Fascia News

By Bernie Clark, July 12th, 2012

Notes from the 3rd International Fascia Research Conference,
held in Vancouver, B.C. in March of 2012.

A few months ago I had the chance to attend a conference all about fascia. As you know, fascia is fascinating, especially if you are interested in understanding why yoga is so healing and healthy for us. I thought I would share some of my notes from the conference and especially some speculations that arose in my mind listening to all these experts. These speculations range from the potential benefits of doing Yin Yoga in a hot environment to wondering if backbend are really advisable for pregnant students. If you would like to comment on these speculations and eavesdrop on my thoughts, read on!

Some speculations related to yoga and Yin Yoga in particular:

• Hot Yin? Gerry Pollack discovered that water structuring within the body is needed for healing and maintaining normal system functions. The energy used to structure water comes from the ambient temperature. He claims that a sauna can help recharge the “batteries” needed to structure water. This may indicate that doing Yin Yoga in a warm room could have physiological benefits even though we may not feel as deep a stretch when the muscles are so warm.
• Cyclical loading and unloading of the cells is required to positively affect tissues. With each loading of a cell, it responds by releasing calcium and ATP (the molecule that provides energy for our bodies at the cellular level) into the extracellular space. However, the cell soon depletes itself and needs to rest to be able to generate more ATP and calcium. This raises an interesting speculation: should we structure Yin Yoga classes (and even yang classes?) so that we repeat the postures but hold them for less time? It may be that the total time needed to achieve optimal remodeling of the tissue need not be achieved in one continuous hold but can be broken up into several shorter sessions?
• Therapists are advised to never massage tumours: the reason is that it is already very difficult to deliver drugs to a cancer tumour because the interstitial pressure (the pressure of the water in the extracellular matrix between the tissues) is low while the pressure in the tumour is high, pushing back anything that tries to enter the tumour. If we stress the tumour area through massage, we may make it even harder to get the drugs into the tumour. The pressure may also decrease our own body’s immune response from getting at the cancer. This would imply for yoga that we don’t want a student with cancer to stress the areas around a tumour.
• Many pregnant women may create a tear in their linea alba, especially after multiple pregnancies. The linea alba is the connective tissue running down the middle of the abdomen that joins the front stomach muscles together (the rectus abdominis.) This tear is known as a diastasis rectus abdominis (DRA). It is caused by the long held stress of the baby pushing against the stomach wall. The question raised is – it is a good idea for pregnant students to increase this pressure by doing backbends (yin or yang)? To be safe, should we suggest no backbends at all during pregnancy? But surely that would be overly cautious and would rob many women, who are not at risk of DRA, of a lovely backbending session. How should we decide when someone is at risk or not?

I would be delighted to hear reactions to any of these thoughts: if you want to share your opinion or experiences, please do so via the Forum at YinYoga.com. What follows now are some little digestible factoids and some broader notes on interesting topics. If you would like to delve more deeply into any of these points, you may want to visit the conference website and check out the presentations and papers.

Miscellaneous factoids:

• Immune cells use the fascia as roads to get to where they want to go!
• When a tendon is stressed, it thins (the Poisson effect) which squeezes water out of the tendon. This fluid flow is healthy and needs to happen in both directions for tissues to be healthy. Presumably, the same thing happens to ligaments as well.
• Cells secrete ATP when subjected to shear, stress or strain. This can block the secretion of cytokines and bad interleukins.
• Every cell responds to mechanical stress, even neurons.
• Fascia and tendons can conduct electricity: tendons contract when this happen.
• Damage within tissues is noticed by the nerves through detection of ph changes.
• Injuries can lead to one of two responses: regeneration of the original tissue (as happens in the bone for example) or repair where different tissues are inserted (scar tissue and adhesions.)
• Adhesions, if left unworked, can become vascularized and innervated. This makes it much harder (and more painful) to remove an adhesion, and thus the body becomes stiffer: range of motion is lost. The longer we leave adhesions the harder they will be to remove. Adhesions are not detected by MRIs or ultrasound because they look like normal tissue. Our inflexibility is not always caused by tight, short muscles! Often it is adhesions between the otherwise sliding surfaces of the body that restricts our range of movement.
• Prostatitis may be a fascia problem! Kegel exercises are good for everybody: male and female – young and old. Everyone can and should do them (I am doing them right now!)
• MRIs are not great at detecting fascia because any movement disrupts the imaging: even breathing is a problem. Ultrasounds don’t differentiate between fat and water.
• People interested in fascia are no longer called Fascists, but rather are Fascinadoes, or Fascinistas.

Neck Pain: Ultrasounds show that neck pain is directly proportional to the thickness of the connective tissue in between the deep fascia of the neck. The thicker this layer, the more pain. Why? Water! Due to increase hyaluronic acid, more water is retained in this region making the neck stiffer. But, if the temperature increases to 40C, then the water turns from its gel state (Jello-like) to the sol state (liquid or solution) minimizing stiffness, and thus lessening pain.

Use it or lose it – if you don’t move your limbs, the sensory representation of that area of the body in the brain decreases. However, if you move the limb, the amount of neurons dedicated to that area increases. Increased movement builds a greater, more detailed map in the brain of the area being moved.

Cyclical loading and unloading is a great way to positively affect tissues. The rate of the cycling is important. The first time stress is applied calcium and ATP are released. But soon these will be depleted and some rest is needed before the cells can release more: thus the need for cycling the stress.

This makes for an interesting speculation for Yin Yoga: should we develop the flows in Yin Yoga to be repeated: hold the poses for less time but revisit them over and over again? For example, hold Butterfly for 1 minute, then do Swan for 1 minute, then back to Butterfly and repeat this pattern five times?

Repetitive Stress Injuries: the earlier we treat the initial problem, the better. At the first sign of pain, start treating with anti-inflammatories, such as ibuprofen (or earthing). If you wait there may be no way to recover later. Later in the RSI cycle, the inflammation has gone so giving anti-inflammatories then is useless. Anti-inflammatories are partially effective depending upon the timing of when they are used and the tissue damaged (they are great for bones but have no effect on nerves.)

Michael Kjaer gave a talk on how tendinous connective tissues are affected by exercise: the worst thing to do for connective tissue is nothing. Tendon stiffness drops significantly after 3 weeks of no exercise. Exercises that grow muscles also grow tendons: tendons are not only thicker but also denser.

Female tendons are weaker than male tendons and they don’t increase as much with training (hardly at all)! He speculates that estradiol (from birth control pills) may be a cause. Testosterone levels do not affect tendons: maybe this is purely an estrogen effect? Oral contraceptives lower levels of IGF1 (Insulin-like growth factor 1) and create less collagen after exercise. Post-menopausal women benefit from hormone replacement therapy because they already have very low levels of IGF1 so the anabolic effect of estrogen is more pronounced. Women who exercise less will not lose as much connective tissue strength than men who exercise little, so it works both ways.

Mechanical loading will increase collagen synthesis in tendons: prolonged training in men will make tendons longer, thicker and denser. No exercise causes lessening (but not so much in women as mentioned above). He has not studied other connective tissues but suspects the same effect will be found. (This implies that Yin Yoga will also strengthen the connective tissues in the same way that exercise strengthens tendons.)

One reason that tendon tears take so long to heal (as anyone who has suffered a hamstring tear knows only too well) is – the fibers are long and narrow: they need to span the full gap of the tear, rather than build up layer by layer. In other words, the fibrils need to regrows to the full distance of the tear and this doesn’t happen very well.

Mechanotransduction: a paper (Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair) was presented seeking to reclaim this term. The authors (K M Khan, A Scott) define mechanotransduction as “the processes whereby cells convert physiological mechanical stimuli into biochemical responses.” Mechanotherapy was first defined in 1890 as “the employment of mechanical means for the cure of disease” (Oxford English Dictionary). We would update this to “the employment of mechanotransduction for the stimulation of tissue repair and remodelling.” This distinction highlights the cellular basis of exercise prescription for tissue healing and also recognises that injured and healthy tissues may respond differently to mechanical load.

Cells experience both tensile and shearing forces when subjected to a stress via yoga or simply living life. “These forces elicit a deformation of the cell that can trigger a wide array of responses depending on the type, magnitude and duration of loading. The key to mechanocoupling, as the name suggests, is the direct or indirect physical perturbation of the cell, which is transformed into a variety of chemical signals both within and among cells.”

“Consider the skeleton as an example of a connective tissue; the body’s sensor is the osteocyte network and the process of regulating bone to load has been referred to as the ‘mechanostat.’ In the absence of activity, the mechanotransduction signal is weak, so connective tissue is lost (eg, osteoporosis). When there are loads above the tissue’s set point, there is a stimulus through mechanotransduction so that the body adapts by increasing protein synthesis and adding tissue where possible (larger, stronger bone).”

“Most medical schools only allocate a perfunctory hour to the fact that physical activity is medicine. This is a major failing of medical education when physical inactivity is the major public health problem of the 21st century.”

Paul Standley: 5 Kinds of Biomechanical Strain

We can compress, torque, stretch or shear tissues or combine these in multiple ways (which is his 5th category). All these stresses affect cell function. The stress on a cell activates the calcium channel in the cell membrane. Within 1 second calcium release increases. The stress can also lead to gene expression! The stress on the cell

• Enhances wound closure
• Reduces cytokine release and the inflammation response
• Reduce cell self-death (apoptosis)
• Induce fibroblast alignment
• Increase interleukin secretion (this reach maximum expression after about 5 minutes of stress – ideal time for a yin pose to be held?)

Interstitial pressure: Interstitial pressure is generally negative with respect to the cell’s internal pressure, causing things to flow into the extracellular spaces. The integrins of the cells connect directly to collagen webs and this allows the cells to stay in place. During inflammation, such as with a bad burn, the interstitial pressure drops drawing more fluid into the extracellular space: result – swelling. This is not caused by leaking of fluid out of the capillaries. Swelling causes integrins signaling to occur.

Solid cancer tumours create high IP, which prevents drugs from getting to the tumours. RMTs are advised to never massage a cancer tumour because that would further increase the pressure in the IP making even harder for drugs and the immune system to reach the tumour area.

Speculation for Yin Yoga: compression and tension created by Yin Yoga could also increase IP, so should we avoid this in tumour areas? What about restorative yoga postures or inversions? This may help to reduce IP.

Hot Yin? Gerry Pollack presented a very fascinating look at the way the body structures water. There is too much detail to recount here (check out his web site for the details) but one interesting discovery was that this structuring of water is powered by ambient energy. Light (UV) can provide the energy as can heat. Infrared saunas can energize the water creating expanded “exclusion zones” (EZ) which are necessary for a host of biological functions, such as assisting blood flow and lubricating joints. Speculation then: Hot Yin could actually assist with improving water structuring inside the body. Curiously, he reported that a cold environment can also increase the EZ because what is important is the temperature gradient that the body is exposed to. Gerry’s assertion is that EZ is necessary for healing.

Diastasis Rectus Abdominis (DRA) and the tearing of the linea alba: Diane Lee discussed the occurrence of DRA for pregnant women and a man who did 400 sits up every day for decades (he tore his linea alba apart.) When this happens, the stomach organs start to push through the stomach muscles and create a pregnant looking pouch in the belly. With each new pregnancy the risk of a DRA occurring increases. What does this mean for yoga in general and yin yoga in particular? Should pregnant women avoid backbends, especially the deepest ones? It would be interesting to hear from students about their experiences. I don’t think that a blanket dogmatic statement such as “never do backbends when you are pregnant” will serve all women well, but certainly it may not be a good idea for some. The question is, how to know when a women is at risk or not? Who should avoid backbends while pregnant?

(Back to Newsletter #12)