The fascial system is complex. Making matters worse, is how relatively new fascia science is which has allowed for some ambiguity on how these things are defined and evaluated to persist, even amongst experts. Across the (several) governing/international bodies and world leading researchers there is a significant amount of disconnect and incongruencies ranging from how fascia is defined to what level of influence this system has. To put it lightly, our collective understanding of the fascial system is still a work in progress.
I’ve been intensely studying fascia for about four years now and being on a short list of American strength and conditioning coaches who has adopted the fascial perspective, I routinely receive questions about fascia and how it should be considered from a performance perspective. One of the more common questions I receive is “well, how do we measure it?” As we’ll discuss throughout this article, although it still may be a bit unclear how we can measure fascial improvements- especially in a definitive sense- but there are still several options that are comprehensive, practical, and valuable for performance.
Measuring Fascia is… Complicated
Let’s start with the anatomical limitations of fascial measurement… as we’ve come to learn, fascia is inextricably linked to virtually every other system in the body, namely, the musculoskeletal system (4). Where muscle ends and fascia begins is not as obvious as you’d think and in fact quite difficult to discern. To provide an example, it’s very clear where we delineate between a bone and a tendon, likewise, identifying where a vascular structure runs adjacent to where a muscle fiber doesn’t require an expert either. But with fascia, this delineation is very complicated to make and is actually different depending on what part of the body you’re looking at. Because of the multidirectional nature of fascial tissue, along with the variability in density and even physical properties, we still technically don’t have a unified definition for fascia as a whole (see below).
Figure 2- A picture of cadaveric fascia as compared to a typical illustration we see in textbooks. As you can notice, there is not a clean and neat separation between tissues or structures as our animations suggest. (Image via: Musculoskeletalkey.com)
Beyond that, and again because this is still a science in its infancy, we are still lacking tools, resources, and technology to measure the tissue itself. This is in part due to the negligence placed on fascia for centuries, in which it was viewed merely as a “packing or filler tissue” that provided no metabolic or biomechanical importance (4). As such, fascia was routinely ignored in clinical/scholarly studies, eviscerated and discarded during surgical procedures, and largely ignored up until the early 2000’s (1). This means our tools and technology needed to examine the fascia appropriately have only really been a priority for about 15-20 years, which is fractional compared to the time we’ve accumulated for studying other biological structures and systems.
To expand a bit on the cadaveric point, recall that fascia is a living tissue, implying that when we die the tissue erodes away shortly thereafter. The conventional process of cadaveric studies includes bodies that have been embalmed, which is a process that uses formaldehyde (among other chemicals) to preserve the structures. It should be very clearly understood what embalming does to the cadaver, and a part of this is denigrating the fascial tissue while also dehydrating the other tissues and vessels (3). I am not stating outright that because of this embalming process our cadaveric research is invalid, however, I would challenge that it has provided a distorted and perhaps incomplete view of anatomy and physiology, particularly for fascial tissue. All of that is to say, a major reason why fascia is difficult to assess and measure in the practical sense is because even at the top research level, we’re still way behind the curve on understanding it as a whole.
So, How CAN We Measure Fascia?
Despite the paragraphs above painting a grim picture, there are of course ways that we can glean insights to fascial improvements. Utilizing a chart provided from chapter 21 (Schleip, Bartsch) from the unbelievably resourceful textbook- Fascia in Sport & Movement (Schleip, Wilke), we can see there are a handful of clinical diagnostics designed to measure fascial function and improvement.
From the list above I include the palpation and subjective feedback pieces, although I would add one extension here- manual sling testing. This is effectively manual muscle testing for the anterior, lateral, and posterior slings, and provides an evaluation of trunk stabilization, firing patterns, and, to a degree, intermuscular relationships. The catch, however, is that these provide little value outside of localized strength improvements, and they’re also subjective. So perhaps in a rehab setting or with athletes who have glaring deficits this may be significant. But without access to expensive equipment or being a highly skilled practitioner, we gotta do the best we can with what we have.
I know my sport science and “but what does the research say” crowds are probably in fits, but bear with me for a second.
The inclusions of specific, objective measurements are obviously gold standard, make no mistake about it. But the reality is that subjective inputs and dare I say indirect or “nuanced” evaluations should not be discarded entirely. For instance, let’s take conditioning markers as an example. Would it be optimal for every coach in every facility to have on-site lactate testing, metabolic carts, and real-time HR and HRV monitoring to assess conditioning sessions… of course it would! But there are so many limitations for most coaches to be able to have the affordances to do so. As such, we default to things like the talk test, subjective RPE scales, and in some cases Apple watches or Garmin’s to provide feedback for our subsequent decision making. In reality, these are subjective, and if you’re going off of values provided by a wrist monitor, they’re also largely inaccurate. I use this example to say if we’re comfortable with subjective and murky (at best) cardiovascular data, why so much pushback on the difficulties of measuring fascia?
My Approach
Collectively I look to three fundamental areas- are they healthy, how do they look/feel/move, and can they perform whatever it is they do at a high level? I don’t get overtly wrapped up in trying to specify exactly what tissues/systems are doing what, because again, if we’re being technical about things, it all becomes indistinguishable. We have just been conditioned to assume things are improving by either bigger muscles, stronger tendons, or improved cardiopulmonary function. And while there are certain things that can be selectively tested, very rarely do those precise isolated assessments mean much in the grand scheme of things anyhow (outside of rehab/glaring deficiencies).
My primary criteria:
-Subjective pain levels
-Movement quality
-Movement enlightenment
-A host of physical batteries such as Y-Balance testing (mobility/stability assessment), 5-rep hex bar deadlift for velocity average (strength-power assessment), and a 25m sled push at bodyweight (anaerobic power capacity)
From my point of view, the pain levels are priority number one in my setting, the quantifiable pretty numbers mean nothing when you’re constantly plagued by injury. Improving fascial health and function can be a major influencer for pain levels by stimulating (or desensitizing) the nociceptive receptors embedded in the tissue (2). The movement quality is a way that I can assess (in a relative sense) an athlete’s ability to coordinate and unify movement. Something I say often is fascia is what “humanizes” our movement, which speaks to the sophisticated symphony that movement is. Improving their ability to integrate movement demonstrates improvements in basic motor control and in some cases expanding their movement pool. And this speaks to the enlightenment piece, which is effectively improving the athlete’s ability to recognize and influence the way they move in space/under load. For me this is a big one, given how the tactical community is often riddled with injuries and compromised movement, giving them a better detection of their own body is an invaluable adaptation.
As for the more conventional batteries, I fully understand these are indirect measures as they relate to fascia, however, think of it like this- If I’ve utilized basically the same testing parameters for the last three years, with the same population, and have continued to veer into a more fascial based approach while continually seeing improved pre-post results, wouldn’t that indicate an improved fascial response? Maybe it does, maybe I’m just blowing smoke up my own ass, but for now, this makes sense to me. But if nothing else, this approach to training is going to be more sensorimotor driven, cognitively stimulating, and proprioceptively demanding, all of which do speak directly to the fascial system.
In summary- use a multitude of assessment points, that are within your ability and scope of practice, and utilize what you collect to continue to help inform and shape your decision making to follow. Have a good understanding of how they move, feel, and how they are performing in sport/duty. From there, assess general tissue qualities, independent functions, and global integration. Improving fascial quality and function should be multifocal and include multiple modalities. How you train and assess don’t necessarily need to change, maybe just modified in a few spots, and looked at from a slightly different perspective.
References:
1.) Adstrum, S. Nicholson, H., 2019. A history of fascia. Clinical Anatomy, 23(7):862-870.
2.) Langevin, HM., 2021. Fascia mobility, proprioception, and myofascial pain. Life, 11, 668.
3.) Schleip, R. Wilke, J. Fascia in Sport and Movement. United Kingdom, Handspring Publishing, 2021.
4.) Stecco, C. Functional atlas of the human fascial system. Toronto, Churchill Livingstone Elsevier, 2015.