Have you noticed that the word “fascia” has become somewhat of a buzzword in the yoga world lately? There have been lots of articles written about this newly-appreciated bodily tissue (I myself have written two of them in the past few years!), and fascia has become a focus in many yoga classes - especially those that include rolling on self-massage tools like balls and foam rollers.
I understand this preoccupation with fascia, because it is a truly fascinating topic. Fascia is a type of connective tissue that forms a continuous body-wide web inside of us, surrounding and interpenetrating all of our muscles, bones, organs, nerves, and blood and lymph vessels. In fact, in addition to forming the architecture that weaves our inner structures together, our connective tissue system as a whole also absorbs and transmits force inside of us, working in conjunction with our muscular system to create smooth, efficient movement. Such insights have the power to expand the way we understand movement, which is very exciting!
In addition to these inherently interesting facts, there are other claims commonly made about fascia that are widely-believed, but reach a bit too far ahead of the research to be actually supported. Today I’d like to address a few of these specific claims in an attempt to encourage our yoga community to embrace a more science-based, productive dialog about the popular topic of fascia and the wonderful practices of massage and rolling.
MYTH #1: ROLLING ON BALLS AND OTHER MASSAGE TOOLS BREAKS DOWN FASCIAL ADHESIONS, KNOTS, AND SCAR TISSUE
Every massage therapist knows the experience of finding a tight spot in her client’s body, massaging it, and feeling it “release” or “relax” underneath her hands. It seems natural to assume that through her hands, she physically broke down a knot in her client’s fascia - and that through rolling on massage tools, we can do the same to ourselves too.
But one lesser-known fact about fascia is that its collagen fibers are literally as strong as steel. [Ref] To actually “break them up” would require so much force application that one’s body would sustain serious injury - this is not something that is achieved by a massage therapist’s hands or by a pair of massage balls.
Although you may feel a tight spot in your body change its texture after rolling or being massaged, this change was not due to the architecture of the fascia changing. For fascia to actually change its architecture, many, many inputs are required over a long time - collagen takes about three years in order to completely change and remodel. [Ref] Any instantaneous changes in tissue quality that you experience as the result of a massage are not the “breaking down” of adhesions, knots, or scar tissue - they are instead changes in tissue tone that are mediated by the nervous system. [Ref]
Once we understand that soft tissue treatments like massage and rolling work primarily via neurological communication instead of via physically breaking down adhesions, knots, and scar tissue, we might be encouraged to administer these treatments more gently than forcefully. When we roll and massage ourselves with deep, forceful pressure, this can often increase nervous system threat levels and sensitivity, which can be counterproductive to our efforts. Gentler, milder work is often more successful at decreasing threat levels and coaxing the nervous system to relax our tissues.
Massage and rolling on balls are undeniably wonderful, potent tools that help so many of us feel better in our bodies, but when we understand more about the mechanism for why they work, we will naturally be able to use them more wisely.
MYTH #2: WE FEEL PAIN IN OUR BODY BECAUSE OUR FASCIA IS FULL OF KNOTS, ADHESIONS, AND SCAR TISSUE
This is a very common belief, but it turns out that it is based on some inaccurate information about how pain works. I’ve written about the science of pain before [here and here], but one of the most foundational aspects of pain is that it is an output from the central nervous system, not an input from the periphery. It’s easy to be confused about this concept because when we feel pain, we feel it in a particular area of our body. It feels like the pain is in our tissues, and it’s our tissues that are therefore causing it. But the pain doesn’t actually reside in our tissues at all - it is 100% an experience that our nervous system has created for us to perceive - most likely to serve as some sort of protective signal.
Because pain is an output and not an input, adhesions, knots, and scar tissues - which are located in the periphery of our body (if they exist at all - but that’s a whole other topic!) - are not actually capable of creating pain. This concept might be tough to grasp, especially because we know that a massage therapist can touch a certain “knotty-feeling” spot on our body and it might feel tender or painful. But the pain you feel there was not created by the knot - it was created by your brain and experienced in that spot. Additionally, we know that we can have other painful-to-the-touch places in our body that do not actually correspond with a “knot” or tight spot that resides there. The flesh in those painful spots instead feels smooth and knot-free. And there are probably quite a few other locations in your body that definitely feel “knotty”-like when palpated, but are not associated with pain at all. [Ref]
As it turns out, pain and tissue quality are separate entities that sometimes overlap, but oftentimes do not. While it's easy to believe that all tight spots underneath our skin are problematic, the truth is that many of them are probably just normal, healthy variations in our tissue texture. And pain, regardless of where it is felt in the body, has less to do with knots, adhesions, and scar tissue, and more to do with a nervous system that has been sensitized around a particular area. This is a helpful, progressive change in perspective because the less that we pathologize the physical feel of "tightness" and "knottiness" in our tissues, the less likely we are to create nocebos for ourselves or our yoga students and massage clients. (A nocebo is a negative expectation of an otherwise harmless event or action that causes negative consequences like pain.)
MYTH #3: OUR FASCIA CAN BECOME DEHYDRATED AND ROLLING ON MASSAGE TOOLS HELPS TO RE-HYDRATE IT
This is an absolutely appealing and intuitive idea, but to the best of my knowledge, we don’t have research that supports this claim. Part of the problem lies in a lack of specificity for how this proposed dehydration/rehydration process would work.
In simple terms, our connective tissue is made up of cells, collagen fibers, and a non-living gelatinous matrix called ground substance. When the claim is made that fascia can be dehydrated, I believe the notion is that its ground substance is dehydrated.
It’s unclear to me how it could be determined that someone’s ground substance is dehydrated, however - can you tell by looking at someone from the outside? Maybe by looking at their skin? Can you tell because they feel pain somewhere? (As we mentioned earlier, pain and tissue quality are poorly correlated.)
Even if there was a reliable way to assess fascial dehydration, it is unclear to me how a massage or rolling on balls or other tools would hydrate it. The ground substance of connective tissue definitely has some water content, but how would the pressure from rolling change this water content? (Water that you drink goes through different channels in your body than water in your ground substance, so that's a different type of hydration than fascial hydration.) Does rolling add new water to fascia (how?), or does it move already-existing water from another part of the body to the deydrated one? If rolling did increase water content, wouldn’t everyone’s glutes be extra hydrated and especially healthy because so many of us squash them with pressure by sitting on them for hours every day?
Most of us believe this hydration claim because we heard it from someone knowledgeable like a smart yoga instructor or an experienced bodywork teacher. But if we actually look to connective tissue biology for some factual basis to the claim, we find that there is little support there. It may be true that massage can hydrate our dehydrated fascia, but research has not yet demonstrated this in a clear way. I believe we would do more of a service to our yoga community by waiting to make claims like this until science begins to produce some solid evidence for them.
In summary, fascia is an incredibly fascinating tissue of the body for an abundance of reasons. But we will better serve ourselves and our students if we shed some of our language about fascia that implies that it is full of painful adhesions and scar tissue that need to be broken down and hydrated. Additionally, massage therapy and self-massage tools like balls and foam rollers are absolutely wonderful, helpful practices that offer great results for so many people. But when we recognize and teach an awareness of the often-overlooked role that the nervous system plays in many of these massage benefits, we will be able to utilize these tools even more powerfully for ourselves and our students and clients.
(If you're interested in exploring these ideas further, you might appreciate this video from Quinn Henoch, Doctor of Physical Therapy:)