An Expert Guide to Your Fascia (Plus Tips on How to Stretch It)

You may have heard about the mysterious tissue known as fascia, but do you know what it is, how it works, and why it can impact your pelvic health?

True to its name, fascia is downright fascinating. It's a complex network of tissue that runs throughout your entire body and helps the different systems of your body communicate with each other. Fascia impacts our health far more than we realize, yet it's often overlooked and poorly understood.

If you're struggling with pelvic floor dysfunction, understanding the role that fascia may play in your body could be key to finding effective treatment and relief. So, let's dive in and explore the wonderful world of fascia.

What is fascia and what does it do?

Fascia is all of the soft connective tissue that runs throughout your body. From head to toe, fascia wraps around, penetrates, and supports every bone, muscle, organ, nerve, and blood vessel to create one three-dimensional, continuous network of tissue throughout the body, forming what is known as the fascial system.

Depending on where it is located in your body, fascia can be further classified as:

• Superficial (fascia in the dermis and adipose tissues)
• Deep (fascia surrounding the nerves, blood vessels, bones and muscle)
• Visceral (fascia surrounding the organs in the abdomen, heart, and lungs)
• Parietal (fascia that lines the wall of a body cavity, including the pelvic fascia)

The specific structure and function of each type of fascia varies, depending on where it is in your body, but a common feature of this connective tissue is that all fascia contains collagen bundles, giving it a strong and supportive structure. In general, healthy fascia is super strong and always “active”, while at the same time being relaxed, wavy, and well-hydrated.

While all of its functions are still being explored, fascia is known to:

• Allow for the transfer of mechanical forces throughout the body.
• Provide stability and support to muscles and organs, helping to maintain proper alignment and preventing injury.
• Play a crucial role in proprioception — the body's ability to sense its position and movement in space — through communication with the nervous system, allowing for fine-tuned control of movements.
• Promote sliding and reduction of friction during motion, which is essential for fluid and efficient movement.
• Newer research reports that fascia is also likely contributing to neurologic function, tissue morphology, and cellular signaling.

How does fascia affect movement and musculoskeletal function?

Recent studies have highlighted the importance of the fascia in regulating muscle function, joint mechanics, and overall movement patterns. For example, research has shown that fascial tissues can influence muscle activation patterns and force production, and that alterations in fascial mechanics can contribute to movement dysfunction and pain.

In addition, the fascia is believed to play a role in sensory and proprioceptive feedback, with evidence suggesting that the fascia may contain mechanoreceptors and proprioceptors that contribute to body awareness and movement control.

How does fascia get injured?

Fascia can become injured as a result of excessive or prolonged loading, as well as direct trauma to the tissue. Fascial health has also been shown to be impacted by aging, exercise, and estrogen. If what is triggering the injury is short-lived, then the body can easily clear those injured cells, however, if injury to the tissue is prolonged or repetitive, persistent inflammation may develop and cause tissues to become stiff, dry, and painful.

Moreover, because the fascia is one continuous and communicating network, these effects may become systemic, spilling over into the bloodstream, leading to widespread secondary tissue damage and impacting pain perception at the central nervous system level. Research has shown that inflammatory cytokines (the molecules secreted by your immune system cells that are supposed to help do damage control) may be elevated in those with chronic lower back pain, and there may even be a relationship between these specific elevated inflammatory cytokines and the development of chronic pain in some.

One common type of fascial injury is myofascial pain syndrome (MPS). Myofascial pain syndrome is a condition in which the fascia and muscles in a specific area of the body become painful and sensitive to touch. Caused by a variety of factors, including poor posture, repetitive motions, and stress, MPS can cause pain, stiffness, and restricted movement.

The development of myofascial trigger points is common in MPS as well. Myofascial trigger points are hyperirritable points of tissue within a muscle, which can be palpated and cause pain in or around the trigger point, or even causing pain in distant tissues. Trigger points may cause more than just pain, and can lead to performance issues in the involved and surrounding muscles.

Another type of fascial injury is adhesions. Adhesions are bands of scar tissue that form between fascial layers or between fascia and muscles. These can be caused by surgery, infection, or inflammation, and can lead to pain and reduced range of motion.

Fascial injury has also been found to contribute to poor coordination of the musculoskeletal system, and even decreased flexibility.

How does fascia impact my pelvic floor?

The pelvic floor plays an important role in supporting bowel, bladder and sexual functions, simultaneously needing to be stiff and supportive of your pelvic organs and to keep you leak free, while also being elastic during sex, bowel movements and childbirth. However, it’s more than just muscle that makes up the pelvic floor — there are also several layers of fascia that are impacting your pelvic health.

With that said, fascia can impact the pelvic floor in all of the same way that it does the rest of your musculoskeletal system, including helping to support and maintain its numerous functions, and then contributing to pain and dysfunction when injured.

Fascial injury has been shown to contribute to conditions like chronic pelvic pain and vulvodynia. In one study, researchers found that those with pelvic pain had thicker and denser fascial layers in the pelvic region compared to those without pelvic pain. Research also shows that when compared to a vaginal delivery, there are changes in the fascia of those who underwent a cesarean section that impact fascial mobility and likely contribute to scar, back, and pelvic pain.

Changes in the fascia’s structure has also been shown to be contributory to urinary incontinence and pelvic organ prolapse.

How can I stretch my fascia?

Stretching is thought to cause a systemic reduction in stretch tolerance, therefore improving fascial stiffness and flexibility throughout the body. Research shows that fascial stretching will not only benefit the targeted tissues, but it can also ease fascial restrictions in adjacent tissues.

For example, studies have shown that stretching a hip flexor on one side of your body improves the range of motion on the other side of your body, and that stretching in your lower limbs can lead to increased flexibility in your upper limbs. This randomized control trial shows that myofascial release to the plantar fascia can release restrictions throughout the entire posterior chain of your body with improved flexibility of hamstrings and lumbar spine.

If you are experiencing pain and muscle dysfunction anywhere in your body, you should always check in with your healthcare provider or physical therapist to help you with your symptoms. It's important to work with a healthcare professional who is trained in treating fascial injuries to determine the best course of treatment for your individual needs.

Below are 5 examples of effective strategies that may be included in your treatment:

1. Dynamic Stretching

Using controlled and specific movements, dynamic stretching can prepare your muscles and fascia for activity. While static stretching (bending over to hold a stretch for the backs of your legs) is still beneficial, dynamic stretching may be better at improving myofascial performance. This randomized control trial found that dynamic stretching improves sprint performance and flexibility more effectively than static stretching.

2. Foam Rolling

Foam rolling is a form of self-myofascial release that involves using a foam roller to apply pressure to specific areas of the body. It can help to release tension in the fascia, improve range of motion, and reduce pain. A systematic review found that foam rolling can be effective in improving range of motion, reducing muscle soreness, and increasing muscle performance.

3. Yoga

Using a series of poses and stretches, yoga can help to improve flexibility, range of motion, and reduce stress. A systematic review and meta-analysis found that yoga can be effective in improving flexibility, balance, and strength. Another systematic review and meta-analysis found yoga was effective in improving pain and physical function in those with chronic low back pain.

4. Proprioceptive Neuromuscular Facilitation (PNF) Stretching

Proprioceptive Neuromuscular Facilitation (PNF) is a stretching technique usually provided by a trained professional such as a physical therapist, which combines static stretching and isometric muscle contractions. PNF has been shown to improve muscle performance and range of motion when applied appropriately.

4. Myofascial release

Myofascial release includes a variety of techniques, including trigger point release that applies a sustained, low load force to the fascial/muscle unit to help improve myofascial function. This systematic review shows that there is good evidence to support the use of myofascial release techniques to improve orthopedic conditions. This study demonstrates how myofascial release to the abdomen, inner thighs and pelvic floor reduced pelvic pain and improved pelvic floor muscle function.