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FasciaFascia, Fascial Lines, and Pain
• BS in Exercise Physiology
from Florida State University
2006
• DPT from AT Still University in
Mesa, AZ. 2009
• COMT from the Ola Grimsby
institute San Diego. 2011
• Owners of Cornerstone
Physical Therapy in Spokane.
Bio
• Fascia and associated
anatomy
• “Fascial Lines”
• Concepts discussed today are
utilized in our practice and will
be demonstrated in this
lecture.
• Credit to Carla Stecco MD for
concepts in fascial discussion,
and to Thomas Meyers for
Fascial Line concepts.
Overview
Myers, 2014
(Stecco, 2015)
(Stecco, 2015)
(Stecco, 2015)
- The SAT, dermis, and SF are understood to protect
against external forces.
- The DAT, DF, and muscle forms a mobile layer and is
understood to isolate musculoskeletal movement.
- Inside the SAT and superficial fascia layers are Ruffini
and Pacinian Corpuscles which allow the tissue to
perceive stretching of the superficial fascia. Their
positioning may help these corpuscles discriminate
between light and heavy pressures
- In scars, where pathological fibrous tissue results in
fusion between the skin, superficial fascia and deep
fascia. The stretching of the deep fascia could affect the
superficial fascia and vice versa.
- In this situation even normal muscular contraction or
skin stretching could result in overstimulation of the
exteroceptive and proprioceptive systems.
Blood Flow
- Two subcutaneous plexuses
- Subpapillary Plexus
- Deep Plexus: Inside the Superficial Fascia
- 1/5 of capillaries necessary for skin vascularization.
Remainder function for thermoregulation
- A fibrotic superficial fascia could choke off the arteries
potentially leading to ischemia
Neural
- Nerves usually thin and follow the retinacula cutis to
reach the skin
- Nerves form a plexus just under the dermis much like the
vascular plexus.
- Nerves are protected from excessive movement because
they usually cross the various fascial planes in an oblique
direction
- Ruffini and pacinian corpuscles present inside the
superficial adipose tissue and the superficial fascia
Fascial Linesor Anatomy Trains as named by Myers.
Superficial Front
Line
Superficial Back
Line
The Lateral
Line
Myers, 2014
The Spiral Line Deep Front Line Arm Lines
Myers, 2014
GENERAL RULES OF DISTINCTION-.
- Tracks Proceed in a consistent direction without
interruption
- Places of interruptions can be described as derailments
- Tracks are made from myofascial or connective tissue
units. These structures must show a continuity of fascial
fibers
- Lines of pull or lines of transmission through the
myofascia must go fairly straight or change direction only
gradually
The Lateral Line
Myers, 2014
Myers, 2014
• Can train car 1 be affected by an abnormality in train car
5?
• Fascia appears to be the medium/mechanism by which
abnormalities within these lines are communicated or
affected.
• Therefore, stimulating or normalizing the myofascial
balance can alleviate pain and dysfunction multiple car
lengths away.
• Receptors within the fascia may be communicating
dysfunction preferentially due to their functional and
anatomical relationship.
The Superficial Back Line
Myers, 2014
Myers, 2014
Myers, 2014
In Summary
- It appears that treating distal tissues, within a series,
can impact pain along the chain/train.
- It is worth noting that fascia is a likely factor in pain
perception or hypersensitivity of musculoskeletal
origin.
- Muscles connected in series likely serve a functional
role, and may implicate other muscles within that
series when in an unnatural state.
Clinical Considerations
- Assess, palpate along these lines and observe for
asymmetry.
- Recommend exercises to offset impairments
identified along these lines
- Yoga for a generalized approach to all planes
- Consider Physical Therapy, Chiropractic, Massage
with providers which will collaborate with you
regarding possibilities of these impairments being
related to their pain.
Postural Considerations
- Ankle dorsiflexion limitations
- Knee hyperextension
- hamstring shortness
- anterior pelvic shift
- sacral nutation
- Lumbar lordosis
- Suboccipital limitations leading to upper cervical
hyperextension
Exercises for Superficial Back
Line
Hep2go, 2018
Exercises for Lateral Line
Hep2go, 2018
Exercises for Superficial Front
Line
Hep2go, 2018
Questions?
Juan Jaramillo DPT
DrJuan@PTCornerstone.com
References
- Stecco, C. (2015). Functional Atlas of the Human Fascial
System. Edinburgh, SCT: Elsevier
- Myers, T. W. (2014). Anatomy Trains (3rd ed.) Edinburgh,
SCT: Elsevier
- Whelton, R. (2017). Whelton Myofascial Referral Technique,
Shoulder Level 1. [Course Handout]
- Hep2Go inc. (2018). Yoga. Retrieved from www.hep2go.com
- A special thank you to our patients who volunteered to share
a portion of their treatment for the sake of this presentation.
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