The Journey of a Thousand Miles: New Technology Helps us Better Understand Fascia
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The Journey of a Thousand Miles: New Technology Helps us Better Understand Fascia

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March 12, 2020
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April 2, 2020

Guest blog by: Todd E. Riddle, DC, CCSP, RKT, CSCS, FAKTR

Manual therapy practitioners have been walking the long journey of fascial therapy for years. For much of this journey we’ve been walking blindly; not having a solid scientific answer to explain the mechanisms for why our approaches work for chronic pain patients.

To be clear, we are still a long way from our desired destination, but this new technology is a step in the right direction. Until recently, most of our explanations for fascial stiffness and pain have come from animal models. The prevailing theory for why patients experience pain relief after manual therapy was due to the changes created in the extracellular matrix (ECM) and a glycosaminoglycan (GAG) called hyaluronan. To make a very long, complicated story short, hyaluronan is a lubricant found in the ECM between muscle fibers. It basically allows for smooth sliding of fibers over each other. For a variety of reasons, such as stroke, immobility, injury, inflammation and so on, hyaluronan can lose bound water, self-aggregate and become more viscous. This can cause the ECM to loose elasticity, muscle fibers to stick to each, create fascial stiffness and affect nociceptors. Some refer to this process as densification and may eventually lead to fibrosis. Menon et al. described this process in 3 phases; a. normal, b. muscle stiffness and c. fibrosis. Intervening between phases “a” and “b” may reverse the process, while stipulating that fibrosis is irreversible. (1)

Now, using T1⍴-mapping, a specialized MRI assessment, researchers are able to indirectly quantify water-bound content in the upper limb muscles. (2) Essentially, this imaging allows researchers to assess, in this case, how manual therapy interventions effect the water content of GAG/hyaluronan. Menon’s new study is a long way from drawing a specific correlation between treatment and outcome, but it’s a step in the right direction. It’s a small, non-randomized case series, so we can’t hang too much on it. However, the findings are interesting.

  • T1⍴-mapping may be useful for detecting biochemical changes in altered fascia that cause pain
  • Statistically significant differences were found between bound and unbound water, pre to post treatment; reductions in unbound water
  • Improvements in DASH scores appear to be associated with improvement in bound water concentrations.
  • High concentrations of unbound water were present away from regions of complaint
  • Interventions aimed at reducing self-aggregated HA (unbounded) and water aggregated HA (bounded) represent a potential therapeutic target.

Interpretation and Extrapolation Time

Research has always speculated that mechanical stimulus to fascia improves the quality/water aggregation of HA. Water-bound HA provides the necessary lubrication to allow structures to smoothly glide. Normally, we have considered mechanical tension to mean movement. But withT1⍴-mapping, we might be on the way to showing that mechanical tension also may include manual therapy. As always, time will tell.

  1. Menon, Rajiv G., Preeti Raghavan, and Ravinder R. Regatte. “Quantifying muscle glycosaminoglycan levels in patients with post-stroke muscle stiffness using T 1ρ MRI.” Scientific reports 9.1 (2019): 1-8
  2. Menon, Rajiv G., et al. “T1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation® in Subjects with Elbow Pain.” International Journal of Environmental Research and Public Health 17.3 (2020): 708.

About Dr. Todd Riddle:

Dr. Riddle serves as the Director of Education and COO for Southeast Sports Seminars and FAKTR, Inc., teaching live hands-on courses and online trainings in sports medicine, physiotherapy and rehabilitation. To learn more about upcoming courses featuring Dr. Riddle, click here.

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