Active Fascial Contractility

Author
Translator
Pages: 23-25
Year: 2006
Dr. Ida Rolf Institute

Structural Integration: The Journal of the Rolf Institute – June 2006 – Vol 34 – Nº 02

Volume: 34

Fonte: Structural Integration – 2006

INTRODUCTION

Fascia is usually seen as serving a passive role in biomechanical dynamics, transmitting mechanical tension that is generated by forces outside of itself. Contrary to this common conception, Staubesand1 and Rolf2 proposed that fascia is able to actively contract and relax by itself and that such fascial tonus changes may be felt by a skillful therapeutic hand. Our research project examined the existence and nature of an active fascial contractility. To do so we followed three major approaches: a literature review, histological examinations, and in vitro contraction tests with fascia.

LITERATURE REVIEW

In the literature we found many indications that fascia can actively contract. This happens in wound healing and in pathological fascial contractures like palmar fibromatosis (Dupuytren’s disease) or frozen shoulder. These contractions are due to the existence and proliferation of a special class of connective-tissue cells with smooth-muscle-like contractility, which are called myofibroblasts. Contractility of these cells has been shown to be dependent on (at least) two factors: the influence of specific cytokines and on mechanostimulation. The presence of myofibroblasts has already been documented in skeletal ligaments, tendons and most densely in visceral ligaments and many organ capsules. There are also indications that a myofibroblast-driven contraction of bronchial connective tissue contributes to chronic asthma.

<img src=’https://novo.pedroprado.com.br/imgs/2006/793-1.jpg’>
Figure 1. Contractile connective tissue cells (myofibroblasts) usually develop out of fibroblasts. Contributing factors for their development and contractility are not only specific cellular messenger substances but also, most importantly, mechanical stimulation. (Reprinted with permission from: Tomasek JJ, Gabbiani G, Hinz B, et al. Myofibroblasts and mechanoregulation of connective tissue remodelling. Nature Reviews Molecular Cell Biology, 2002; 349-363.)

HISTOLOGICAL ANALYSIS

In our histological analysis we examined whether myofibroblasts are also present in normal human fasciae, such as the lumbar fascia, fascia lata, or plantar fascia. Basically we found significant amounts of myofibroblasts in all our tissues (n=39). Density was higher in younger patients and in areas with a strong crimp (wave) formation in the collagen fibers. 3 (See Figures 2A, 2B and 3.) Most contractile cells are also found close to blood vessels – and therefore probably also close to nerves. The intramuscular connective tissue layer of the perimysium impressed with a particularly high density of myofibroblasts.5

<img src=’https://novo.pedroprado.com.br/imgs/2006/793-2.jpg’>
Figure 2A. Lumbar fascia of a older person (76 yrs.), showing very little collagen crimp (wave formation) and no visible contractile cells in this section.
Figure 2B. Lumbar fascia of a yonger person (19 yrs.) with strong crimp formation of the collagen fibers and many connective tissue cells which can be recognized as myofibroblasts, since they stanined positively to the immunohistochemical application of an antibody for alpha-smooth muscle actin.

IN VITRO FASCIA-CONTRACTION TESTS

In our in vitro contraction tests we suspend strips of fresh animal fascia or surgical human fascia in an organ bath. The tissue strips are stretched isometrically and their resistance force is recorded, while we test for responsiveness to potential contractile agents. Neither adrenaline nor acetylcholine induced any tonus changes. Yet with mepyramine (the most common contractile agent in myofibroblast research) we got clear and significant contractile responses that started within 0.5 to 10 minutes and lasted 20 to 90 minutes after substance addition. The addition of an nitrous oxide donator resulted in relaxation (3). Furthermore the hormones adenosine and oxytocin induced clear contractions in the testicular capsule (of rat tissues which we used for these tests), yet not in muscular fasciae.

The measured contraction forces were strong enough to result in significant influences on musculoskeletal dynamics when assuming a similar contractility in larger fascial sheets in vivo (e.g. 38 N for the thoracolumbar fascia).’ Together with Dr. Ian Naylor (University of Bradford, U.K.), we recently made another interesting discovery: on the catch musculature of mussels the application of mepyramine results in an almost identical contraction curve as in our fasciae, whereas such a slow and long-lasting reaction is untypical for smooth-muscle or skeletal-muscle contraction. We speculate that the fascial contractility may rely on a similar molecular kinetic as the (phylogenetically more archaic) catch contractility of mussels, and that this contributes to the amazing ability to hold an active tension over very long times without much energy expenditure.

Figure 3. The group of younger patients showed a higher density of contractile cells (myofibroblasts) in their lumbar fascia and also more crimp formation than the two older groups (n=39). See image below.

CONCLUSIONS

– Fascia is able to actively contract and thereby influence biomechanical behavior. This ability is facilitated by the existence of contractile connective-tissue cells (myofibroblasts), whose regular presence in normal human muscular fasciae we demonstrated histologically. The slow and long-lasting contraction (minutes to hours) has similarity with smooth-muscle contractions as well as with molluscan catch contraction.

– This offers the possibility of a new understanding for many pathologies that involve a chronically increased myofascial tonus. Examples include conditions such as torticollis, low back pain associated with paraspinal compartment syndrome, tension headaches, and others. Similarly a decreased fascial tone could be a contributing factor in conditions that are often associated with decreased myofascial tension, such as in back pain due to segmental spinal instability, peripartum pelvic pain, or fibromyalgia. While usually other factors play a major role as well in these pathologies, it is possible that their progress could be influenced additionally by the regulation of fascial tissue tone.

– Visceral fasciae (capsules, membranes, ligaments) seem to have a higher contractility than epimysial muscular fascia. The increased presence of myofibroblasts in the intramuscular perimysium could possibly explain the common tendency of tonic muscles to “shorten” (i.e. increase in their elastic tissue stiffness). If true, this would encourage the exploration of specially related therapeutic approaches to influence fascial contractility in chronically shortened tonic muscles.

– Fascial tone is not only regulated by cellular messenger substances, but most of all through mechanical stimulation. Since it is known that cellular effects of mechanical stimulation often occur within certain “windows” only (neither too much nor too little), this suggests important implications and challenges for manual therapies like osteopathy, Rolfing, and myofascial release methods. It will be of great value to examine with continuing research if and how certain modalities of manual touch influence fascial contractility.

– Further research is indicated and promising. Provided we are successful in covering part of our expenses with the help of external funding, a continuation of our research project over two to three years is projected.

ACKNOWLEDGMENTS

Our project has been financially supported by the European Rolfing Association (Munich, www.rolfing.org), the Rolf Institute of Structural Integration (USA, www.rolf.org), and the International society of Biomechanics (USA, www.isbweb.org). Additionally we would like to express our personal gratitude to Prof. Michael Pattersen (USA), Prof. Rainer Breul (Munich), Dr. Ian L. Naylor (Bradford, U.K.), Prof. Frank Lehmann-Horn (Ulm), Dr. Boris Hinz (Lausanne), Prof. Jochen Staubesand (Freiburg), and PD Dr. Joerg Massmann (Munich). This paper is an updated summary of a presentation at the 1st International Congress of Osteopathic Medicine (Freiburg, Germany 15-18. Sept. 2005), the abstracts of which have been published in the journal Osteopathische Medizin (Elsevier Science) 1 / 2006.

LITERATURE

1.Staubesand J, Li Y 1996. Zum Feinbau der Fascia cruris mit besonderer Beriicksichtigung epi- and intrafaszialer Nerven. Manuelle Medizin 34: 196-200.

2.Rolf IP 1977. Rolfing: The Integration of Human Structures. Dennis Landman, Santa Monica.

3.Schleip R, Klingler W, Lehmann-Horn F 2004: Active contraction of the thoracolumbar fascia-Indications of a new factor in low back pain research with implications for manual therapy. In: The proceedings of the Fifth interdisciplinary world congress on low beck and pelvic pain. Melbourne. Editors: Vleeming A, Mooney V, Hodges P; ISBN 90-802551-4-9

4.Schleip R, Klingler W, Lehmann-Horn F 2005. Active fasciaI contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. Medical Hypotheses 65(2): 273-7.

5.Schleip R, Naylor IL, et al. 2006. Passive muscle stiffness may be influenced by active contractility of intramuscular connective tissue. Medical Hypotheses 66(1): 66-71

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