Fascia pain in other areas of the body other than the foot and iliotibial band is a new concept to some, but we have been helping patient's recover from this hidden pain generator for a while now.
Fascia 101
Fascia is a spiderweb-like casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. The tissue does more than provide internal structure. Fascia has nerves that make it almost as sensitive as skin. When stressed, it tightens up. When it dries up and tightens around muscles, it can limit mobility and cause painful knots to develop.
Healthy fascia is smooth, slippery, and flexible. Factors that cause fascia to become gummy and crinkle up (called adhesion or knots) include:
- A lifestyle of limited physical activity (too little movement day after day)
- Repetitive movement that overworks one part of the body
- Trauma such as surgery or injury
Determining whether your pain is due to muscles, joints or fascia can be difficult. In general, muscle injuries and joint problems feel worse the more you move. Fascia adhesions tend to feel better with movement and also respond well to heat therapy, which helps bring back the tissue’s elasticity.
For some people, adhesions can worsen over time, causing the fascia to compress and contort the muscles it surrounds. This can result in hard, tender knots in the muscles, called trigger points. Myofascial pain syndrome is a condition in which those trigger points cause pain to occur:
- During movement
- When pressure is applied
- In seemingly unrelated parts of the body (referred pain)
Treatment focuses on relieving pain and getting tight fascia and muscle fibers to relax. Treatment options focus on exercise therapy and breaking down of trigger points through compressive techniques.
Keeping your fascia healthy has many benefits. You’ll move more easily, have a better range of motion, and experience less pain.
Plantar Fasciitis
The most common type of fascia related pain
Plantar fasciitis is one of the most common causes of heel and bottom of the foot pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes called the plantar fascia. Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.
- Runners
- People who are overweight
- Those who wear shoes with inadequate support
Illiotibial Band Syndrome
Illiotibial Band Syndrome (ITBS) is one of the most common injuries in runners presenting with lateral knee pain.
Is a common knee injury that usually presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line, and inferior to the lateral femoral epicondyle. It is considered a non-traumatic overuse injury and is often concomitant with the underlying weakness of muscles. Overuse is thought to be caused by repetitive knee flexion and extension movements frequently seen in cyclists and runners. This repetitive motion causes excessive friction between the lateral femoral epicondyle and the iliotibial tract.
The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh from the iliac crest and inserts at the knee. It is composed of dense fibrous connective tissue that appears from the tensor fascia latae and gluteus maximus. It descends along the lateral aspect of the thigh, between the layers of the superficial fascia, and inserts onto the lateral tibial plateau at a projection known as Gerdy’s tubercle. In its distal portion, the iliotibial tract covers the lateral femoral epicondyle and gives an expansion to the lateral border of the patella. While the iliotibial band does not have any boney attachments as it courses between the Gerdy tubercle and the lateral femoral epicondyle, this absence of attachment allows it to move anteriorly and posteriorly with knee flexion and extension.
The main symptoms of ITBS are:
- Sharp pain on the outer aspect of the knee, particularly when the heel strikes the floor, that can radiate into the outer thigh or calf
- Pain that tends to worsen when running or coming downstairs
- Audible snapping sensations when the knee bends
- Swelling on the outer side of the knee
- Exercise-related tenderness over the lateral femoral epicondyle
- An acute, burning pain when pressure is applied on the lateral femoral epicondyle with the knee in flexion and in extension
The treatment of ITBS is usually non-operative, and physiotherapy should be considered the first and best line of treatment. Due to the variety of potential causes of IT band syndrome, it is necessary to consider areas that may be contributing to abnormal body mechanics. Especially with knee conditions, the joints above (hip) and below (ankle/foot) should be assessed to determine if they are contributing to the problem.
Thoracolumbar Fascia
The thoracolumbar fascia (TLF) is a large area of connective tissue, roughly diamond-shaped, which comprises the thoracic and lumbar parts of the deep fascia enclosing the intrinsic back muscles.
Most developed in the lumbar region, it consists of multiple layers of crosshatched collagen fibres that cover the back muscles in the lower thoracic and lumbar area before passing through these muscles to attach to the sacrum.
People are starting to investigate the TLF as a potential pain-generating structure in the back. Abnormal connective tissue structure may be a predisposing factor for LBP, or a consequence of injury and/or changes in movement patterns occurring as a result of chronic pain. A potentially important consequence of injury may be fibrosis and adhesions, causing loss of independent motion of adjacent connective tissue layers which could further restrict body movements.
