Active Fascial Contractility Fascia is able to contract and relax in a smooth- muscle-like manner and thereby influence biomechanical behavior Rolfing” Instructor, and Werner Klingler M.D. Fascia is usually seen as serving a passive rule in biomechanical dynamies, ransmit- ting mechanical tension that és generated by foraes outside oF itself: Contrary to this common conception, Staubesand! and Rolf! proposed that fascia is able to actively. contract and relax by itself and that such fascia tonus changes may be feltby a skill- ful therapeutic hand. Our research project examined the existence and nature of an active fascial contractility: To do s0 we fo: owed three major approaches: a Tterature reviews histological examinations, and in vitro contraction tests vith fascia LITERATURE REVIEW In the [iterature we found many indice vom that fascia cam actively contract This happens in wound healing and in pathological fascial contractures ke pol Figure 1 Contractile connective tissue calls (myotivroblasts) usually develop out of fibroblasts, Contributing factors for their development and contractity are not only ‘speoitic celular messenger substances but also, most importantly. mechanical stimulation. (Reprinted with permission from: Tomasek JU, Gabbiani G, Hine al. Myofibrobiasts and mechanoregulation ‘of connective tissue remodeling, Nature Reviews Molecular Cel! Biology, 2002; 349-363) S/RLCICRML Beara / June 20065 mar fibromatosis (Dupuytren’s disease) tr frozen shoulder. These contractions are due to the existence and proliferation of a special class of connective-tissue cells with smooth-musele-like contractility, whieh are called myofibroblasts. Contractility of these cells has been shown tobe dependent on fat Teast) v0 factors: the influesice of specitic cytokines anel on mechanostimulation. The presence of myofibroblasts has already been. slocumented in skeletal ligaments, tendons. and most elensely in visceral ligaments, and many organ capsules. There are also indications that a myosibroblast-deiven contraction of bronchial connective tissue contributes to chronic asthma, HISTOLOGICAL ANALYSIS In our histolugicat analysis we examined whether myofroblasts are sls present ia normal human fascia, such as the lumbar fascia, lsc ata, or planta fascia. Basically we found significant amounts of myo' broblasts in all our tissues (9=39), Density was higher in younger patientsand inareas with a strong, crimp (wave) formation inthe collagen fibers. (See Figures 2A, 2B and 3.) Mest contractile cells are also found close 1 blond vessels ~ and therefore probably also close to nerves, The intramuscular connective tissue layer of the perimysiam impressed with a particularly high densits cof myofibroblasts. IN VITRO FASCIA- CONTRACTION TESTS In ourin viteo contraction testswve suspend strips of fresh animal faseia or surgical human fascia in an organ bath, The tissue strips are stretched! isometrically and their resistance force is recorded, while we test {for responsiveness 10 potential contractile agents. Neither adrenaline nor acetyl Tine induced any tonus changes. Yet with Prtoemetirbiet swssesvitong,Figure 2 Lumbar fascia of an older person (76 yrs.), showing very bile collagen cmp (wave formation) and no visible contractile cells in this section Figure 2B Lumbar fascia ot a younger person (79 yrs.j with strong crimp formation of the collagen fibers and many connective tissue cells which ‘can be recognized as myofiorobiasts, since they stained positively to the immunohistacherical application of an ‘antibody for alpha-smooth muscie actin. conte Calsinne 39 128 ‘mcoiagen Comp 80 44 13 <32 yr. 54-58 yrs, Figure 3 The group of younger patients showed a higher density Cf contractile cells (myofibroblasts) in their lumbar fascia and also more crimp formation than the two older groups (1 9), Time (in mepyramine (the most common conteadtile agent in myofibroblast research) we got clear and significant contractile responses thot started within (5 40 10 minutes and asted 20 to 91) minutes alter substance addition. The addition of 3 resulted! in relaxation (3). Further more the hormones adenosine sndloxytocin| induced clear eontractionsin the testicular capsule (of rat tissues which we used for these tests), yet not ia muscular faseiae, The measured contraction forces were strong enough to resaltin significant influ ences on musculoskeletal dynamics when assceting, a similar contractility in larger al sheets in vivo (eg. 38 for the tho: Together with Dr. fan Naylor (University of Bradford, U.K, we recently made ry: on the catch muscolature of mussels the: fas sacolumbar fascia) snother interesting discov spplication of mepyramine resultsin an lenost identical contract fasciae, whereas such a slow and Tong.tast- ing reaction is uneypical for smooth-muscle orskeletal-mescle contraction, We speculate that the fascial couteactility: may rely om a molecular kinetic as the (phyloge rnetically niore aechaic) catch contractility ‘of mussels, and tbat this contributtes to the amazing ability to hold an active tension ‘over very Tong times without much energy expenditure CONCLUSIONS *# Fascia is able to actively contract and thereby influence biomechanical behav- ior. This ability is taciltated by the exis: tence of contractile connective-tissue cells (myofibroblasts), whose regular presence iy normal human muscular fascia we strated histologically. The stow and long-lasting contraction (minutes to jure 4 Example of an induced fascial relaxation in our organ bath: addition of a nitrous oxide donator substance at minute § and again at minute 10. Sraocro Essen / JUNEZLOSems STE OP 0 hours) has similarity with smooth-muscle contractions as well as with molluscan cateh contraction * This offers the possibility of a new un- derstanding for many pathologies that involve a chronically increased myofascial tonus. Examples inelude conditions such as torticollis, 1ow back pain associated ‘with paraspinal compartment syndrome, tension headaches, and others. Similarly a decreased fascial tone could be a contrib. uting factor in conditiorts that are often associated with decreased! myofascial ten- sion, such as in back pain due to segmental spinal instability, pripartum pelvic pain, or fibromyalgia. While usually other factors play a major role as well in these patholo- gies, it is possible that their progress could beinfluenced additionally by the regulation of fascial tissue tone, * Visceral fasciae (capsules, membranes, ligaments) seem to have a higher contrac tility than epimysial muscular fascia, The increased presence of myofibroblasts in the intramuscular perimysium could pos- sibly explain the common tendency of tonic muscles to “shorten” (Le. inerease in their clastic tissue stifiness). If true, this would encourage the exploration of specially re- lated therapeutic approaches to influence fascial contractility in chronically shortened tonic muscles. + Fascial tone is not only regulated by cel- lular messenger substances, but most of all through mechanical stimulation. Since it is known that cellular effects of mechani: cal stimulation often occur within certain “windows” only (neither too much nor too Little), this suggests important implications and challenges for manual therapies like ‘osteopathy, Rolfing, and myofascial release methods. It will be of great value to examine ‘with continuing research if and how certain ‘modalities of manual touch influence fascial contractility + Further research is indicated and promis. ing, Provided we are successful in cover ing part of our expenses with the help of external funding, a continuation of our research project over two to three years is projected. ACKNOWLEDGMENTS ‘Our project has been financially supported by the European Rolfing Association (Mu- nich, www.rolfingorg), the Rolf Institute of Structural Integration® (USA, www. rolf.org), and the International Society of SrrucTURAL InrecRaTion / fuse 2006, Biomechanics (USA, wwwisboeeb.org) Additionally we would like to express oar personal gratitude to Prof. Michael Pat tersen (USA), Praf. Rainer Breul (Munich), Dr lan L. Naylor (Bradford, U.K), Pro. eank Lehmann-Horn (Ulm), Dr. Boris Hinz (Lausanne), Prof, Jochen Staubesand (Freiburg), and PD Dr. Joerg Massmann (Munich). This paper is an updated sum- rary of a presentation atthe I Interna- tional Congress of Osteopathic Medicine (Freiburg, Germany 1518. Sept 2005), the abstracts of which have been published in the ourmal Osteopathische Medizin (Elsevier Science 1/2006. LITERATURE 1. Staubesand J, Li Y 1995, Zum Feinbiva der Fascia cruris mit besonderer Bertick- sichtigung epi- und intrafaszialer Nerven. ‘Manuelle Medizin 34: 196-200, 2. Rolf IP 1977. Rolfing: The Integration of Human Structures. Dennis Landman, Santa Monica. 3, Schleip R, Klingler W, Lehmann-Horn F 2004: Active contraction of the thoraco- lumbar fascia—Indications of a new factor in low back pain research with implications formanual therapy. In: The proceedings offre Fiftk interdisciplinary world congress on low back and peivic pain. Melbourne. Editors: Vieeming A, Mooney V, Hodges P; ISBN 90-802551-4-9 4, Schleip R, Klingler W, Lehmann-Horn F 2005. Active fascial contractility: Fascia may De able to contract in a smooth muscle-like :manner and thereby influence museulosk- cletal dynamics. Medical Hypotheses 65(2): 27347. 5. Schleip R, Naylor IL, et al. 2006, Passive ‘muscle stifiness may be influenced by active contractility of intramuscular connective tissue. Medica! Hypotheses 66(1): 6-71 wwwsraléong 5