FasciaFascia, Fascial Lines, and Pain

• BS in Exercise Physiology

from Florida State University

2006

• DPT from AT Still University in

Mesa, AZ. 2009

• COMT from the Ola Grimsby

institute San Diego. 2011

• Owners of Cornerstone

Physical Therapy in Spokane.

Bio

• Fascia and associated

anatomy

• “Fascial Lines”

• Concepts discussed today are

utilized in our practice and will

be demonstrated in this

lecture.

• Credit to Carla Stecco MD for

concepts in fascial discussion,

and to Thomas Meyers for

Fascial Line concepts.

Overview

Myers, 2014

(Stecco, 2015)

(Stecco, 2015)

(Stecco, 2015)

- The SAT, dermis, and SF are understood to protect

against external forces.

- The DAT, DF, and muscle forms a mobile layer and is

understood to isolate musculoskeletal movement.

- Inside the SAT and superficial fascia layers are Ruffini

and Pacinian Corpuscles which allow the tissue to

perceive stretching of the superficial fascia. Their

positioning may help these corpuscles discriminate

between light and heavy pressures

- In scars, where pathological fibrous tissue results in

fusion between the skin, superficial fascia and deep

fascia. The stretching of the deep fascia could affect the

superficial fascia and vice versa.

- In this situation even normal muscular contraction or

skin stretching could result in overstimulation of the

exteroceptive and proprioceptive systems.

Blood Flow

- Two subcutaneous plexuses

- Subpapillary Plexus

- Deep Plexus: Inside the Superficial Fascia

- 1/5 of capillaries necessary for skin vascularization.

Remainder function for thermoregulation

- A fibrotic superficial fascia could choke off the arteries

potentially leading to ischemia

Neural

- Nerves usually thin and follow the retinacula cutis to

reach the skin

- Nerves form a plexus just under the dermis much like the

vascular plexus.

- Nerves are protected from excessive movement because

they usually cross the various fascial planes in an oblique

direction

- Ruffini and pacinian corpuscles present inside the

superficial adipose tissue and the superficial fascia

Fascial Linesor Anatomy Trains as named by Myers.

Superficial Front

Line

Superficial Back

Line

The Lateral

Line

Myers, 2014

The Spiral Line Deep Front Line Arm Lines

Myers, 2014

GENERAL RULES OF DISTINCTION-.

- Tracks Proceed in a consistent direction without

interruption

- Places of interruptions can be described as derailments

- Tracks are made from myofascial or connective tissue

units. These structures must show a continuity of fascial

fibers

- Lines of pull or lines of transmission through the

myofascia must go fairly straight or change direction only

gradually

The Lateral Line

Myers, 2014

Myers, 2014

• Can train car 1 be affected by an abnormality in train car

5?

• Fascia appears to be the medium/mechanism by which

abnormalities within these lines are communicated or

affected.

• Therefore, stimulating or normalizing the myofascial

balance can alleviate pain and dysfunction multiple car

lengths away.

• Receptors within the fascia may be communicating

dysfunction preferentially due to their functional and

anatomical relationship.

The Superficial Back Line

Myers, 2014

Myers, 2014

Myers, 2014

In Summary

- It appears that treating distal tissues, within a series,

can impact pain along the chain/train.

- It is worth noting that fascia is a likely factor in pain

perception or hypersensitivity of musculoskeletal

origin.

- Muscles connected in series likely serve a functional

role, and may implicate other muscles within that

series when in an unnatural state.

Clinical Considerations

- Assess, palpate along these lines and observe for

asymmetry.

- Recommend exercises to offset impairments

identified along these lines

- Yoga for a generalized approach to all planes

- Consider Physical Therapy, Chiropractic, Massage

with providers which will collaborate with you

regarding possibilities of these impairments being

related to their pain.

Postural Considerations

- Ankle dorsiflexion limitations

- Knee hyperextension

- hamstring shortness

- anterior pelvic shift

- sacral nutation

- Lumbar lordosis

- Suboccipital limitations leading to upper cervical

hyperextension

Exercises for Superficial Back

Line

Hep2go, 2018

Exercises for Lateral Line

Hep2go, 2018

Exercises for Superficial Front

Line

Hep2go, 2018

Questions?

Juan Jaramillo DPT

DrJuan@PTCornerstone.com

References

- Stecco, C. (2015). Functional Atlas of the Human Fascial

System. Edinburgh, SCT: Elsevier

- Myers, T. W. (2014). Anatomy Trains (3rd ed.) Edinburgh,

SCT: Elsevier

- Whelton, R. (2017). Whelton Myofascial Referral Technique,

Shoulder Level 1. [Course Handout]

- Hep2Go inc. (2018). Yoga. Retrieved from www.hep2go.com

- A special thank you to our patients who volunteered to share

a portion of their treatment for the sake of this presentation.