Friday, September 3, 2010

Ankle Sprains or Inversion Sprains – Part 4

Fascia and Inversion Sprains
Fascia was once thought to be nothing more than packaging material covering muscles and organs. Back in school, when we worked in the dissection lab, we went out of our way to remove this material in order to expose those structures that were considered to be more important (an experience that I have heard repeated by many individuals in the medical field). Unfortunately, this lead to the very misleading perspective that fascia was unimportant.

Now, 20 years later I, and many others, have come to a very different conclusion. Fascia is everywhere, weaving through, and interconnecting every component of our body. Robert Schleip from Ulm University in Germany (of the Fascia Research Project) describes fascia extremely well when he describes fascia as “the dense irregular connective tissue that surrounds and connects every muscle, even the tiniest myofibril, and every single organ of the body forming continuity throughout the body.” In other words, fascia is the physical manifestation of the kinetic web that we have discussed so many times in our blogs and books.

Schleip R. Fascial plasticity—a new neurobiological explanation: part 1. J Bodyw Mov Ther. 2003;7(1):11–19.

Fascial interconnections are not theoretical entities; they are actual physical structures that have been well mapped out. Researchers such as Thomas Meyers (Anatomy Trains) and Luigi, Carla, and Antonio Stecco (Fascial Manipulation) have spent decades researching these interconnections. During the last International Fascia Research Congress at the University of Amsterdam, I had the privilege of listening to medical experts from around the world confirm this and related fascial research. (Take a look at these excellent articles for more details.)

Fascia as an Anchor for Force Generation

When one considers the prevalence of fascia throughout the body, it is not surprising to discover that it actually plays a critical role in all bodily actions, and that it is much more than the “bubble wrap” that many considered it to be.
In conventional medical theories, muscles have both an origin and insertion at the bone(s). In this view, when a muscle contracts, it pulls the origin toward the point of insertion to create motion. In reality, muscle fibers actually originate from, and insert into, fascial fibers. These fascial fibers, in turn, insert into multiple regions of the bone, and even into adjacent muscles. These additional points of contact and control provide the muscle with the ability to generate force in multiple directions.
In reality, when a muscle contracts to perform an action, only certain sections of the muscle contract. Force is not generated from just the origin and insertion points, but also through the numerous fascial connections. Anatomists at the University Maastricht in the Netherlands have done some incredible research that confirms this understanding.

Van Mameren H. Reaction forces in a model of the human elbow joint. Anat Anz. 1983;152:327–328.

Fascia as a Neurological Feed Back Loop

Muscles work together as functional units that coordinate their actions across multiple joints. Depending on the degree of motion required, and amount of force that is needed, each muscle will contract only specific areas of the muscle, rather than the entire muscle. As incredible as it may sound, these very specific motions are largely coordinated by the neurological receptors embedded in the fascia, and not by the brain. This is a form of non-localized intelligence, a concept that has long been postulated, but is only now being acknowledged as occurring in all life forms.

Fascia is full of two types neurological receptors - mechanoreceptors and proprioceptors. A mechanoreceptor is a sensory receptor that responds to mechanical pressure or distortion. A proprioceptor is a sensor that provides the brain with information about joint angle, muscle length, and tension.
Motion is coordinated by the feedback of the neurological receptors in the fascia when tension is transfered from one area to the next. (Previously these receptors were only thought to be located within just the muscles).

Fascial Lines and an Inversion Sprain

When we evaluate an inversion sprain of the ankle, we must also take into consideration all the fascial connections to the structures that are involved in performing and coordinating ankle motion. It is important to look at the big picture, and take into consideration that multiple muscles, working across multiple joints (all of which are interconnected by fascia) are all required to coordinate these motions.

In the case of an inversion sprain, the fascial connections we should consider is in the Lateral Line (see Anatomy Trains by Thomas Meyers). The following is a short synopsis of the lateral line. I have also included a link to the Anatomy Trains dissection video about the Lateral Line – Thomas Meyers Lateral line Video.

Lateral Line
· Beginning at the foot with the peroneal muscles, fascial interconnections travel up the outer leg to just below the knee (fibular head). This fascia then connects directly into the lower IT band into the deltoid complex (gluteus maximus, gluteus medius, and tensor fascia latae).
· The fascia then connects to the pelvis (iliac crest), which connects into the abdominal muscles (internal and external obliques), and then into the quadratus lumborum which connects into the ribs and the spine.
· The fascia then travels up between the ribs (intercostals muscles) and continues up the body to connect into the fascia of the neck (SCM, splenicus cervicis, and scalenes).

Once you see these videos, you will find it very hard to dispute the importance of these fascial connections.

Bottom Line: You can try treating inversion sprains with all the right techniques (ART, Graston, Massage etc.) and find that you still have not resolved a chronic inversion sprain if you did not consider, and treat, the fascial interconnections


In addition to the soft-tissue treatment component, you must also address the osseous (bone/joint) component. Joint manipulation helps to restore active range of motion in the ankle and speed recovery. It is very common for several of the joints of the feet to become stiff and rigid, due to either the initial injury or due to soft-tissue compensations over a period of time.

The exact area that requires joint manipulation varies depending on the severity of the sprain, number of reoccurrences, and the length of time that has passed since the injury occurred. The longer you wait, the more compensations your body must make, and the longer it will take to treat and recover from the injury.

In part five of Ankle Sprains we will provide Rehabilitative Exercises For Ankle Sprains.

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