Physiology of Connective Tissues and Fascia Update Knowledge for Orthopaedic Surgeons & Rehabilitation Carers

Unlike traditional views, fascia and connective tissues are not just unimportant structure without special function. Instead, fascia can be considered a large organ without boundaries, existing as a wide-spread network, carrying multiple function. In musculoskeletal functions, fascia supports joint mobilizations, helping to form architecture of stabilizing and motivating complex controlling joint stabilities and movements. Although fascia does carry a simple function of providing tissue protection and gliding, it fulfils this role via active channels. Fibrocytes contained in the fascia are actively responding to stress and tension; while stem cells are supporting tissue regeneration. Proprioceptive receptors in the fascia carry messages to the brain central which respond quickly and actively to stabilization requirements and other activities. The interstitial fluid within the fascia and neighboring cells and muscles are not simple “leakages” from vascular and lymphatic channels. Instead, the cellular activities within the fascia which helps to form the architecture of bodily movements, could be an important influencing force of both vascular and lymphatic circulation. The interstitial fluid, therefore, deserves to be considered the third fluid system of the human body with its specific function. The new discoveries of the fascia, therefore, carry special implications on physiological and pathological changes relevant to therapy and rehabilitation. Classical view of Connective Tissues Since anatomical dissections started in quest for better understanding of the human body, connective tissues existing outside and surrounding important structures and organs are revealed and described. The general attitude of anatomists and later surgeons (who dissect and give constructive measures to tissues and organs) towards connective tissues is that they are simple separating sheets of life tissues without specific function. Subsequent, observations have made a variety of fibrous connective tissues which have been given specific terminologies like: aponeurosis, ligament, tendon, retinaculum, joint capsule, epineurium, meninges, vessel coverages and periosteum. All these structures belong to simple interconnecting tensional tissues, and many varieties have been called “fascia” which in Latin, refers to bound together straps and bundles. Since fascia and other connective tissues are simple separation structures carrying no specific function, destruction and disturbance of which is expected to be followed by spontaneous replacement of a thicker and more fibrotic tissues. Reveal of the Complicated Function of Connective Tissues and Fascia a) Musculoskeletal Function When joint motions were studied in details, biomechanical observations revealed that although muscle contraction is the main motivating force, contractile tissues around and special fascial arrangements all participate in synchronous supportive contractile or relaxant activities. It is now clear that connective tissues carry two district functions: to allow structural gliding and to facilitate transfer of forces. Tissue gliding is important for functional protection. The fact that important structures like muscles and organs always possess two layers of soft tissue coverages (fascia), one inner sheet wrapping tight the structure and one outside sheet to facilitate gliding. In the case of muscles and joints, the surrounding fascia ensures that the related joint remains stable in whatever position change [1]. The classical observation that fascia helps to hold small vessels and nerves which need to provide nutrition and messages in their role of interconnection. The real situation is that not only does the fascia provide passages for the vascular and nerve channels but nerve receptors: muscle spindles; Golgi tendon organs and Ruffini corpuscles; laminated or paciniform corpuscles; and free nerve endings are scattered around [1]. The implication is that movements affecting the fascia would be simultaneously initiating neurological messages up and down the fascia, possibly also extending to the connecting network of connective tissues [2]. The Myofascial connections between the adjacent muscle groups would allow much dynamic planning for therapeutic measures designed for musculoskeletal disorders [3].