Fascia is Forreal- Everything You Need to Know

I’ve spent the better part of the last eight years intensely studying and understanding the fascial system, particularly, for how it relates to training athletes and injury restoration. So, yea, I might be a bit biased on the subject, and dare I say passionate. My work and publications over the years are simply a reflection of what I do, what I believe in, and what I find to be successful for the athletes I work with. I produce curriculum and content being truly indifferent to the readers opinion. I’ve always done my best to disregard whatever the “status quo” of our field suggests, opting to just be as transparent and authentic as I’m able to. I publish to share, not to sell.

Fascia has been a polarizing topic of interest, often subject to contentious debate and rarely discussed with modest viewpoints. As any topic becomes more popularized or “trendy”, the opportunity for divisiveness increases, and whether for or against it, our contemporary world ravishes at the opportunity to be polarizing in their viewpoint at all costs. There's a ton of content questioning and challenging the legitimacy of fascia. I typically stay level headed about it, but every now and then I come across something that does strike a nerve and prompt some level of provocation. Beyond the subject matter, in this case fascia, I have a dwindling tolerance for people doing social media videos {using other people’s work} to make self-fulfilling absolutist statements that are misleading, if not misinforming. Not to mention when these are videos are produced merely for the sake of generating personal attention and clout on social media without providing any substance or value.

So, given the post I came across this weekend, the purpose of this article is to bluntly and objectively demonstrate two simple points- that fascia is real, and that it can (and should) be considered in training.

Quick Backstory

In 2018, while at VHP, I was assigned to work with an athlete who would quickly and profoundly change the way I viewed the human body and how to train it. This individual was a high-level Special Operator, 34 years old, active duty, and a father of two young children. About a year prior, he had been diagnosed with some form of rare deep thoracic cancer, not only jeopardizing his career but very much his life. Thankfully he was able to have all the tumors removed and determined to be cancer free, but it did not come without consequence. The process to retrieve and remove the tumors was devastating. He would require several rounds of chemotherapy, countless operations, including having to break the sternum and all 12 ribs on the right side of his body, cut through damn near every major muscle, while severing all the surrounding connective tissue.

By the time he had gotten to us it was clear that our work was cutout for us, his body had been ravaged, including an egregious level of asymmetry in the upper body. We had about six weeks to help get this individual back to a physical state that would permit him to meet the requirements to maintain his eligibility. We quickly determined this was a case where the conventional bench/squat/dead strength training approach was not going to be conducive for this individual. We needed to approach this differently.

So I had to look into some alternative routes, and at this time, anything beyond the conventional S&C playbook was completely foreign to me. But my demand to find an alternative would lead me into some interesting material- to include the fascial system. My rabbit hole began. What started initially with Tom Myers and the Anatomy Trains material would roll into other fascial experts like the Stecco’s and Robert Schleip. What we put together for this individual was not only able to help him reach his goal of remaining operational, but it was so successful, that it prompted us to audit and completely rebuild our internal model for how we approached human performance. We would go on to develop and adopt a fascial based approach for all of our athletes, and for the next 5 years would continue to see incredible outcomes with our Special Operations athletes. Fascial Based Training was formed.

Let’s Clear the Air…

• Even if fascia is real, does it really even do anything?

  • Yes, it’s real, and yes it has several functional roles. Fascia is an extra- and intramuscular connective tissue spanning the entire body. It has a versatile anatomy, playing an integral role in human postural integrity, movement coordination, and elastic or propulsive mechanics of movement.

• Why is it just now becoming “a thing”?

  • Fascia was initially discovered way back in the 1600's, and became more properly identified in the late 1800’s, identified by researchers and surgeons as a “packing” or “filler” tissue. However, for nearly a century it was largely overlooked and deemed to be non-functional and simply discarded in research or medical practice (1).

• Compared to other connective tissue types, fascia is more of an aqueous (watery) substance and is therefore much more difficult to study.

• For the last 100 years the majority of contemporary anatomical research is conducted on bodies that have been doused in preservatives, chemicals, and embalmment fluid- all of which denigrate and dehydrate the fascial tissue. This makes fascia very challenging to study in cadaveric research.

• Nevertheless, with some advances in technology and a growing ability to study fascia, it’s now more widely recognized and becoming better understood. With improved research, discourse, and debate, have been on a rise with intensification over the last decade.

• Can you train it?

  • Think of this in the same way we consider energy systems in training- The three primary energy systems (ATP-PCr, Glycolytic, and Oxidative) are all working at all times just in varying capacities based on demand.

  • The same concept is true for contractile and connective tissues in training- we can’t specifically or selectively recruit connective tissues or muscles, but we can bias what is being emphasized through the training parameters that are applied.

  • Fascia is a global connective tissue, just as we have the demand to emphasize tendons in training or rehab the same should be held for fascia. Through specific parameters and applications, we can bias our inputs towards fascia.

• “There’s no good research to support fascia”

  • This is patently untrue. There is a rapidly growing body of research investigating fascia, and from a wide range of viewpoints. A few key names and organizations to be aware of include- The Stecco’s, Tom Myers, Robert Schleip, Jan Wilke, and Ida Rolf to name a few (see full reference list below).

  • I have a personal research file with well over 100 fascia studies, if you’re interested, email me and I’ll send you the file.

• Bottom Line

  • Conventional anatomy and biomechanics we’ve be taught aren’t wrong, they’ve just been incomplete. Recognizing fascia and its significance does not supplement these conventional principles, it is simply in addition to.

  • Fascia is important, and I do believe we should adopt a better lens for it in our view of the body and training. But it is not exclusive to muscles or tendons. It’s imperative to understand both sides can- and do- exist.

  • Fascia is not a main contributor for force production but plays an instrumental role in how forces are attenuated, distributed, and transferred throughout the body.

  • There is also an extensive sensorimotor network embedded within fascial tissue, making it imperative for motor control and movement coordination.

Fascia Anatomy 101

Fascia is a global connective tissue that spans and interconnects virtually all aspects of our anatomy. While possessing many functional roles and responsibilities within the body, from a mechanical perspective, fascia is vital for structural integrity, body awareness, and motor coordination. Although fascia is continuous throughout the body, it is not uniformed. This singular connective tissue sheath creates an interconnected network throughout the body that tightly envelops muscles, tendons, and even organs and nerve fibers.

Fundamentally fascia has a wide reaching and versatile anatomy. Fascia is loosely packed tissue that has non-linear fiber arrangements. This non-linearity gives a greater pliability to the tissue, allowing it to stretch greater lengths compared to muscles or other connective tissues (49). However, fascia is not fragile, and this is commonly misunderstood. Fascia, particularly deep fascia, has a dense, lattice-like structure that has a more robust strain capacity than tendons (40). This gives fascia a pronounced significance regarding eccentric strength capacities, helping to disperse and distribute eccentric forces throughout the body.

No differently than other connective tissues (tendons, ligaments, cartilage), fascia is made up predominantly of collagen, water, and elastin fibers. Fascia is highly viscoelastic (compliant), allowing it to stretch and glide without friction. Fascia also has plastic properties allowing it to deform significantly and return to form without damage (42, 44, 48, 51).

Fascia has  strong thixotropic properties, making it sensitive to changes in temperature directly affecting. the ability for adjacent tissues to glide (or stretch). The density or rigidity of fascial tissue is largely dependent on the tissue location and function within the body. For instance, the abdominal fascia (parietal peritoneum) is very thin and compliant, whereas the medial plantar fascia is extremely dense and fibrous. Considering the mechanical demands of the foot compared to the abdomen, this adaptation in density is a result of Davis’s Law, which governs that connective tissue will remodel based on the stressors applied.

There are several classifications of fascia (superficial, deep, aponeurotic, epimysial), which are broadly organized based on location and functionality within the body. For instance, where superficial fascia is predominantly involved in sensorimotor functions, it has no real significance for force transmission. Think about superficial fascia like we do the sensors in our cars, constantly surveying the vehicle and its surroundings. The superficial fascia works in the same way, in which countless proprioceptors and sensory bodies are constantly receiving relaying information from the environment and signaling messages to the brain (36, 38).

Conversely, where the superficial fascia is a sensorimotor hotbed with little role in force transmission, the deep fascia has the opposite function, playing less of a role in sensorimotor functions but is instrumental for kinetic force transmissions. The deep fascia is denser, more fibrous and has a much greater tensile strength than its superficial counterpart. The deep fascia functions like a massive rubber band encasing muscles and tendons. The deep fascia promotes increased mechanical stiffness and integrity making it essential for complete kinetic integration and force transmission (34, 35,).

This vast sensorimotor network within fascial tissue is an essential attribute for athletes, and this has been considerably overlooked in research and performance applications. Compared to muscle, fascia contains an estimated 6-10x greater concentration of proprioceptors and free nerve endings (21). Body control and position are keenly reliant on this attribute of fascia, as activation of these deep sensors is a catalyst for pre-tensioning the connective tissue which promotes optimal length-tension relationships under load (44, 45). Additional receptors that are unique to fascial tissue include nociceptors which detect pain sensitivity, interceptors which are essential for registering body awareness, and even have specialized receptors that are designed to detect vibrational or pressure changes within the body (9,10, 40).

Fascia also possesses what is known as piezoelectric properties (32), which describes a mechanical phenomenon stimulating an electrical charge when stress is applied. Due to its expansive role in neural and proprioceptive functions, fascia is intimately involved in complex performance attributes such as motor control and awareness, movement literacy and coordination, mechanical integrity and movement timing. The complex synergy and timing between multiple structures coordinating harmoniously (i.e., sprinting) is significantly influenced by the integrity, strength, and acuity of the fascial system.

What About The Slings?

Fascial slings, lines, or chains are the common terms you’ll see to describe the functional aspect of fascial anatomy. For all intents and purposes, these can be seen as interchangeable, although I have recently tried to use “myofascial lines” as my description. ‘Fascial slings’ or ‘lines’ are colloquial terms used to describe specific areas of densified fascia that create continuity spanning the extremities and torso.

Relating back to Davis’s Law, collagen is produced where stress occurs, and this remodeling process is influenced by the intensity, frequency, duration, and direction of the stress applied. If we consider the basic mechanics of locomotion and primitive patterns, we can see a clear relationship between limbs, extremities and these identified myofascial lines. Humans are bimodal beings, meaning we organically move in contralateral patterns, requiring synchronicity and coordination between opposing sides of the body (left to right AND front to back). The fascial network is instrumental- both mechanically and structurally- in how these locomotive and primitive patterns are formed.

This underscores the theory I now hold, that the primary myofascial lines exist simply because they represent areas of densified/fibrous connective tissue due to the fundamental mechanics of human motion. In other words, we take 6,000-10,000 steps per day, repetitive ‘loading’ on these quintessential MSK structures places load on the corresponding myofascial lines we see above. This is even true for the intrinsic myofascial line, as its predominant function is supporting the diaphragm and pelvic floor. Recall that breathing is far from a passive action, of which we perform up to 20,000 times per day. This volume of action reinforces and stresses the surrounding myofascial tissue, creating a kinetic “line”.

So… How Do We Train It?

Alright so probably what you’re really here for... how do we actually train it? Fascial based training is more of a change in philosophy than in strict practice. In other words, it’s less of a change in the “what” and more so a shift in “how”. We’ve already determined that “isolating” or selectively recruiting fascia is not a real thing, when we move, under load or otherwise, all structures (bone, muscle, tendon, fascia) are all being worked. But emphasizing fascia in training is no different than how we bias energy systems in conditioning (i.e., aerobic vs anaerobic). We know all energy systems are always at work, but through adjusting specific parameters in which conditioning is prescribed, we can bias aerobic or anaerobic efforts. Similarly here, through the manipulation of training parameters we are able to direct training efforts more towards connective tissues, such as fascia.

Adopting a fascial approach can be achieved through five simple principles:

1.)   Training parameters such as load type, intensity and range, body position and pressure, direction and velocity are all quintessential for creating a connective tissue bias in training. This is where the primary differences are found when differentiating training that is focused on developing muscle as opposed to fascia.

Parameter	Contractile Tissue Biased	Connective Tissue Biased
Load	Heavy, static, compressive	Moderate, dynamic, tensile
Stability	High external stability	High internal stability
Position	Bilateral	Unilateral, contralateral
Direction and Range	Linear, full range	Non-linear, partial or variable range
Effort and Intent	Overcoming, overload	Resilience, variability

A fascial emphasis should include moderate/submaximal loading (60-80%), performed with high velocity. Rather than pursuing pure overload, some increase in load with increased variability and speed is ideal for fascial adaptations. Where musculotendinous adaptations are acquired through static load, fascia, along with other extramuscular connective tissues tends to respond best to accommodating resistances (i.e., band or cable) as compared to static loading. Where contractile efforts should have high external stability (load), fascial training is more reliant on developing intrinsic stabilization. This speaks to the value of open chain, dynamic movements for fascial tissue. When we incorporate open chain applications, fascia is stressed to promote internal stability predominantly through the deep fascial structures.

2.)   Foot to Fingertip. Where training for muscular adaptations focuses more isolated efforts, fascial adaptations suggest total body movements with an emphasis on the integration of these body parts. We want to have particular emphasis on connecting through the distal extremities, and pressurizing through the hands and feet. Rather than itemizing the body as “upper body” and “lower body” we want to see everything as being “total body”. I organize my training split based on anterior-lateral focus, and posterior-spiral focus. Essentially anterior-lateral includes pressing, hip flexion, and side bending, where posterior-spiral includes pulling, hip extension, and rotation.

Foot to fingertip also emphasizes the significance of having active hands and feet in training. I’m a big proponent of barefoot training, a primary reason for this is the high concentration of dense fascial tissue lining the plantar surface of the foot. The same is true for the hands, as the palmar fascia functions similarly to the plantar fascia in that it is highly concentrated in sensory bodies and plays an integral role in promoting complete tensioning throughout the entire myofascial or kinetic line. If you want to increase fascial adaptations, do some barefoot training, and emphasize how hands and feet interface with the ground.

3.)   Fascia isn’t fragile- load it. The greatest misconception with fascia is that it’s fragile and responds mostly to passive therapies and bodyweight stretches. This is patently mistaken. Fascia, no different than other connective tissues, must be loaded (heavy, fast, and frequently) in order to drive true adaptation. In addition to load, high braking forces (deceleration), change of direction, and ballistic actions are all also great stimuli for fascial adaptations. The dynamic applications are ideal for improving the elastic stretch and recoil of fascia, which is a prominent feature of fascia during high velocity actions such as jumping and sprinting. Where tendons respond best to high linear force, time under tension, and intensive plyometrics, fascia responds best to moderate force at higher speeds, variable loading, and extensive plyometrics.

4.)   Improve the ability to tolerate variability. Sport is a microcosm of chaos, and in most cases, has very little predictability or ‘exact’ repetition. Athletes are constantly perceiving and adjusting to the environment around them, which is perpetually dynamic in sport. As such, subtle changes in position, pressure, direction, velocity, or exertion of force are the fabric from which sport is sewn together. This speaks to the value of variability within the training setting. We need to have a handful of central criteria (press, pull, lunge, squat) but rather than oversaturating “the basics” we need to elucidate these patterns with subtle variabilities. The adaptations for connective tissue, particularly fascia, are becoming more resilient in a multitude of positions and load demands, rather than being explicitly robust in one or few ranges and paths of movement.

5.)   Remove as much bilateral load as possible. Considering the structure and directionality to the primary myofascial lines, it should be clear as to why we would want to limit bilateral options. The diagonal and helical orientation of these primary myofascial lines is more conducive to split stance, staggered stance, or single-leg movements. The split positioning puts one hip in flexion and the other in extension, this gives us full tensioning on one posterior line, and one anterior line. Conveniently, this is also the case for walking and sprinting mechanics, which reinforces the preference for split vs bilateral loading. I am NOT saying bilateral is “bad” or dangerous, but in my view, it’s less conducive to how athletes are required to move, so we minimize the usage.

Closing

I wrote a 3300-word article on fascial training and never once used the word stretch, release, Bosu, unstable, or hyperarch. Fascia is a real thing; it really is anatomically significant, and it does have a significant influence on performance. There is so much misinformation and misunderstanding of fascia, and it’s the goofy condescending videos for IG clout that highlight this lack of understanding.

No, fascia is not the panacea of performance, it does not negate our musculoskeletal anatomy, and will never supplement what our industry has been developed around entirely. We need to have a better appreciation for the complex, dynamic system that is the human body, and think that just maybe we haven’t completely figured this human performance thing out yet. Our field is still in its infancy, with formal strength and conditioning still being less than 50 years old. Recognize and appreciate that with new understanding comes new philosophy, and new philosophy drives new applications.

Fascia isn’t a fad, it’s fundamental. Part 2 to follow this week.

References:

1. Adstrum, S. Nicholson, H., 2019. A history of fascia. Clinical Anatomy, 23(7):862-870.

2. Blottner, D. Huang, Y. Trautmann, G. Sun, L., 2019. The fascia: Continuum linking bone and myofascial bag for global and local body movement control on earth and in space. A scoping review. Human Space Explor, 14(15).

3. Bordoni, B. Myers, T., 2020. A review of the theoretical fascial models: Biotensegrity, fascintegrity, and myofascial chains. Cureus, 12(2).

4. Bordoni, B. Lintonbon, D. Morabito, B., 2018. Meaning of the solid and liquid fascia to reconsider the model of biotensegrity. Cureus, 10(7).

5. Bordoni, B. Mahabadi, N. Varacallo, M., 2020. Anatomy, fascia. Stat Pearls.

6. Brandl, A. Wilke, J. Egner, C. Reer, R. Schmidt, T. Schleip, R. 2023. Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain.Front. Med. 10:1177146.

7. Cowman, MK. Schmidt, TA. Raghavan, P. Stecco, A. Viscoelastic properties of hyaluronan in physiological conditions. F1000Research, 4:622.

8. Day, J. Stecco, A., 2012. “Fascia anatomy in manual therapy: Introducing a new biomechanical model.” Fascial Manipulation. 

9. Fede, C. Petrelli, L. Guidolin, D. Porzionator, A. Pirri, C. Fan, C. De Caro, R. Stecco, C., 2021. Evidence of a new hidden neural network into deep fasciae. Sci Reports, 11.

10. Findley, T. Chaudry, H. Stecco, A. Roman, M., 2012. Fascia research- A narrative review. J Bodywork & Mvmt Thera, 16, 67-75.

11. Frederick, A. Frederick, C., 2017. Stretch to Win, Human Kinetics.

12. Frederick, A. Frederick, C.,2020. Fascial Stretch Therapy, Handspring Publishing Limited.

13. Garofolini, A. Svanera, D., 2019. Fascial organization of motor synergies: a hypothesis. Eur J Transl Myol, 29(3): 185-194.

14. Huijing, PA. Baan, GC., 2002. Myofascial force transmission: muscle relative position and length determine agonist and synergist muscle force. J Appl Physiol 94: 1092 – 1107.

15. Jung, E. Ly, VT. Buderi, A. Appleton, E. Teodorescu, M., 2019. Design and selection of muscle excitation patterns for modeling a lower extremity joint inspired tensegrity. IEEE Conference on robotic computing, Naples, Italy.

16. Kodama, Y. Masuda, S. Ohmori, T. Kanamaru, A. Tanaka, M. Sakaguchi, T. Nakagawa, M. 2023. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering, 10, 474.

17. Krause, F. Wilke, J. Vogt, L. Banzer, W., 2016. Intermuscular force transmission along myofascial chains: a systematic review. J Anat., 228:910-918.

18. Kumka, M. Bonar, J., 2012. Fascia: a morphological description and classification system based on a literature review. J Can Chiropr Assoc, 56(3), 179-191.

19. Langevin, HM., 2021. Fascia mobility, proprioception, and myofascial pain. Life, 11, 668.

20. Levin, S. Martin, D., 2012. “Biotensegrity- The mechanics of fascia.” Fascia- The Tensional Network of the Human Body. Schleip, R. Findly, T, Churchill Livingston, 2012, 137-142.

21. Maas, H., 2018. Significance of epimuscular myofascial force transmission under passive muscle conditions. J Appl Physiol, 126, 1465-1473.

22. Maas, H. Finni, T., 2018. Mechanical coupling between muscle-tendon units reduces peak stresses. Exerc Sport Sci Rev, 46(1), 26-33.

23. Maas, H. Noort, W. Smilde, HA. Vincent, JA. Nardelli, P. Cope, TC., 2021. Detection of epimuscular myofascial forces by Golgi tendon organs. Exper Brain Res, 240, 147-158.

24. Maas, H. Sandercock, TG., 2010. Force transmission between synergistic skeletal muscles through connective tissue linkages. J Biomed and Biotech.

25. Minasny, B., 2009. Process of fascial unwinding. Intl J Thera Massage Body, 2(3).

26. Monfils, MH. Plautz, EJ. Kleim, JA., 2005. In search of the motor engram: motor map plasticity as a mechanism for encoding motor experience. Neuroscientist, 11(5):471-483.

27. Morikawa, m. Maeda, N. Komiya, M. Hirota, A. Mizuta, R. Kobayashi, T. Kaneda, K. Nishikawa, Y. Urabe, Y., 2021. Contribution of plantar fascia and intrinsic foot muscles in a single-leg drop landing and repetitive rebound jumps: an ultrasound-based study. Int. J Environ Res. 18, 4511.

28. Myers, T. Anatomy Trains: Myofascial meridians for manual and movement therapists- 2ND ed. Churchill Livingstone, Edinburgh, 2009.

29. Parisi, B. Allen, J. Fascia Training: A whole-system approach. New Jersey, Parisi Media Productions, 2019.

30. Parisi, B. Allen, J. Fascia Training in Application: Applying the new science of speed, power, and injury resilience. Smart Fish Productions, 2023.

31. Poo et al., 2016. What is memory? The present state of the engram. BMC Biol, 14(40).

32. Purslow, P. 2010. Muscle fascia and force transmission. J Body Mvmt Thera, 14: 411-417.

33. Purslow, P (2020) The Structure and Role of Intramuscular Connective Tissue in Muscle Function. Front. Physiol. 11:495.

34. Rauch, J. Leidersdorf, E. Reeves, T. Borkan, L. Elliott, M. Ugrinowitsch, C., 2020. Different Movement Strategies in the Countermovement Jump Amongst a Large Cohort of NBA Players. International Journal of Environmental Research and Public Health, 17, 6394.

35. *Santuz, A. Brull, L. Ekizos, A. Schroll, A. Eckardt, N. Kibele, A. Schwenk, M. Arampatzis, A., 2019. Humans exploit robust locomotion by improving the stability of control signals. BioRxiv.

36. Scarr, G. Biotensegrity- The structural basis of life. United Kingdom, Handspring Publishers, 2014.

37. Schleip, R., 2002. Fascial plasticity- a new neurobiological explanation: part 1. J Body Mvmt Thera, 7(1):11-19.

38. Schleip, R. Gabbiani, G. Wilke, J. Naylor, I. Hinz, B. Zorn, A. Jager, H. Breul, R. Schreiner, S. Klinger, W., 2018. Fascia is able to actively contract and thereby influence musculoskeletal dynamics: A histochemical and mechanographic investigation. Front Physiol, 10: 336.

39. Schleip, R. Muller, DG., 2012. Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. J Body Mvmt Thera.

40. Schleip, R. Wilke, J. Fascia in Sport and Movement. United Kingdom, Handspring Publishing, 2021.

41. Schultz, R. Feitis, R. The Endless Web: Fascial anatomy and physical reality. Berkley, CA. North Atlantic Books, 1996.

42. Sinhorim, L. dos Santos Amorim, M. Ortiz, ME. Balduino, E. Bianco, G. de Silva, FC. Vargas, V. Schleip, R. Reed, WR. Mazzardo-Martins, L. Martins, DF., 2021. Potential nociceptive role of the thoracolumbar fascia: A scope review involving in vivo and ex vivo studies. J Clin Med, 10:432.

43. Smith, H. Strong, P.2020. Structural Elements of the Biomechanical System of Soft Tissue. Cureus, 12(4).

44. Stecco, A. Giordani, F. Fede, C. Pirri, C. De Caro, R. Stecco, C. 2023. From Muscle to the Myofascial Unit: Current Evidence and Future Perspectives. Int. J. Mol. Sci., 24, 4527.

45. Stecco, A. Macchi, V. Stecco, C. Porzionato, A. Day, J. Delmas, V. De Caro, R., 2009. Anatomical study of myofascial continuity in the anterior region of the upper limb. J Body Mvmt Thera, 13:53-62. 

46. Stecco, A. Stern, R. Fantoni, I. De Caro, R. Stecco, C. 2015. Fascial disorders: Implications for treatment. PM R, 1-8.

47. Stecco, C. Functional atlas of the human fascial system. Toronto, Churchill Livingstone Elsevier, 2015. 

48. Stecco, C. Pirri, C. Fede, C. Yucesoy, C. De Caro, R. Stecco, A., 2021. Fascia or muscle stretching? A narrative review. Appl Sci, 11, 307.

49. Tai,Y. Woods, EL. Dally, J. Kong, D. Steadman, R. Moseley, R. Midgley, AC. 2021. Myofibroblasts: Function, Formation, and Scope of Molecular Therapies for Skin Fibrosis. Biomolecules,11,1095.

50. Tijs, C. Bernabei, M. van Dieen, JH. Maas, H., 2018. Myofascial loads can occur without fascicle length changes. Integ Comp Biol, 58(2):251-260.

51. Varghese, JG. Priya, GH., 2017. Role of fascia in human function. J Res Pharm Tech, 10(8):2759-2764.

52. Venkadesan, M. Yawar, A. Eng, CM. Dias, MA. Singh, DK. Tommasini, SM. Haims, AH. Bandi, MM. Mandre, S., 2020. Stiffness of the human foot and evolution of the transverse arch. Nature, 579, 97.

53. Wilke, J. Hespanhol, L. Behrens, M. 2019. A systematic review and meta-analysis of the prevalence of extramuscular connective tissue lesions in muscle strain injury. Ortho J Sport Med, 7(12).

54. Wilke, J. Schleip, R. Yucesoy, C. Banzer, W., 2018. Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol, 124:234-244.

55. Zhang, Z. Wang, J., 2014. Effects of perceptual clues on the subconscious neuromuscular feed-forward and feedback control. Acta Psychol Sin, 46(1):50-57.

56. Zugel, M. Maganaris, CN. Wilke, J. Jurkat-Rott, K. Klingler, W. Wearing, SC. Findley, T. Barbe, MF. Steinacker, J. Vleeming, A. Bloch, W. Schleip, R. Hodges, PW., 2018. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med, 52:1497.

57. Zullo, A. Fleckenstein, J. Schleip, R. Hoppe, K. Wearing, S. Klingler, W., 2020. Structural and functional changes in the coupling of fascial tissue, skeletal muscle, and nerves during aging. Front Physiol, 11:592.