What is fascia?

Fascia is a sheet of connective tissue, primarily made up of collagen, and is located just below the skin. This amazing tissue surrounds, connects, and separates muscles and organs within the body. Simply put, fascia is like plastic wrap. These connections come together in a myriad of ways and provide us with a road map to follow pain patterns that have formed over time.

Is your shoulder pain due to myofascial trigger points in the opposite leg or is it referring from your gallbladder? Is the sudden increase in headaches stemming from the tiny muscles at the base of your skull or due to a restriction in your right rectus abdominis muscle, which is also restricting your diaphragm on that side? Or is the low back pain stemming from the thick fascia underneath your feet, you may know this as the plantar fascia, or vice versa?

The symptoms you are experiencing may be unbearable and confusing, but the silver lining is that your fascia will provide us with so many answers. This is why your initial visit here at Urban Wellness Clinic includes a full body assessment. How are the movement patterns throughout your whole body? Does your shoulder hike up on one side? In what way are active ranges of motion restricted? And our all-time favorite question to ask: Do you have any scars?!

Why are we asking about old scars anyway?

Remember the plastic wrap analogy? How irritating is it when we try to pull a clean and even sheet of plastic wrap but one simple mishap and a whole corner jumbles up? That’s how fascia can act up as well. Think of a post-surgical scar, perhaps you have one? You have undergone damage to the skin, fascia, muscle and then been stitched back together. The tissue underneath that scar is jumbled up just like the plastic wrap and needs to be smoothed out in order to function the way it was intended to! Now, plastic wrap in the kitchen is not something we want to spend time ironing out, but at Urban Wellness Clinic we focus on scars, old and new, because they play such an important role in fascial patterns and how the body compensates.

What is the difference between scar tissue and a trigger point?

A trigger point is a small area of restricted fascia, palpable under the skin, and is found in the muscle belly. A trigger point can cause tenderness, refer pain to another spot in the body, and/or cause a local twitch response, which is a quick contraction in a band of the affected muscle. This is typically triggered in the body when someone palpates a trigger point, say in your neck or shoulders.

A scar is visible on the skin and can be the result of a wound, post-surgical work or an old injury that did not heal properly. Scars can be elevated on the skin due to the increase in fibrous tissue in the area. A new scar, when palpated, can feel like there are small granules of sand while an older scar will start to feel like leather.

A trigger point is something we all have heard of and most definitely have experienced. Although there may not be local pain or referral, we all have trigger points within our body. These can arise from staying in the same position for long periods of time or poor movement patterns. Scars are different, as not everyone has them, but for those who do, there is most definitely a direct relationship to how your body is compensating.

Research on Fascia

A research article was published in the Journal of Multidisciplinary Healthcare and it is 19 pages of jaw-dropping and mind-blowing information all about scars and fascia! As someone who has seen how scars can create major compensations in the body firsthand, I was definitely geeking out over this article. In fact, I reference it during visits with patients all the time. Scars and even burns can affect your musculoskeletal system, emotional response, and sympathetic nervous system! Other great highlights I took away from the article:

• Your skin will send and receive information from the entire body.
• The mechanoreceptors on the skin, which are cells that respond to touch, pressure and sound, continuously respond to the way the body is positioned, i.e. postural overload.
• A horizontal scar on the skin can produce 3x the amount of tension on the underlying fascia as opposed to a vertical scar.
• Your skin (an external organ) and internal organs undergo a similar healing process. There are 4 main stages: hemostasis, inflammation, proliferation, and remodelling. When looking at a wound on the skin, that means clotting/ stopping the blood, forming a scab, an infiltration of cells to help repair the skin, and then remodelling of the skin underneath and on the surface.
• A hypertrophic scar, keloid scar or atrophic scar can form due to a previous scar formation. Scars can alter the healing process and move it to a non-physiological state, which in turn forms these more intense lesions on the skin.
• Due to the skins connection to the sympathetic nervous system (the system that helps you in fight or flight scenarios), there can also be an alteration in the skin with emotional responses. Excessive sweating, for example, is your skin’s way of responding to internal or external stressors and wanting to maintain its temperature.
• Breathing patterns and eye movements can produce a sympathetic response in the skin. How? Think of that deadline at work looming. You have 30 minutes on the clock and 60 minutes worth of work left to do. You start to breathe in shallow breaths, likely into your chest, and your mind starts to race. The beads of sweat that form on your forehead and palms is the sympathetic response! Your skin is responding to the stress in your body, all while various stress hormones (a more in-depth topic) begin to rise.

The reason it takes time to allow for healing, postural changes, and musculoskeletal compensations is that the skin itself is constantly changing. It works to adapt to stress and load and find ways to heal quickly and get you out of pain. The good news is, there are ways to help kick start the healing process again or retrain the body to function the way it is intended to.

A Common Compensator: The C-Section Scar

At Urban Wellness Clinic we see so many amazing Mama’s to be and Mama’s who are taking time out for themselves post-childbirth. We spend a lot of time going over strength training, both for pre and post-childbirth, and of course, ways to take care of the skin.

Webster Technique is utilized during pregnancy and this technique involves soft tissue work to the round ligament, which is only palpable during the later childbearing months. This ligament can mimic muscular tension as it is the only ligament in the body that has muscle fibres! It grows and stretches with the belly and working through this tight area can help alleviate a lot of pain and tension.

If you have scheduled or already undergone a C-Section, then the C-Section scar is important to work through as well. Again, this can be an old C-section scar that you can still give time and attention to. A common way the body compensates is that the C-Section scar has altered the abdominal musculature and the fascia surrounding it. When working on core strength and stability, the C-section scar can be a hurdle to making progress. At Urban Wellness Clinic, we use Neurokinetic Therapy to find out where else the scar is forming compensations. We then utilize soft tissue techniques to work on your scar, teach you how to continue to care for it at home, and then strengthen the areas that it has weakened or altered over the years.

There is an immediate and positive response that we see with patients in the office and we love showing our patients how quickly they can jump on the path to better healing.

How Can Urban Wellness Clinic Help?

Neurokinetic Therapy (NKT): We utilize this method at Urban Wellness Clinic on the daily. This technique is a muscle strength testing system that allows us to test muscles individually towards others in the body. This feedback from individual patients helps us understand what muscles need to be strengthened vs. stretched and vice versa. It is a great way for the doctor and patient to understand where the compensations are taking place and allows for great feedback when checking your individual progress with treatment.

Active Release Technique (ART): ART is a well known and effective way to work through trigger points in the body. Once we have tested with NKT, we can utilize ART to the specific muscle or muscle groups and alleviate the tension that has built up in the fascia surrounding the muscle.

Graston Technique: For some areas of the body, such as the plantar fascia, the use of Graston tools can be more beneficial. Since fascia under the feet or in the hand can dive deep or thicken in certain instances, it is helpful to break down the scar tissue with this tool. Your practitioner will utilize the appropriate Graston tool to break down the scar in question and help restore proper movement and function to the area.

Foam Rolling: This is a wonderful at-home method, especially after a strength training session! Once your practitioner has educated you on the way your body is moving and compensating, the right muscles can be targeted with a foam roller. Commonly, we tell patients to work on their IT band, the quadriceps muscles, calves and thoracic spine.

The skin is the largest organ of the body, and this fact is all too often forgotten. As we continue to respond to the signs and symptoms currently manifesting and affecting our day-to-day, it is equally important to take care of our organs, i.e. the skin! Visit Urban Wellness Clinic for your full body assessment and let us help you take care of all things inside and out. Feel free to call us at 212-355-0445 or set up an appointment hello@urbanwellnessclinic.com

Yours in Health,

Dr. Monisha Mallik, D.C.