Sacroiliac Joint Dysfunction :: The Fundamentals of Fascia

So, about fascia. My aim in this blog post is to convince you to consider that healthy, malleable fascia is a vital part of the solution you’re seeking. I’m also gonna admit up front that I’m no expert on the subject, and that I am currently in guinea pig mode because I’m testing that theory on my post-surgical self. Two to three times per week I’m working with physical therapists who are trying to break up fascial restrictions and return my body to a more balanced and free-flowing state. You’re welcome to watch it all unfold in real-time here, because I’m going to be honest about whether it actually makes a difference for me or not. So far the jury’s still out, though it has already helped me—especially in my neck/shoulder area. But of course that’s not been my primary concern. As it turns out, maybe there is no “primary” concern when it comes to a well-tuned body.

 

If you follow this blog you know that I’ve been in chronic pain for more than three decades (yes, 30 years.) More than anything I have considered that mine was a structural problem, and I believe that at its core, it was. (You can read about it here and here.) I had stabilization surgery on January 28, 2016, and it fixed a major structural dysfunction that I’ve been living with more than half of my life. It’s not that I don’t have other mechanical problems—structural or otherwise. I am about to get an MRI of my hip to see what’s going on with my ongoing groin pain. As for the success of the SI surgery, you can follow my recovery by clicking on the surgery link under categories. It’ll start you from the beginning.

 

Whether I have a hip issue or not, I believe my wayward sacroiliac joint gave birth to many soft tissue dysfunctions, ones that have profoundly contributed to my chronic pain syndrome. These compensation patterns are deeply ingrained and are in desperate need of correction. If you’re wondering what I mean, read on.

 

If you Google fascia, you’ll most likely get a lot of links to heady definitions and extensive explanations. In other words, most of what’s out there is written for clinicians and other members of the medical community. Or it’s written by those people and they keep forgetting that us lay people need it in simpler language. As a result, a lot of what’s written about fascia is over our heads. Or it’s simply too laborious to wade through pages and pages of technical jargon to get a basic understanding of the concept. Ain’t nobody got time for that.

 

But after a lot of surfing and sorting, I finally found someone who has written about fascia in an informative, accessible way. Her name is Brooke Thomas and I have been in touch with her about using quotes from her awesome little 34-page eBook, entitled, Why Fascia Matters. She has graciously given me permission to quote her here, so that perhaps we can all understand what’s at stake a little better. Besides the fact that she’s a good writer, the other thing I love about her tiny primer is that it is fully annotated, meaning she cites references for information she offers and claims she makes. (The book is free and I’ll post a link to it at the end of this page.)

 

From here on out, I will place all quotes that are not mine in italics so you’ll know they’re others’ words and not mine.

 

So back to the task at hand. What is fascia? Here’s Thomas’ description:

 

“Many have thought of fascia as a glorified body stocking- a seamless piece of tissue that Saran Wraps you just underneath the skin. While this is true of the superficial fascia, it’s important to understand that it is a richly multi-dimensional tissue that forms your internal soft tissue architecture.

 

In fact, fascia has been defined as all of the soft fibrous connective tissues that permeate the human body (Findley and Schleip 2007). These tissues come in a wide range of densities on a broad spectrum from cotton candy to a leather strap.

 

From the superficial (“body stocking”) fascia, it dives deep and forms the pods (called fascicles) that actually create your musculature like a honeycomb from the inside out. Imagine what it looks like when you bite into a wedge of orange and then look at those individually wrapped pods of juice- we’re like that too! It also connects muscle to bone (tendons are considered a part of the fascial system), and bone to bone (ligaments are also considered a part of the fascial system), slings your organ structures, cushions your vertebrae (yep, your discs are considered a part of this system too), and wraps your bones.”

 

If you want a visual for what she’s talking about, watch this quick video I found a few days ago (it isn’t her video. I found it elsewhere.) The grapefruit analogy is brilliant and really helped me visualize the three dimensional nature of fascia. And it also includes footage from the video “Strolling Under the Skin,” which, as I understand it, is real footage of fascia that was exposed during a hand or wrist surgery.

 

I do so much better understanding explanations when there’s a visual component.

 

Thomas goes on to explain that all too often, people who are in pain receive treatment for the one part of the body that’s most symptomatic. Instead, she says it’s imperative that we realize that our body functions and dysfunctions are a united whole, and that when there’s dis-ease in one part of the body, it absolutely affects the other parts of our anatomy.

 

For starters, Thomas compares our bodies to architectural structures that utilize distributed tension. She introduces us to the word “tensegrity,” a term reportedly coined by a man named Buckminster Fuller in the 1960’s. Tensegrity refers to the “tensional integrity” of a structure. In architecture, it’s an engineering term. So what does this concept have to do with fascia, and its role in chronic pain and freedom of movement? Thomas explains:

 

“Well it (again) totally changes our framework from parts to whole. In tensegrity- in this case in regards to the human body- structures are stable and functional not because of the strength of individual pieces, but because of the way the entire structure balances and distributes mechanical stresses. Tension is continuously transmitted through the whole structure simultaneously. Which means that an increase in tension to one piece of the structure will result in an increase in tension to other parts of the structure- even parts that are seemingly “far” away.”

 

This, says Thomas, can result in a domino effect. If our fascia gets bound or restricted as a result of falls, accidents, or mechanical weakness or dysfunction, the negative effect builds over time, creating what I’ve always described as, “feeling like the Tin Man in the Wizard of Oz.” Everything is tight and my range of motion grows smaller and smaller because I’m constantly protecting the pain. It’s a natural reflex to limit movement to avoid pain. But it doesn’t serve us well in the long run.

 

Finally, one of the most revealing things about Thomas’ treatise (and one of the most validating for me) is her description of the extreme sensory nature of fascia. In short, it makes me think of one word: Fibromyalgia (which I’ve had since the early nineties. In fact, back then they called my condition, “myofascitis.”) Says Thomas:

 

“It turns out fascia is our richest, and our largest, sensory organ with ten times higher quantity of sensory nerve receptors than the muscles (Van der Wal 2009). In fact, it is possible that it may be equal or superior to the retina, which has thus far been considered the richest human sensory organ. (Mitchell and Schmidt 1977)”

 

Later on in the same section, she says,

 

“Put another way, fascia is “our most important perceptual organ. (Schleip 2003)”

 

Other things I’ve read recently about Fascia:

 

According to John Barnes, a physical therapist and revered myofascial release expert, myofascial restrictions can exert up to 2,000 pounds of pressure per square inch on pain sensitive structures. If that’s true, and if I do have the restrictions I think I do, no WONDER I have been in chronic pain! This could be one explanation for debilitating chronic pain.

 

There are several theories as to how fascia gets restricted, though accident and injury are the most common culprits. When I was listening to one of Brooke Thomas’ podcasts today, she was interviewing Tim Anderson and Geoff Neupert of Original Strength. Neupert speaks brilliantly to the adaptive nature of our bodies. Here is what he said:

 

“Compensation is a survival mechanism, really. It’s to enable your body to keep going forward until it cannot keep going forward. A great contrast would be your car. Your car doesn’t have compensations. If the starter doesn’t work, the starter doesn’t work, right? You have to get the starter replaced. If your body has something that doesn’t work, well then, other systems kick in. Other systems aid and help your body keep moving forward.”

 

So what I deduce from that (and let’s be clear, these are only theories—I’m just thinking out loud here) is that having severely damaged pelvic ligaments for decades required a lot of my other soft tissue to step up and do the work of the ligaments that couldn’t carry their weight. It was a less than optimal and certainly less functional solution, but it kept me moving forward!

 

My awesome physical therapist, Katrina (whom you will meet in the next blog post) believes that when soft tissue adapts, it actually morphs and changes both molecularly and structurally. And I’ve heard of that. My former father in law had a huge artery blockage in his leg, and—I kid you not—his body manufactured a bypass. It was a weak and second-rate bypass, but it kept his leg functioning! Anyway, I asked Katrina if transformed soft tissue could ever go back to just doing its own job, or if once it was changed, it was changed forever. Her answer? It can absolutely go back to minding its own business. It takes time.

 

Another fascial restriction theory is that fight-or-flight syndrome can cause fascia to go on “lockdown.” I can’t even begin to tell you how true this rings for me. I’ve arguably lived in fight or flight my entire life, but if I told you all of the stressful live events that have happened to me in the last 10 years, you probably wouldn’t even believe me. Someday I’ll write about that on this blog. But suffice it to say, the fight-or-flight component is quite intriguing. I’d venture a guess that any of us who deal with chronic pain have some sort of tripped out fight-or-flight mechanism.

 

Learning about fascia gives me some things to think about in terms of understanding my journey thus far. If stuck fascia (for lack of a better term) is actually a reality for me, I can smack my forehead and say, “THAT’S why five years of yoga made me stronger and gave me more balance, but never put a lasting dent in my rigid muscles!” And, “That’s why twenty bajillion chiropractic adjustments and acupuncture treatments gave me some temporary relief and kept me from deteriorating, but never resulted in any lasting change.” If fascia is fundamental, we must address it if we want long-term stability and health.

 

I’m going to leave you with a visual. After I got a better understanding of what fascia is and how it’s involved in the chronic pain process, I started thinking about how I could create an observable example. I actually bought three different kinds of chewing gum and wanted to get one of those mesh, fishnet produce bags to show how a fascial restriction in one part of the body affects another. But when I met with Katrina to interview her, she just HAPPENED to be wearing a sweater that could perfectly illustrate what I wanted to convey. And we did a one-take, impromptu video demonstration. (We were actually re-creating it because she showed me and I said, “Stop! Let me video this!) Pay attention to what happens to a distant part of the sweater when she grabs and twists another part (which represents scar tissue or another type of restriction.) I think you’ll see how one part of the body profoundly affects another.

 

 

Resources:

 

If you want a quick primer on fascia, download Brooke Thomas’ book. It’s light reading packed with plenty of punch. She’s great at breaking complex concepts into bite-sized pieces. You can find it here.

 

Also, check out Thomas’ podcast, called Liberated Body. I haven’t listened to more than a few episodes, but they’ve been super enlightening. I’m currently listening to her interview with Dr. Helene Langevin, who—among MANY other accolades, is the Director of the Osher Center for Integrative Medicine at Harvard Medical School. They’re talking about connective tissue and inflammation (which is super interesting to me because I have autoimmune disease.) A quick reminder: don’t take everything you hear or read personally, even if an expert says them. When I was listening to another podcast I realized that one guest’s ideas wouldn’t necessarily apply to me since I’ve recently had fusion surgery. Use common sense. Take what you like and leave the rest. But there’s enough rich info in these recordings that it’s worth sorting through and finding what applies to you at this stage of your recovery.

 

Photo by Tamaki Sono, licensed under Flickr Creative Commons. No changes were made.