Fascia: the structure that unites the east and the west.

Fascia. A word that was, in former times, neglected in western universities by the majority of medical students and professors alike. Fascia was seen merely as a packing material and not many thought of its important integrating role to keep everything in our bodies running smoothly.

There were medical systems, some of them thousands of years old, that had another perspective on the body and knew about the importance of these visible, tangible structures. And like other discoveries in the world, as the first western explorers set their foot on the fascia continent, others had been exploring this territory already to a great extend and came up with meticulous descriptions and maps of the region.

Histology and anatomy have been brilliant at describing what is in the body, but they have completely ignored the space between things. Further study will reveal that the concept of Jing Luo Mai provides a more complete understanding of this connective tissue network. (Daniel Keown, 2019)

What is Neijing?

The findings and ideas about that continent can be found in one of the basic works of Chinese Medicine. The “Huangdi Neijing”, written about 2400 years ago. Many western scholars have been studying these texts. Among them, Dr. Edward Neal has provided new insights into this amazing medical book for over 20 years with translations based on clinical observations both in western and in eastern medicine.

These ancient texts give detailed descriptions of sinews and membranes, which resemble a lot the trajectories and characteristics of myofascial chains and trajectories described by modern day researchers like Tom Myers and Luigi Stecco. Just as connective tissue is seen as a meta system capable of many physiological and structural functions, ''Acupuncture channels form a network throughout the body, connecting peripheral tissues to each other and to central viscera''. (Kaptchuk, 2000). This network is called Jing Luo Mai and is described in great anatomical details in the Neijing texts. Not only can you find descriptions of anatomy, physiology and physio-pathology in that book but there is also a whole treatment system based on needle techniques.

Acupuncture and needle techniques for fascia

The ancient Chinese had a complex and refined system to treat the body via those sinews and membranes and one of the treatment methods uses the manipulation of those structures via needles. Langevin and Yandow (2002) proposed that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to the mechanism of action of acupuncture and suggests a potentially important integrative role for interstitial connective tissue.

Manipulation of the acupuncture needle can thus cause a lasting change in the extracellular matrix surrounding the needle, which in turn can influence the different cell populations sharing this connective tissue matrix (e.g., fibroblasts, sensory afferents, immune and vascular cells).

According Langevin's findings, the stimulation of connective tissue by the acupuncture needle has an impact on fascia structure and cell physiology through mecanotransduction. This type of action resembles in a certain way to the concept of Qi wich is central to the channel system. Although the concept of channel ''Qi '' has no known physiological equivalent, terms used in acupuncture texts to describe the more general term “Qi” evoke dynamic processes such as communication, movement, or energy exchange (O’Connor and Bensky, 1981).

But if we understand Qi from the perspective of the proper functioning of fascia, we do not discover a new acupuncture, but rather a system of treatment based on careful palpation and observation, a system whose most fundamental principles are in complete accord with the model of the fascia mechanism. (Steven Finando, 2010). As James L. Oschman stated in 2012, there is an almost perfect match between fascia and acupuncture therapeutic approaches.

The goal of classical Neijing acupuncture is to regulate the various tissue planes of the body in order to restore the free flow of blood, and in doing so, allow the body to return to its original state of balance and innate self-healing. (Edward Neal, 2017).

Acupuncture is distinct from other techniques working on the fascia.

1- Acupuncture can treat the fascia deep inside the body with minimal trauma to the rest of the body.

2- Acupuncture can influence fascia at multiple locations at the same time and have effects at the site being needled as well as far apart from it.

3- A variety of needles techniques (26) are described in the ancient Neijing medical texts. Many of them are aiming at specific tissue planes such as fascia.

Conclusion

‘’It’s all the same body, and we have different perspectives on it, and I think part of what is going on here, if we are all talking about the same body, then maybe the issue that separates us is all about language and metaphors, I think this kind of work is starting to allow us to see where east and west meet. ‘’ (Neil Theise, 2018)

Unmeasurable experience of therapists and countless research papers nowadays confirm the positive effects of acupuncture on our health also via the modern western scientific method.

If the fascia network of the body is indeed the physical substrate of the meridians of TCM, there are important clinical and research implications. Specifically, if evidence continues to mount in support of this view, then the fasciae should receive greater attention in both diagnostics and treatment. (Yu Bai and Al. 2011).

The new research on fascia is shedding light on the old knowledge and by combining both worlds, therapists nowadays have a powerful tool to help people having a healthy and thriving life. As recently proposed by Luigi Stecco: fascia is indeed the structure that unites the east and the west.

Text by Elmar Pestel and Simon Bélair.