Fascia more than myofascia!
Introducing the Arthro-myofascial complex
By Robbert van Amstel & Karl Noten
Fascia is a specialized connective tissue sheat and is most often misplaced as synonym for connective tissue, simple because it is not known that it is a general name for various phenotypes structures like the stratum membranosum, deep fascia, epi-peri-endomysium, capsules, and ligaments which are interfascial linked. Better said, it is a fascial network which consists of different fasciae. A fascia is a sheath of connective tissue that forms beneath the skin to attach, enclose, and separate not only muscles, but also bones, nerves, blood vessels, and organs. Each fascia within this network consists of a unique extracellular matrix that determines the fascial biomechanical content. This biomechanical content is expressed in viscoelasticity. The viscoelastic property of fascia determines the stiffness and thereby the resistance to stress. Take these elements into account, and you will see that fascia isn’t that vague, though, it should be classified into 1) a fascia, 2) fasciae (multiple a fascia) and 3) the fascial system (Schleip et al., 2019). Besides the ‘ more known’ myofascia we also have to mind the superficial fascia, deep fascia, and arthrofascia which is a nice classification for clinicians (van Amstel et al. NPJ). These fasciae working together in human movements . These are important clinical factors in an arthro-myofascial approach (Noten & van Amstel 2021) for clinicians and physiotherapists. See picture 1.
by Robbert van Amstel & Karl Noten
Picture 1. Sagittal view MSK ultrasound rectus femoris/ vastus intermedius
Fascia classification from skin to bone/joints regarding the Fascia Nomenclature Committee (1-12). These are divided in a broader sense for clinical purpose by Noten, (2020); van Amstel & Noten (2021).
RV, Rectus Femoris; VI, Vastus intermedius
” A fascia is a sheath, a sheet, or any other dissectibleSchleip, Hedley & Yucesoy ,(2019)
aggregations of connective tissue that forms beneath
the skin to attach, enclose, and separate muscles and
other internal organs”.
” The fascial system surrounds, interweaves between, andAdstrum et al., (2017)
interpenetrates all organs, muscles, bones, and nerve
fibers, endowing the body with a functional structure,
and providing an environment that enables all body
systems to operate in an integrated manner”.
Schleip, R., Hedley, G., & Yucesoy, C. A. (2019). Fascial nomenclature: Update on related consensus process. Clinical Anatomy, 32(7), 929-933.