Ep 496 – The Fascia Debate: More Than Just a Tissue with Rachelle Clauson and Nicole Trombley

0:00:00.2 Speaker 1: Massage therapists, are you looking to enhance your skills and improve your practice? Here's your chance. The American Massage Conference is back. This three-day event will be at Disney Springs in Orlando, May 16th to 18th, and kicks off with Free Friday, which is open to everyone. The weekend has over 20 educators offering approved continuing education and a tribute to the late great Eric Dalton, as well as nightly cocktail receptions to network and unwind. Head over to massagetherapymedia.com/conferences to secure your pass and join us in connecting therapists globally.

 

0:00:40.0 Rachelle Clauson: Hi everyone. Welcome to the ABMP podcast, a podcast that speaks to the massage and Bodywork community. I'm Rachelle Clauson.

 

0:00:48.4 Nicole Trombley: And I'm Nicole Trombley. Rachelle and I are long-time massage therapists, and we write the Anatomy for Touch column for Massage and Bodywork magazine.

 

0:00:56.3 RC: And when we aren't writing or massaging, we're busy studying in the dissection lab and teaching. We are the co-directors of AnatomySCAPES, a continuing education company for hands-on professionals.

 

0:01:08.5 NT: And right now, we're busy putting together our next free live online event, Scar Tissue, A View Beneath The Surface. We'll be exploring a three-dimensional view of scars.

 

0:01:21.3 RC: This is such an important and beautiful perspective on scars for massage therapists. We meet our client's scars at the surface, at the skin level, but those scars often have depth and create changes in the relationship between tissues. When we deepen our view of this tissue, we experience a change in our understanding. Please join us. It is a free anatomy-focused event, and it's easy to sign up, and we even have a free gift for you when you do. Just head over to our website, anatomyscapes.com, for details. The link is also in the show notes.

 

0:01:55.8 NT: This is a really exciting time for AnatomySCAPES as we've been traveling a lot over the past few months. How's the jet lag going, Rachelle? 

 

0:02:04.8 RC: Not bad, actually. For some reason, I just keep waking up at the same time of morning, no matter what time zone I'm in. I just don't always remember which city I'm in. We actually just spent 10 days in Italy in February for the Fascia Winter School. And then I stayed in Europe a little longer, all the way through to the middle of March, and did guest lectures at hands-on workshops in both France and England, followed by CONNECT Congress, Fascia in Sports Medicine, which was held in Munich, Germany. I was able to interview a lot of the scientists, so look out for those interviews on our website. So many great conversations and presentations, all in this continually evolving world of fascia research.

 

0:02:49.6 NT: Massage therapists are one community that tends to be really interested in fascia. It helps us understand the body better and it gives us more insight into what's happening under our hands at the treatment table. But sometimes fascia is dismissed as just another trend. But fascia is not a trend. It's our anatomy.

 

0:03:10.0 RC: But we kind of get why it's easy to dismiss sometimes. There's not always clarity on what's included when we say fascia. And that problem is not unique to the massage industry. Anatomists themselves aren't really sure exactly what gets categorized as fascia in the body. It's funny to think about that because when it comes to anatomy, it often seems like it's a done deal, like everything's been discovered. Like this is the aorta, here's the humerus, and here's biceps brachii.

 

0:03:37.5 NT: But anatomy is a dynamic field of study with new understandings and definitions always proposed and debated. And fascia is definitely one of those evolving conversations.

 

0:03:53.0 RC: Today's podcast episode is a conversation that we recorded on the road just a few weeks ago from our apartment in Florence, Italy, just after leaving Winter School. We didn't have our good Yeti microphones with us, so we kinda went rogue and we used my fancy new iPhone Pro 16 built-in mic.

 

0:04:11.3 NT: So as you're listening, picture us sitting in a warmly lit living room on a gold brocade couch with our voices echoing off the hundreds of years old walls as we reflect on a new proposed definition of fascia as a whole body system. We're in Florence right now. We just traveled from Padua, which is one of the oldest universities. It's the second oldest university, I think, in all of Europe.

 

0:04:38.6 RC: It's amazing.

 

0:04:40.3 NT: And is one of the historical centers of study of anatomy. We were at Winter School, which is a week-long seminar where we get to study with some of the top researchers in fascia right now. And one of the things that was presented at this week long symposium was a new definition of fascia that has been submitted for consideration. How are you feeling about that, Rachelle? You've been studying fascia pretty intensely for a solid 10 years.

 

0:05:08.2 RC: Yeah, it's been a really interesting thing to observe, you know, and be a part of watching this discussion evolve. I was in Washington, DC At the Fascia Research Congress when the Nomenclature Committee submitted their proposition for a new updated definition of fascia, which was a bit controversial at that time, as it still appears to be, but it was a clarification. The main thing about that definition after three years of a very particular process that they went through in order to come to this conclusion, which was with many conversations of sorting everything out, they ended up with two definitions which seem to answer the call a little bit better. So before, classically, fascia is merely a dissectible sheath or sheath or other collagenous aggregation within the body. This is a very limiting and very narrow, a very piece by piece kind of oriented definition, which doesn't really satisfy a lot of the work that we do in holistic working with the whole body, and even in the areas of sports and movement, but is the one that's been used when working with just classical anatomy and surgical approaches, the naming of things.

 

0:06:22.8 NT: It's literally the definition on the books. And I was going to back up for a second and like, what on earth is nomenclature? Right? Like, what is that? 

 

0:06:31.4 RC: Nomenclature is the study.

 

0:06:32.1 NT: What is that? And it's a system of naming and categorizing things in a really systematic way so that there's one name for one thing and so that people can communicate with each other, that surgeons can communicate with surgeons, that clinicians, researchers, that people are talking about the same thing. I mean, there's definitely, I mean, can we think of like structures in the body that have multiple names that drive us? 

 

0:06:56.1 RC: Oh my gosh. Yeah.

 

0:06:56.9 NT: What is life? You know, so I do a lot of work in reproductive health and gynecology, obstetrics, pregnancy and postpartum. And we're working with pelvic organ prolapse and some of the gynecological considerations. The names of the structures in the female pelvis have so many different names, like five, six different names for the same supposed structure. And it makes communication really difficult for researchers. As is that way for several structures in the body, definitely for fascia. And anatomy societies have really tried to categorize everything. So there's a systematic naming and there's actually a list. Where does fascia fit in that? Because we have a problem with fascia.

 

0:07:38.2 RC: Right. I mean, it's interesting even just thinking about what are we saying here? We're talking about a common language. I mean, you think about other areas of life where we have many names for the same thing based on language, like for example, in English versus Italian versus Spanish versus Thai versus Chinese or all the languages of the world can, you know, be talking about something as simple as the hand, and that is going to be called different things in different languages. So take that concept and bring it down to all of these very fine and detailed structures that live within the human body. If, you know, you say orange and I say green and like the green wire, cut the green wire, there's a good one, you're like the green wire, you hold up the orange wire, it's like no that's not the green wire, that's the orange wire. Well I call this color orange, suddenly you have a massive miscommunication and breakdown.

 

0:08:30.9 RC: I think part of why this is also a complex thing is that the fascial system itself is less defined because it's a connecting system than some of the other structures we have in the body that seem more finite. For example, the bones. They're very separate from each other. They're connected when they're inside of you. But if you were to take them, we've all seen skeletons that came, those pieces, each piece has a name. And when it comes to fascia, there's a lot of transitional planes where things in gradation shift from being one structure to the next structure because it is a connecting system. And so the naming of the where the borders of what you're naming, let alone what you're calling it, is also under a level of debate and question. But for example, let's talk about something tangible, the superficial fascia. What do you mean when you say superficial fascia? 

 

0:09:27.3 RC: Are you talking about a membrane that's close to the dermis? Are you talking about a membrane that is above the muscle? Are you talking about the entire layer? Are you talking about the superficial adipose tissue, the membrane or multiple membranes and the deep adipose tissue all together? On the limbs, there's an aponeurotic fascia that envelops the limbs before you come to the fascia that's of the muscles. And in some texts, they will refer to that as the superficial fascia because it's not the deep fascia of the muscles. And that is not even within the same morphology or role that we typically would think of for superficial fascia. So massive confusion, very complicating. And I mean, disastrous, really, because you can read a piece of research and actually not know what they're referencing and completely disagree with them because the word they're using to describe the thing they're talking about is not the same word that you use to describe the thing that you're talking about.

 

0:10:30.4 NT: And so not only does that make it really difficult to have conversations, but it also makes it really hard to repeat research. To repeat research and it also doesn't really lend any credibility to fascia so that, you know, why would surgeons start paying attention to fascia when all the discussion on fascia is conflicting ideas and they can't even communicate with each other. What is fascia anyway? So why should I, a surgeon, care about it? Right? So this is really important that we've got clear definitions for communication.

 

0:11:01.4 RC: The purpose of communication. I mean, it doesn't change, calling it by a name or another name doesn't change what it is. It changes the way we think about it perhaps, but most importantly changes with what level of clarity we can communicate to each other. So this new definition has had a bit of a change in my thinking, as we've been teaching about anatomy through a facial lens for quite a while. And we've been talking about back to that Washington, DC Nomenclature Committee definition. That definition came up with the two definitions, the one that was more structural and one that was more functional. This was a good distinction to be made because it kind of left in place some of the particularities that are already commonly used within the medical and surgical practices. And so for their the purposes of communicating within those realms, these devices of communication made more sense. But when it came to this functional aspect, it's a broader, more inclusive.

 

0:12:03.6 RC: So let me be specific. For example, instead of just discussing a ligament as a separate thing from fascia, even though it is completely continuous with another fascia, let's talk about tendons, you know, as being separate from muscle. If you know the organization of a muscle and tendon, they are completely continuous with each other. Otherwise, they wouldn't work. You know, our muscles aren't just stapled on with tendons to the bones. The muscle is completely intrinsically continuous throughout the tendon that then merges to the bone.

 

0:12:35.4 NT: Right. Thank goodness.

 

0:12:38.4 RC: Yeah. The amount of loads and force that we put through our body would not work. It's not what it is. So whether it would work or wouldn't work, it's not what it is. So understanding these kinds of continuities allows us to talk about a system, the fascial system, as being seamlessly continuous from the tendons through the muscles, through the ligamentous structures, through the adventitia, through the neurovascular bundles, through the septa, through the deep fascia, what am I missing? We call it the wheel of wonder. Superficial fascia, the deep fascia.

 

0:13:10.9 NT: Noam, one of the very specific additions that I really appreciated in this new definition was the way the superficial tissues are discussed from the skin's dermis all the way through the fats and through the superficial fascia and actually including the skin's dermis as part of the superficial fascia system.

 

0:13:30.9 RC: And why would we do that? 

 

0:13:32.6 NT: Why would we do that? 

 

0:13:33.7 RC: Why wouldn't we do that? But let's explain why would we do that? 

 

0:13:37.4 NT: Because it's continuous. It is...

 

0:13:38.5 RC: And it's made out of the same stuff, right? So collagen being its primary element.

 

0:13:43.0 NT: Yeah. And one of the things we were able to do in Padua was actually go into the histology lab and look at these tissues under the microscope. And when you're looking at that layer of fat under our skin and you see the fat is organized by these collagen septa called skin ligaments, you can follow them through the superficial fascia all the way to the dermis. These strands of collagen are continuous. There is no separation. You move my dermis, I'm moving my fat, I'm moving my superficial tissues. So under the microscope, they're absolutely continuous. And so it's interesting to have that reflected in this new definition of fascia.

 

0:14:19.6 RC: That's a new, that's a change. So that's one of the additions that's been changed. I think the other big thing that's been a change in thinking for me, or the thing that's been a big change in thinking for me, we've talked about, let me go back to that two-part definition that was produced at the Facial Research Congress. It was in 2016, maybe 15, 15 or 16, but the one that was in Washington, DC, there was the fascia as a dissectible item still really, and then the fascial system, that was that broader definition that is one that makes more sense to people who do yoga or train in sports medicine or do massage therapy, that it's that broader, more inclusive of all of the collagenous network that makes up this continuity system that communicates and does all of these things with itself. So in that broader definition, we started saying the fascial system to be clear. So even in. AnatomySCAPES, when we're teaching, we say, just be clear, we're talking about the whole system. So don't get mad at me for saying a tendon and still talking fascia, because in this fascial system definition, that's true.

 

0:15:27.3 RC: But even though we were saying system, it didn't really land completely with me that there's a distinction between a system and a tissue. So let's talk about the four tissues of the human body. So there's four tissues, primary tissues, as they've been chosen to be categorized in the human body. You have connective tissue, muscle tissue, nerve tissue, and epithelial tissue, stuff that your skin and other parts of your body are made out of. So when it comes to the connective tissue, it's the most weird collection of tissues because it's really diverse. So you've got something as liquid and different as blood that's part of the connective tissue and bone. So you've got some liquid stuff, you got some hard calcified stuff, you got red stuff and white stuff. And then you also have all the other things like cartilage, tendon, ligaments and fascia. So when we talk about fascia as a system, we're not talking about fascia as a tissue. And Nicole, you know, we've been teaching that fascia can either be loose or dense, which is actually being borrowed from the connective proper tissue can be loose connective tissue or dense connective tissue. A fascia as a system is kind of bigger than that.

 

0:16:49.0 NT: Yeah, to continue with that loose or dense. So connective tissue is defined by what's outside the cells, right? So muscle cells are all lined up, epithelial cells are all lined up. But connective tissue has a lot of stuff outside the cells. It's got its extracellular matrix with lots of fibers and where a lot of the water in our body lives, right? Back to the ground substance. The list of it. Sure. Hyaluronin. At AnatomySCAPES, we like to talk about the cells and the gels and the fibers. So the arrangement of these gels and fibers can be really dense and so you're going to find that definitely in the ligament, definitely in a tendon. Right. You can think of these dense tissues and how they, I mean, they feel dense under our hands, But then some of the looser tissues, right. And so looser tissues are going to be like the loose connective tissue.

 

0:17:38.2 RC: Gliding between muscles. Yeah.

 

0:17:40.6 NT: Gliding, right? Yeah. So that's the loose and dense, but like as a system...

 

0:17:45.0 RC: It goes beyond that, right. So we use this concept of loose and dense to help describe the tissues of the, it helps us to understand the function and the organization of a particular area of the fascial system that we're talking about. But let's talk about what is a system. So we talked about the four tissue types, but take me back earlier in this from micro to macro.

 

0:18:07.1 NT: Yeah, well, I mean, in system, I mean, we're all pretty familiar when we think of the digestive system, the nervous system, like these types of systems. Now we're talking about fascia as a system in that type of categorization. Right. And so systems are really just a way that biologists categorize life. Right. So we can start at the most micro. You think about atoms and molecules. Different types of...

 

0:18:31.1 RC: Teeny, teeny tiny.

 

0:18:32.7 NT: Like individual structures of unit that are organizing what's in our bodies and then the world around us and we go for molecules and the next unit is usually the cell. And then cells are organized into higher organization at the level of tissues. And those were the tissues like connective tissue, epithelial tissue, and blood.

 

0:18:51.8 RC: Now we're at the four we talked about before. After starting with the cell, you get to that. Now we go beyond the four tissue types and we have...

 

0:19:00.6 NT: Tissues are organized into organs. And then organs together form a system.

 

0:19:09.0 RC: So we have to talk about organs if we're talking about the fascial system.

 

0:19:10.9 NT: Are there fascial organs? 

 

0:19:11.0 RC: What are the fascial organs? The argument is yes, there are. And so what would, without having our like textbooks in front of us, can we pull out what is an organ definition? The definition of an organ is multiple tissues to form a specific function. So for example, while staying in the fascial system, we've been talking about referencing perhaps a retinacula as an organ of the fascial system because it has a particular organization and a particular function.

 

0:19:41.5 NT: So the straps around my ankle.

 

0:19:43.2 RC: Yes. And your wrist.

 

0:19:44.0 NT: And my wrist.

 

0:19:45.4 RC: And a few other places.

 

0:19:45.9 NT: And a few other.

 

0:19:49.2 RC: Yeah. It tends to be dense connective tissue that's combined with some loose connective tissue, and it's innervated by another tissue, nerves in particular in this case, and vasculature.

 

0:20:00.6 NT: For it to be an organ, I don't know that it has to have all of them.

 

0:20:00.7 RC: No, of course not. But it just has more than one tissue type, which that's where then this is the part where I got in and was like, oh, duh. Because I hadn't really been thinking about the fascial system as having multiple tissue types within it. I've been thinking about just being a purist. It's one of, it's a subset of the connective tissue system, or sorry, connective tissue. And I think instead of saying subset of connective tissue, I need to catch up with what my mouth has been saying, which is it's a system, which means that there are multiple tissues within. And as a system, the role of fascia is also particular for several different functions. We talked about in movement, force transmission and organizing the muscles. It organizes the fat. It's a tensionally loaded system. That's what collagen is really good at is transmitting force because it's freaking strong. And even when it's in a loose arrangement, it has a kind of strength to it, but bring in Hyaluron and you get all these crazy amounts of glide. So as a system, it has multiple functions, reducing friction between structures and also communicating tension load between structures. It's pretty cool stuff, actually.

 

0:21:23.3 NT: Yeah. And you know, you and I were having this competition earlier. We've been debriefing this for a few days now.

 

0:21:28.2 RC: Yes.

 

0:21:29.3 NT: But we're having this conversation around the rethinking. And we teach a lot about the innovation of the fascial system that has the research of the past couple 15 years and it's we've been talking about fascia as a nerve aid and so it's like this connective tissue with nerves in it. Right. But we're talking about it still as connective tissue when it's like, duh, that's an orion by definition.

 

0:21:51.1 RC: It's an orion by definition, more than one tissue type. We're making sense. Four tissues. We've got more than one tissue. We talk about innervated fascia that's serving a particular function. And it's got this collagen, that's great, but that loading of the collagen then is signaling with the brain and the muscles. And sometimes it's just a mechanical transduction, that's another podcast altogether. Another topics, but there's this innervation of fascia already. We've jumped to where we're talking about something that is a system because collagen by itself only does certain things, nerves by themselves only do certain things. And frankly, they don't do much of anything. It's when they're working together that now you have the structure that is then receiving signals. And now you have a communicating system, the fascist system. Yeah, I know, right? I know. And you can hear these things over and over and over again, and still just all of a sudden have a moment of hearing it for the first time. You're like, how have I even actually been teaching it, and I still didn't hear when I was saying? 

 

0:22:55.1 NT: Yeah, no. And we will. This paper was just published. So the definition was formally presented out to the community of research and anatomy in January 2025 and we'll definitely link to the site on that and I am sure there will be a lot of conversations coming up over the next several months And this summer at the Fascia Research Society, it's Fascia Research Congress.

 

0:23:22.8 RC: The conversation will continue. The conversation will continue. In summary, there's a new definition that is not entirely new. It's just trying to be more specific. And I think that as we develop in anything in life, you start off with kind of the rough draft of what you're trying to say, and then you start to get clarity around what it is that needs to be said, and then you become more specific about it and more thoughtful and considering all of the implications that something may have. And as this area of research is developing, it has to have clean languaging in order for things to move forward. Otherwise, it's a confusion of languages. It's a confusion of intention and meaning. So this is progress. It's progress. And it's probably still going to be a bumpy road because people have some pretty defined ideas on what they think it should be. But I think the way we move forward is we listen to each other. We understand for what reasons certain things are wanting to be done. That big part of the push to be clear in our communication is to be able to further research.

 

0:24:30.0 RC: Researchers in different countries or even in different rooms need to be able to know what they're talking about. Yeah. And so instead of just coming up with multiple, multiple definitions, an agreed upon definition is the hope, the goal, and the intention. So we invite you to learn more about the definition of the fascial system by reading this paper for yourself. We'll include a link at the end, and tell us what you think. Let's open the conversation as we see how that plays a role in our practice and in our lives.

 

0:25:04.2 NT: And if you would like to learn more about the fascia system and see the fascia system, we have opportunities coming up this fall.

 

0:25:12.7 RC: Oh, we do. Yes. In October, we're doing the journey into the Matrix, our flagship course, which is a wonderful, I say introduction, it's not exactly introductory level and at the same time it can be. So if you're lost, you've been hearing fascia, you don't know what it is, this is absolutely the perfect starting point for you to get some, I don't know, get your feet on the ground with it, to have some very strong foundational concepts that you can start to layer in more information moving forward. If you've been studying fascia for a while, but you've never found your way to the dissection lab in a supported and really beautiful environment we have that opportunity for you here, too. I think when we study in the dissection lab, Nicole, I mean doesn't really matter what level you walk into the lab with you will always be learning something.

 

0:26:02.1 RC: You're either seeing something again for the first time or you really are seeing something for the first time. There's so much to see in the human body. So if you would like to join us, go to our website at www.anatomyscapes.com. That's like landscapes, but with anatomy. Anatomyscapes.com and register for our October course for Journey into the Matrix 2025. So thanks for joining us and we'll see you next time.