Deep fascia

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Deep fascia
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Identifiers
Latin fascia profunda
Anatomical terminology

Deep fascia (or investing fascia) is a fascia, a layer of dense connective tissue that can surround individual muscles and groups of muscles to separate into fascial compartments.

Contents

This fibrous connective tissue interpenetrates and surrounds the muscles, bones, nerves, and blood vessels of the body. It provides connection and communication in the form of aponeuroses, ligaments, tendons, retinacula, joint capsules, and septa. The deep fasciae envelop all bone (periosteum and endosteum); cartilage (perichondrium), and blood vessels (tunica externa) and become specialized in muscles (epimysium, perimysium, and endomysium) and nerves (epineurium, perineurium, and endoneurium). The high density of collagen fibers gives the deep fascia its strength and integrity. The amount of elastin fiber determines how much extensibility and resilience it will have. [1]

Examples

Examples include:

Fascial dynamics

Deep fascia is less extensible than superficial fascia. It is essentially avascular, [2] but is richly innervated with sensory receptors that report the presence of pain (nociceptors); change in movement (proprioceptors); change in pressure and vibration (mechanoreceptors); change in the chemical milieu (chemoreceptors); and fluctuation in temperature (thermoreceptors). [3] [4] Deep fascia is able to respond to sensory input by contracting; by relaxing; or by adding, reducing, or changing its composition through the process of fascial remodeling. [5]

Fascia may be able to contract due to the activity of myofibroblasts which may play a role in wound healing. [6]

The deep fascia can also relax. By monitoring changes in muscular tension, joint position, rate of movement, pressure, and vibration, mechanoreceptors in the deep fascia are capable of initiating relaxation. Deep fascia can relax rapidly in response to sudden muscular overload or rapid movements. Golgi tendon organs operate as a feedback mechanism by causing myofascial relaxation before muscle force becomes so great that tendons might be torn. Pacinian corpuscles sense changes in pressure and vibration to monitor the rate of acceleration of movement. They will initiate a sudden relaxatory response if movement happens too fast. [7] Deep fascia can also relax slowly as some mechanoreceptors respond to changes over longer timescales. Unlike the Golgi tendon organs, Golgi receptors report joint position independent of muscle contraction. This helps the body to know where the bones are at any given moment. Ruffini endings respond to regular stretching and to slow sustained pressure. In addition to initiating fascial relaxation, they contribute to full-body relaxation by inhibiting sympathetic activity which slows down heart rate and respiration. [3] [8]

When contraction persists, fascia will respond with the addition of new material. Fibroblasts secrete collagen and other proteins into the extracellular matrix where they bind to existing proteins, making the composition thicker and less extensible. Although this potentiates the tensile strength of the fascia, it can unfortunately restrict the very structures it aims to protect. The pathologies resulting from fascial restrictions range from a mild decrease in joint range of motion to severe fascial binding of muscles, nerves and blood vessels, as in compartment syndrome of the leg. However, if fascial contraction can be interrupted long enough, a reverse form of fascial remodeling occurs. The fascia will normalize its composition and tone and the extra material that was generated by prolonged contraction will be ingested by macrophages within the extracellular matrix. [9]

Like mechanoreceptors, chemoreceptors in deep fascia also have the ability to promote fascial relaxation. We tend to think of relaxation as a good thing, however fascia needs to maintain some degree of tension. This is especially true of ligaments. To maintain joint integrity, they need to provide adequate tension between bony surfaces. If a ligament is too lax, injury becomes more likely. Certain chemicals, including hormones, can influence the composition of the ligaments. An example of this is seen in the menstrual cycle, where hormones are secreted to create changes in the uterine and pelvic floor fascia. The hormones are not site-specific, however, and chemoreceptors in other ligaments of the body can be receptive to them as well. The ligaments of the knee may be one of the areas where this happens, as a significant association between the ovulatory phase of the menstrual cycle and an increased likelihood for an anterior cruciate ligament injury has been demonstrated. [10] [11]

It has been suggested that manipulation of the fascia by acupuncture needles is responsible for the physical sensation of qi flowing along meridians in the body, [12] even though there is no physically verifiable anatomical or histological basis for the existence of acupuncture points or meridians. [13]

Related Research Articles

<span class="mw-page-title-main">Fascial compartment</span> Section within the body containing muscles and nerves and surrounded by fascia

A fascial compartment is a section within the body that contains muscles and nerves and is surrounded by deep fascia. In the human body, the limbs can each be divided into two segments – the upper limb can be divided into the arm and the forearm and the sectional compartments of both of these – the fascial compartments of the arm and the fascial compartments of the forearm contain an anterior and a posterior compartment. Likewise, the lower limbs can be divided into two segments – the leg and the thigh – and these contain the fascial compartments of the leg and the fascial compartments of the thigh.

<span class="mw-page-title-main">Fascia</span> Layer of connective tissue in the body

A fascia is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, deep, visceral, and parietal, and further designated according to their anatomical location.

<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

<span class="mw-page-title-main">Omohyoid muscle</span> Human neck muscle

The omohyoid muscle is a muscle in the neck. It is one of the infrahyoid muscles. It consists of two bellies separated by an intermediate tendon. Its inferior belly is attached to the scapula; its superior belly is attached to the hyoid bone. Its intermediate tendon is anchored to the clavicle and first rib by a fascial sling. The omohyoid is innervated by the ansa cervicalis of the cervical plexus. It acts to depress the hyoid bone.

<span class="mw-page-title-main">Aponeurosis</span> Tissue which connects muscles to other organs

An aponeurosis is a flattened tendon by which muscle attaches to bone or fascia. Aponeuroses exhibit an ordered arrangement of collagen fibres, thus attaining high tensile strength in a particular direction while being vulnerable to tensional or shear forces in other directions. They have a shiny, whitish-silvery color, are histologically similar to tendons, and are very sparingly supplied with blood vessels and nerves. When dissected, aponeuroses are papery and peel off by sections. The primary regions with thick aponeuroses are in the ventral abdominal region, the dorsal lumbar region, the ventriculus in birds, and the palmar (palms) and plantar (soles) regions.

<span class="mw-page-title-main">Endomysium</span> Connective tissue ensheathing individual muscle fibres

The endomysium, meaning within the muscle, is a wispy layer of areolar connective tissue that ensheaths each individual muscle fiber, or muscle cell. It also contains capillaries and nerves. It overlies the muscle fiber's cell membrane: the sarcolemma. Endomysium is the deepest and smallest component of muscle connective tissue. This thin layer helps provide an appropriate chemical environment for the exchange of calcium, sodium, and potassium, which is essential for the excitation and subsequent contraction of a muscle fiber.

<span class="mw-page-title-main">Tibialis anterior muscle</span> Flexor muscle in humans that dorsiflexes the foot

The tibialis anterior muscle is a muscle of the anterior compartment of the lower leg. It originates from the upper portion of the tibia; it inserts into the medial cuneiform and first metatarsal bones of the foot. It acts to dorsiflex and invert the foot. This muscle is mostly located near the shin.

<span class="mw-page-title-main">Palmar aponeurosis</span>

The palmar aponeurosis invests the muscles of the palm, and consists of central, lateral, and medial portions.

<span class="mw-page-title-main">Thoracolumbar fascia</span> Anatomical Feature

The thoracolumbar fascia is a complex, multilayer arrangement of fascial and aponeurotic layers forming a separation between the paraspinal muscles on one hand, and the muscles of the posterior abdominal wall on the other. It spans the length of the back, extending between the neck superiorly and the sacrum inferiorly. It entails the fasciae and aponeuroses of the latissimus dorsi muscle, serratus posterior inferior muscle, abdominal internal oblique muscle, and transverse abdominal muscle.

<span class="mw-page-title-main">Fascia lata</span> Deep fascia of the thigh

The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular septum. The fascia lata is thickened at its lateral side where it forms the iliotibial tract, a structure that runs to the tibia and serves as a site of muscle attachment.

<span class="mw-page-title-main">Inferior extensor retinaculum of foot</span> Y-shaped band placed in front of the ankle-joint

The inferior extensor retinaculum of the foot is a Y-shaped band placed in front of the ankle-joint, the stem of the Y being attached laterally to the upper surface of the calcaneus, in front of the depression for the interosseous talocalcaneal ligament; it is directed medialward as a double layer, one lamina passing in front of, and the other behind, the tendons of the peroneus tertius and extensor digitorum longus.

The antebrachial fascia continuous above with the brachial fascia, is a dense, membranous investment, which forms a general sheath for the muscles in this region; it is attached, behind, to the olecranon and dorsal border of the ulna, and gives off from its deep surface numerous intermuscular septa, which enclose each muscle separately.

<span class="mw-page-title-main">Anterior cruciate ligament injury</span> Ligament injury near the knee

An anterior cruciate ligament injury occurs when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, an audible cracking sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

<span class="mw-page-title-main">Fascial compartments of arm</span> Anatomical compartments

The fascial compartments of arm refers to the specific anatomical term of the compartments within the upper segment of the upper limb of the body. The upper limb is divided into two segments, the arm and the forearm. Each of these segments is further divided into two compartments which are formed by deep fascia – tough connective tissue septa (walls). Each compartment encloses specific muscles and nerves.

<span class="mw-page-title-main">Posterior compartment of thigh</span> One of the fascial compartments that contains the knee flexors and hip extensors

The posterior compartment of the thigh is one of the fascial compartments that contains the knee flexors and hip extensors known as the hamstring muscles, as well as vascular and nervous elements, particularly the sciatic nerve.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

<span class="mw-page-title-main">Golgi tendon organ</span> Proprioceptive sensory receptor organ that senses changes in muscle tension

The Golgi tendon organ (GTO) is a proprioceptor – a type of sensory receptor that senses changes in muscle tension. It lies at the interface between a muscle and its tendon known as the musculotendinous junction also known as the myotendinous junction. It provides the sensory component of the Golgi tendon reflex.

Fascia training describes sports activities and movement exercises that attempt to improve the functional properties of the muscular connective tissues in the human body, such as tendons, ligaments, joint capsules and muscular envelopes. Also called fascia, these tissues take part in a body-wide tensional force transmission network and are responsive to training stimulation.

<span class="mw-page-title-main">Vaginal support structures</span> Structures that maintain the position of the vagina within the pelvic cavity

The vaginal support structures are those muscles, bones, ligaments, tendons, membranes and fascia, of the pelvic floor that maintain the position of the vagina within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to pelvic organ prolapse. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and urinary retention.

Fascial Manipulation is a manual therapy technique developed by Italian physiotherapist Luigi Stecco in the 1980s, aimed at evaluating and treating global fascial dysfunction by restoring normal motion/gliding to the system.

References

  1. ↑ Hedley, Gil (2005). The Integral Anatomy Series Vol. 2: Deep Fascia and Muscle (DVD). Integral Anatomy Productions. Retrieved 2006-07-17.
  2. ↑ Rolf, Ida P. (1989). Rolfing . Rochester, VT: Healing Arts Press. p.  38. ISBN   0892813350.
  3. 1 2 Schleip, Robert (2003). "Fascial plasticity – a new neurobiological explanation: Part 1". Journal of Bodywork and Movement Therapies. 7 (1): 11–9. doi:10.1016/S1360-8592(02)00067-0.
  4. ↑ Gatt, Adrianna; Agarwal, Sanjay; Zito, Patrick M. (2021). "Anatomy, Fascia Layers". StatPearls. StatPearls Publishing.
  5. ↑ Myers, Thomas W. (2002). Anatomy Trains. London, UK: Churchill Livingstone. p. 15. ISBN   0443063516.
  6. ↑ Tomasek, James J.; Gabbiani, Giulio; Hinz, Boris; Chaponnier, Christine; Brown, Robert A. (2002). "Myofibroblasts and mechano-regulation of connective tissue remodelling". Nature Reviews Molecular Cell Biology. 3 (5): 349–63. doi:10.1038/nrm809. PMID   11988769.
  7. ↑ Chaitow, Leon (1988). Soft Tissue Manipulation. Rochester, VT: Healing Arts Press. pp. 26–7. ISBN   0892812761.
  8. ↑ Schleip, Robert (2003). "Fascial plasticity – a new neurobiological explanation Part 2". Journal of Bodywork and Movement Therapies. 7 (2): 104–16. doi:10.1016/S1360-8592(02)00076-1.
  9. ↑ Paoletti, Serge (2006). The Fasciae: Anatomy, Dysfunction & Treatment. Seattle, WA: Eastland Press. pp. 138, 147–9. ISBN   093961653X.
  10. ↑ Wojtys, E. M.; Huston, L. J.; Lindenfeld, T. N.; Hewett, T. E.; Greenfield, M. L. (1998). "Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes". The American Journal of Sports Medicine. 26 (5): 614–9. doi:10.1177/03635465980260050301. PMID   9784805.
  11. ↑ Heitz, N. A.; Eisenman, P. A.; Beck, C. L.; Walker, J. A. (1999). "Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females". Journal of Athletic Training. 34 (2): 144–9. PMC   1322903 . PMID   16558557.
  12. ↑ Kimura, Michio; Tohya, Kazuo; Kuroiwa, Kyo-Ichi; Oda, Hirohisa; Gorawski, E. Christo; Zhong, Xiang Hua; Toda, Shizuo; Ohnishi, Motoyo; Noguchi, Eitaro (1992). "Electron Microscopical and Immunohistochemical Studies on the Induction of 'Qi' Employing Needling Manipulation". The American Journal of Chinese Medicine. 20 (1): 25–35. doi:10.1142/S0192415X92000047. PMID   1605128.
  13. ↑ Mann, Felix (August 2006). "The Final Days of Traditional Beliefs? - Part One". Chinese Medicine Times. 1 (4). Archived from the original on 2009-01-22.
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