Muscle Adhesions…Fact or Fiction

It is a commonly held observation among physical therapists, chiropractors, and massage therapists alike, who have a direct physical association with patients, that there are irregularities in body tissue. These irregularities in tissue are found when pressure is applied to specific spots on the patient, and they experience pain. The lack of motion, injury, surgery, and/or chronic irritation are usually the root cause of these irregularities.

Many practitioners attribute the development of this irregular tissue to the fascia of the tissue. The fascia is the envelope of the muscle, it is clear and surrounds even the organs. The purpose of the fascia is multifaceted. It has only been in the last five years that people have started to see the importance of the fascia. Dr. Daniel Keown of The Spark in the Machine describes the fascia tissue as innervated (meaning there are nerves that run to it), so it is your first line of defense for sending and receiving messages to all the soft tissue.

Fascia is also a means of receiving water to the inner cellular matrix of the soft tissue. The role of hydration that fascia has is further discussed by Dr. Dana Cohen and Gina Bria in the book, Quench. Another purpose for fascia is to help limit the friction created between tissue through movement. When you get abnormal movement in the body your fascia will begin to knot up, resulting in an increased amount of friction in the tissue, which leads to inflammation and pain because the tissue is no longer gliding smoothly over each other.

Although observed by practicing care-givers who work with patients, the research surrounding the observation of these fascial adhesions is severely lacking, but many practitioners discuss this fascia phenomena. I have experienced firsthand the difficulties that adhesions in the fascia can create during my time in the military. When I was trying out to be a Green Beret in something called Selection of SFAS (Special Forces Assessment Selection). I had just completed a preliminary course with the other candidates, and I started to experience a debilitating pain in my knee. I perceived it as retro patellar pain (which is pain behind the kneecap), this would be a key development in my understanding of how the body works. Although I perceived my pain as originating from within my knee, I learned later that this was not the source of my problem. My knee started to lose function, it wasn’t bending properly, and I was walking with a limp. In an effort for relief, I saw many doctors, but they could not determine the root cause. It wasn’t until I spoke with a physical therapist that finally diagnosed it as ITBS (IT band syndrome). Whenever the medical community uses the word syndrome, it means they aren’t very clear as to why something happens, but it is a recognized phenomenon. Despite the lack of research surrounding fascial adhesions, thankfully methods of correction and relief have been developed to help combat the syndrome.

In my particular case, there was a giant knot of fascia on the outside of my thigh, just above the knee, approximately 6 inches above where I perceived the source of my pain. This was an important lesson to me that pain does not necessarily lead you to the source of the problem. Pain can be deceiving, but this is not always the case, sometimes the pain is exactly where the problem is. Thankfully, through the use of a myofascial technique I was able to find relief, and subsequently my retro patellar knee pain disappeared. The myofascial technique I used is called myofascial release; many people use a foam roller for ITBS. I personally took a bamboo stick and rolled it on my thigh several times a day. In using myofascial release with a bamboo stick I was increasing the blood flow and subsequent hydration throughout the fascia. The second benefit of this technique was the release of toxic buildup, as it helped to break it up and pass it through my body. This is an under studied area of the body, as well as the underlying processes that contribute to these problems. Although understudied, it does not mean they don’t exist or that there aren’t methods to help improve its presence in your body. Myofascial release is commonly used in physical therapy and recommended by personal trainers to help keep your body in a healthy state. As a result of this topic being understudied, what I am communicating are theories, but it is also supported by many other practitioners in literature and in practice.

A number of things can cause fascial adhesions in the body, it can be a change in your walking stride/gate. In my case I had just had special inserts put into my shoes to help combat plantar fasciitis, which changed how I walked and the points of pressure in my body, this resulted in ITBS. My theory, as well as other medical practitioners’ thoughts about the genesis of this problem, is based around thie idea that there are a number of things that contribute to the development of fascial adhesions in the body. These include a change in Range of Motion (ROM) of a joint, either due to injury or chronic and long-term stressors, disuse, and/or sedentary behavior. It doesn’t take long for the fascial adhesions to develop; in my case it took a matter of weeks. If you are sitting or staying still for large amounts of time your body will begin to create adhesive materials. This is thought to be your body creating a certain level of efficiency which is used to create relief on the strain and stress that is put on muscles by having this adhesive material stabilize your muscles and lesson the stress to other muscles. It could also be a protective mechanism after an injury. Your body wants to avoid certain movements, and in order to protect the injured part of your body your body will limit the ROM in a muscle or joint to help protect it from further injury.

In clinical practice I have found three effective ways of breaking up adhesions in the body. First, stretching! Stretching increases blood flow to target tissues, it also forces muscles that are under tension to relax. The reason why your muscles relax is because you have special nerves in the muscles that are programmed to detect high levels of tension in the muscles. Once these tension detectors get tripped, as a protective mechanism your body will actually relax those muscles you are stretching to keep them from tearing. Second, exercise! The tension of your muscles, when used properly can help breakup the adhesions. Lastly, but not least, the chiropractic adjustment! This adjustment is very effective at breaking up adhesions in the joint and requires less time to accomplish a similar result as stretching and exercise.

Works Cited

Keown, D. (2014). The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine. Macmillan Publishers.

Cohen, D. and Bria, G. (2021, January 12). Quench (Reprint). Hachette Go.

Cao, Q. W., Peng, B. G., Wang, L., Huang, Y. Q., Jia, D. L., Jiang, H., Lv, Y., Liu, X. G., Liu, R. G., Li, Y., Song, T., Shen, W., Yu, L. Z., Zheng, Y. J., Liu, Y. Q., & Huang, D. (2021). Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World journal of clinical cases, 9(9), 2077–2089. https://doi.org/10.12998/wjcc.v9.i9.2077

Muscle Pain: It May Actually Be Your Fascia. (2021, August 8). Johns Hopkins Medicine. Retrieved September 16, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia#:%7E:text=Fascia%2DRelated%20Muscle%20Pain%20and%20Stiffness&text=Factors%20that%20cause%20fascia%20to,such%20as%20surgery%20or%20injury

Case, A. (2021, December 21). What Is Muscle Adhesion and How Does It Occur? Integrated Rehabilitation Services. Retrieved September 16, 2022, from https://integrehab.com/blog/injuries/what-is-muscle-adhesion-and-how-does-it-occur/