ultimately, we do the same movements over and over again in everyday life, but also in routine recreational sports. Unusual movements such as stretching, stretching, jumping with both legs… are missing. Children are a good source of inspiration. For example, how they shimmy from rung to rung with their arms on the climbing frame at the playground. You should try a lot more as an adult. Among other things, this keeps the fascia supple and can help avoid pain.
Conclusion: For scientists, muscle training is by no means out, and fascia training is not solely beneficial. It is a useful addition.
Muscles have long been considered more exciting
The new findings about fascia contribute their part to many research topics – among other things to the understanding of the origin of pain. There is still a lot to do in this area. The hype surrounding the fascia is partly explained by the fact that for a long time researchers paid little attention to connective tissue. For many decades, muscles and nerves were considered to be much more exciting than the white fiber bundles that enclose and run through organs and muscles. Connective tissue. When we eat meat we generously cut away the sinewy stuff.
“In many old surgical textbooks,” reports fascia expert Klingler, “the connective tissue is described in detail. For example, 100 years ago it was still considered a pathway system for infections. ”With the discovery of antibiotics, it was no longer so important to deal with connective tissue. It was considered a rather irrelevant filler material.
Fascia hold our body together
Research has only been focusing on the fascia for a few years. Fasciae, like muscles, can contract and are very important for our ability to move. They act as a sense organ. In addition to their role in the development of pain, they play a key role in our body perception: how we move around in space, whether we are bringing a hand close to the body or stretching a leg far away, we sense this via sensory cells in the fascia – without that we have to look in the mirror for that.
Last but not least, fasciae form a kind of inner suit that holds the whole body together elastically, gives it shape and contour: In a three-dimensional network, the fibrous collagen tissue runs through the body in every conceivable direction, forms tendons and ligaments, encases muscles, organs, joints and even individual blood vessels and nerve cords. Which connective tissue structures scientists summarize under the term fascia is currently being reassessed.
Healthy fascia adapt to the respective requirements: in some places fascia form a network that is as delicate as cobwebs, in others – for example on the lower back – the fasciae run in dense, strictly ordered layers.