The organ of the body that transmits movement, packages the body, makes up the body’s contour and holds us in place is the mesodermal tissue, or the connective tissue. Examples of connective tissue are bone, ligament, tendon, blood vessel and fascia. Fascia is composed of varying proportions of collagen and elastin, spreading throughout the body from the deepest layer to the most superficial layer, just underneath the skin. Myofascia is the term referring to the fascia and the muscle it is encasing. There are several types of fascial sheaths. The endomysium that surrounds individual muscle fibers. The perimysium that surrounds bundles of muscle fibers, and the epimysium that wraps around entire muscle groups. Fascia protects, insulates, and promotes muscle over muscle sliding. During contraction, muscles exert internal pressure on the fascial tissue.

During habitual tension and holding, fascial tissue thickens and toughens enclosing the muscle, restricting muscle lengthening and function. Myofascial release has proven to reverse this effect, allowing the fascia to regain its natural elasticity.

Hooks are one way that bone and myofascia interact to stabilize, redirect or change the quality of movement. These hooks often become foci of movement inhibition. The coracoid process is a small hook-like projection on the lateral edge of the anterior portion of the scapula, inferior to the shaft of the clavicle (see figure 1 below). It is the point of attachment from the arm to the shoulder, and can be palpated at the deltopectoral groove between the deltoid and the pectoralis major.

There are four structures associated with the coracoid process that I would like to highlight, because they are so commonly injured in yoga, among many other sports.

In figure 2, the coracoid process is colored yellow. If you image this hook as the center of a clock, the pectoralis minor points down towards 4 o’clock, the coracobrachialis and the short head of the bicep brachii point down toward 7 o’clock, the coracoacromial ligament points up toward 10 o’clock, and the coracoclavicular ligament points up toward twelve o’clock.

A. The Pectoralis Minor
At: 4 o’clock
Origin (O): 3rd, 4th, 5th ribs
Insertion (I): coracoid process
Action (A): deprsses, adbucts and upwardly rotates the scapula

B. Coracobrachialis
At: 7 o’clock
O: coracoid process
I: medial surface of mid-humeral shaft
A: shoulder flexion and abduction

C. Sort head of the bicep brachii
At: 7 o’clock
O: coracoid process
I: tuberosity of radius and aponeurosis of bicep brachii
A: elbow flexion, forearm supination, shoulder flexion

D. Coracoacromial ligament
At: 10 o’clock
Unlike most ligament that connect two different bones, the coracoacromial ligament connects the coracoid process of the scapula to th acromion of the scapula, forming the coracoacromial arch, which helps protect the rotator cuff tendons and subacromial bursa from the acromion. Two research studie one written by DeFranco and Cole the other by Hesmezacar, Akgun, Ogut, et al. showed that, “There was no statistical significance between rotator cuff degeneration and the type or geometric measurement of the ligament. However, the coracoacromial ligaments with more than 1 bundle showed significant association with rotator cuff degeneration with a longer lateral border and larger coracoid insertion.” In other words, the geometric shape of the ligament seems not to contribute to rotator cuff injuries. Rather, in shoulders where the ligaments where found to have more than one bundle (image a rope with an additional strand), the ligament seems to infringe upon the space between the coracoid process and acromion, challanging the overall functional movement of the shoulder and, therefore, contributing to rotator cuff degenration.

E. Coracoclavicular ligament
At: 12 o’clock
E1: trapozoid
E2: conoid
The coracoclavicular ligament includes both the trapezoid and the conoid ligament. They extend from the coracoid process up to the inferior surface of the middle portion of the clavicle. Together they stabilize the acromioclavicular joint, forming a strong bridge between the scapula and the clavicle.

As yoga teachers and massage therapists, it is important to observe the funtionality of all muscles. A good place to take a look at the muscles mentioned above is in chaturanga dandasana. Is the student’s shoulders rounding forward? Ideally, the jaw bone is in line with the shoulders, elbows, hips, knees and heels. One straight line running through the body, parallel to the floor. If the student is struggling with this pose, it is not necessarily because of weakness, but rather dysfunction in the above mentioned structures attaching to the coracoid process.

A great to way to train the muscles to elongate is practicing chaturanga dandasana with a strap. Another way to improve the function of these muscles is through myofascial release.

If the muscle was previously injured, there will typically be a lot of adhesion surrounding the area. The adhesions and the stressed muscle will force pressure into the fascia; a shoulder with restricted movement. When the fascia is released, the muscle regains its full length yielding a shoulder that functions optimally, and a very pretty chaturange dandasana.

Source: The Enless Web by R. Louis Schultz, PhD and Rosemary Feitis, D.O.

What Does Yoga and Myofascial Release Do: A Mechanical View

As Presented by Dr. Tom Findley, M.D., PhD, at the 3rd International Fascia Research Congress in Vancouver, B.C. Canada in 2012, hosted by Massage Therapists’ Association of British Colombia

Yoga and myofascil release affect the fascial tissue and its component cells. They alter the morphology of fibroblasts, switching them from resting to active states.

What is Fascia?
As defined by Grays Anatomy, the fascial are fibroareolar or aponeurotic laminae of variable thickness and strength formed in all regions of the body.

Where is fascia found in the body?
Fascia covers every structure in the body including bones, neurons, muscle cells, muscle fibers, muscle groups, blood vessels, and organs.

What does fascia do?
It lubricates allowing muscles to glide and slide. It insulates holding tissue together, and it transmits force protecting tissue from traction and compression forces.

What is fascia made of?
Fascia is made up of collagen fibers, which are produced by fibroblasts.

What are fibroblasts?
Fibroblasts are the most common cells of connective tissue. They are responsible for collagen synthesis and remodeling, embryonic development, mechanical homeostasis, wound repair, aging, fibrosis, tumorigenesis and tissue engineering.

What are examples of fibrous connective tissue?
The dermis and subcutaneous tissue of the skin, organ tissue, stroma and capsules. A major component of these connective tissues is type I collagen protein.

What are the morphologies of fibroblasts?
The same fibroblast cell can live in two different states. At low tension states the cell is small and is at rest. The cell proliferation and the matrix biosynthesis are off. At high tension states, the cell is larger and is active. The cell proliferation and matrix biosynthesis are on.

How long does it take the cell to switch morphologies, from resting to active state?
The cell can switch back and forth fairly easily and rather quickly.

Is the process dependent on temperature?
Yes. If the temperature is increased the process happens faster. Likewise, if the temperature is decreased the process slows down.

How does myofascial release work?
When you bend and straighten your elbow, the upper arm bone moves closer or farther away from the lower arm bones. If ligaments where not tensioned, they would be too slacked or stretched at certain angles. Muscles, therefore, run in series with and tension ligaments allowing ligaments to be functional at every angle. There are only two joints in the body where the bones do not change distance in relation to each other.

What are the two joints where the bones do not separate or move toward each other?
The knee joint housing the ACL, and the joints of C1 and C2.

So how does yoga and myofascial release work?
Similar to how muscles tension ligaments, muscles tension tendons. At the transition point, where muscles insert into tendons, golgi tendon organs are found. When the goldi tendon organs are pressed, the muscle gives up. This is the “open,” pain free sensation people feel after yoga and myofascial release.

Dr. Serge Gracovetsky graduated in 1968 from the Swiss Federal Institute of Technology. He, thereafter, obtained his PhD from the University of British Colombia. Following, he went to Concordia University as faculty and retired in 2000.

His interest in fascia stemmed from his back problem. He consulted 7 different orthopedic surgeons and neurosurgeons, and received 7 different diagnoses. “I thought that if you bring your car to a mechanic and he gives you a diagnosis, then you bring your car to another mechanic and [he] gives you a different diagnosis then maybe these mechanics are not really competent. And if I have 7 different diagnoses with all kind of different treatments, 4 recommended surgery and 3 did not, I thought the best course of action was to do nothing and head straight to the library and try to understand what was the problem. So that’s the way it started.”

WHAT IS FASCIA?

Fascia is the “saran-wrap” like material that covers every one of our cells, muscle fibers, organs, and fills every space in our being. It is made up of a protein called collagen. Collagen has no electrical activity; therefore, it cannot be measured. Consequently, it frequently goes unnoticed. It is left under the table, unspoken of, even as one of the primary structural components of the human body. Nevertheless, its function is vital. Hence, it is imperative to pay attention to the mechanism of fascia.

The human body is designed for specific function like locomotion. We are walking machines challenged by the gravitational field. To solve this problem, fascia is added to the system. Accordingly, we do not start by looking at fascia and asking what to do with it. Instead, we start by analyzing the desired function. Then, work on assembling the necessary components required to execute that function.

SKIN

The skin can be looked at like a cover for underlying structures, and as a shield isolating the human body from the surrounding environment. However, since we have to spend our entire lives carrying around the heavy weight of skin, we might as well use find multiple uses for it.

POTENTIAL AND KINETIC ENERGY ON THE SKIN

Peter Huijing from Amsterdam found that by deforming the tissue, the body could either store or release energy. Through deformation of tissue, the body can release energy without firing another muscle. Because energy storage is important for energy conservation, the storing and releasing of energy in the skin improves the efficiency of the body during movement. Dr. Gracovetsky states, maybe they [scientists] will find that the skin is not just the insulating barrier, but has a mechanical role in the task of human locomotion at minimum cost.

LUMBARDORSAL FASCIA

Compare the width, girth and size of your legs to the width, girth and size of the spine. The legs have a significantly greater firing cross section than the spine. Therefore, the force from the legs up the spine must be channelled through an additional structure. Hence, the lumbardorsal fascia.

FROM WALKING TO RUNNING
No structure can be loaded continuously. During walking, running or in isometric exercise, the load on tissue changes consistently from fascia to muscle, and muscle to fascia. The frequency of oscillation is affected by the kind of the activity and the need for rest. When switching from walking to running, frequency of oscillation increases because 1) the body shifts from a muscle based system to a ligamentous driven system, and 2) the tissue is under a greater amount of stress during running and the allocated load time on one particular tissue is, therefore, decreased.

Take a look at the heartbeat. If our heart was to produce a constant pressure, the artery would burst. Instead, the heart beats, then relaxes, then pulses, then relaxes, giving the artery the required time for recovery. In this manner, the heart can beat a billion times before death. Similarly when walking or running, the load shifts from muscle to collagen not stressing one particular tissue at one specific time, permitting movement over the course of the life cycle.

WALKING IN BATTLE

Before the airplane, men, at times, were required to walk hundreds of kilometers during battle. If done without rest, exhaustion would prevail by the time they reached the battle field. In order to have rested soldiers, it was required to divide the time between walk and rest. The rule of the British during Napoleon’s time, was to walk for 45 minutes and rest for 15 minutes. If the average human where to walk for 3-4 days, he/she would need 3-4 days to recover.

REST
In life, we learn to allocate time among our activities and rest, in order to carry out a full days of work without becoming overly exhausted. This gives us the space to fully recover for the next day. Without full recovery, the body is drained and illness and disease become present.

How much “stress” or activity one can take on and how much recovery one needs is a very personal thing. Regardless, we must accept that we need to give up part of our lives for sleep and recovery.

GOOD AND BAD PAIN
Good pain is the warm sensation you feel deep in your muscles during a solid workout or when your bodyworker is breaking up adhesion. Sometimes its hard to decipher between good and bad pain. Is it my mind telling me I can’t keep going, or my body telling me I need to stop? Am I challenging my edge or breaking my body down?

Bad pain is the pinching, sharp, shooting, icy pain we feel in joints. It is how our bodies communicate with us, giving us a warning, telling us to stop. If we ignore it, we do so at a certain cost.

As a professional athlete, it is justifiable to ignore the warning and keep playing for the remainder of the game. But there is a price to be paid, because our bodies do not fully recover from a collagen injury.

THE IMPORTANCE OF ALIGNMENT
When out of alignment, the spine is overstressed. Hence, the importance of body mechanics in sport and recreational activity. So we have two choices, learn to play sport in proper alignment or keep getting hurt.

CONCLUSION
Without fascia and the oscillation of load, we would not be ale to walk, run, and move. It is the supporting structure that keeps us up right and mobile. Its intelligence increases our efficiency and keeps us healthy.

SOURCE: Dr. Serge Gracovetsky interviewed by Waffa Al-Natheema presented by Institute of Near African Studies at the Fascia Congress Harvard Medical School Boston, MA October 4&5 2007.

NEUROMUSCULOSKELETAL REEDUCATION: Yoga and Bodywork / Myofascial Release: why function therapists should focus on function versus alignment, why we feel pain, why bodywork (myofascial release) is so important, what happens to load during yoga poses, why urdhva dhanurasana is the best low back stretch ever, and how myoafascial release and yoga make up neuromusculoskeletal reeducation.

FASCIA
Fascia is a tough connective tissue made up of a protein element called collagen. It spreads throughout the body in a three dimensional web surrounding muscle fibers, muscle groups, tendons, ligaments, bones, organs, cells, and fills the spaces in between. It holds everything inside the body together in its proper place, and configures the unique tone of the legs, arms, torso and face. Fascia is the most elastic element in the body and has the ability to change extensively upon touch.[1] During myofascial release, bodyworkers can feel the immediate tactile change of soft tissue underneath their fingertips.

FASCIA AND TENSEGRITY
Fascia is a system of tensegrity, or tensional integrity. When it is injured either from stress, trauma, overuse, inflammatory illness, or repetitive motion, it responds by increasing tensional forces. It coheres surrounding tissue, gaining thickness and density. This can lead to adhesion; the binding of nerves, muscles, blood vessels, and internal organs; and the pulling of bodily structures out of alignment. If the body goes untreated, without myofascial release, the body enters the cycle of compensation and structural imbalance. When adhesion is present in the body (which can feel small like peas, large like golf balls, or thick and tough like a taught non resilient bungee cord), the sliding and gliding effect on muscle over muscle and nerves in between muscle is reduced or diminished and movement no longer comes from individual muscle fibers or groups. Instead the affected area moves as a glued complex tugging at adjacent structures pulling the body out of alignment. The result is a cyclical pattern of constriction and compensation in the body and mind, causing asymmetry and manifesting signals of distress and sensations of pain.[1]

POISSON’S RATIO AND FASCIA EFFICIENCY
When an object is stretched, like muscle, Poisson’s ratio measures the rate of contraction, perpendicular to the applied load, to the rate of extension, parallel to the direction of the applied load.[3] Ultimate efficiency is a ratio of 1:1. Oddly enough, fascia has a Poisson ratio of 1:1.[2]

Although fascia is stretched during spine flexion, a greater degree of stretch is experienced during spine extension, which is why a properly performed and aligned urdhva dhanurasana (backbend) is the most effective stretch for lumbardorsal fascia (low back) pain. To ensure correct function of fascia and to counter fascia’s reverse pull during back bending, it is imperative to fire the abdominal muscles (rectus abdominus, psoas major and iliacus). This, in conjunction with lordosis, controls force transmission efficiency and contributes to Poisson’s 1:1 ratio.[2]

FUNCTION
The musculoskeletal system is an unstable structure. It is affected by thought, gravity, and stimuli from the environment, and stabilized by the central nervous system. Although some doctors focus on stability, it is instability in the body that permits optimal function. For example, take a military jet. If a missile is fired at the jet, it is the unstable structure that can evade threat. If the structure where built more stable, it would not be as quick or efficient and would not be as able to avoid harm. Similarly, the instability in human structure allows us to dash from and escape a bull, because our structure is more unstable than his. Therefore, one should not look for structural stability at the expense of function. This is evident in spine fusions. Nevertheless, functional stability is most important. For example, a humming bird beats his wings 100 times per second while his beak is steady inside a flower. If he had to use muscle to compensate for the motion of his wings, he would catch fire. This is why he has a neck, which decouples his head from his body. In humans, the neck decouples the head from the motion of the shoulders during movement.[2]

LOAD OSCILLATION AND NEUROMUSCULOSKELETAL REEDUCAITON
Fascia is made up of collagen, which is visco-elastic. When stressed over time, viscous materials, like honey, resist strain linearly. Elastic materials, like rubber bands, strain instantaneously and quickly return to their original state upon the removal of stress. Since viscoelastic materials, like collagen, hold both viscous and elastic characteristics, they experience time dependent strain. Because collagen is visco-elastic and has a stretch response of 1/3 of a second, it cannot be loaded continuously. Therefore, force oscillates between fascia and other structures like muscle and ligament, which means a true static yoga pose does not exist. Instead, posture is dynamic and continuously modified, even during stillness. It is the holding of yoga poses (still and dynamic) that changes neural pathways. In other words, function is driving alignment.[2] This is called neuromusculoskeletal reeducation.

LOAD OSCILLATION IN LOW BACK
Load oscillation in the lower back is controlled by lordosis, which is controlled by the psoas. The psoas, however, is not designed to balance the load because it is attached to the fulcrum. The constant load transmission, instead, requires a very specific spine-pelvis coordination, triggered by trunk flexion and rotation of the pelvis. To increase load on fascia and decrease muscle activity, extend the spine; hence, urdhva dhanurasana for low back pain. To increase load on muscle and decrease load on fascia, flex the spine (forward folds). Anterior rotation of pelvis increases load on muscle, while posterior rotation decreases load on muscle.  A 50/50 load on fascia and muscle is at 30 degrees of flexion. Regardless of flexion or extension, fascia is critical for minimizing and equalizing stress. Gait requires lordotic oscillations to alternate loading of tissues.[2]

MANUAL THERAPISTS AND MOVEMENT THERAPY
Manual therapists, like bodyworkers and physical therapists work within the fascial network. By focusing on function and approaching the body in this manner, the therapist promotes soft tissue manipulation, encouraging the body to readjust tensional and asymmetrical forces. This causes muscles, tendons, ligaments, organs and bones to shift back into proper alignment.[1] Movement therapy after myofascial release, like yoga and physical therapy, can teach the body to move in the new aligned space. Together the combination of myofascial release and movement therapy is called neuromusculoskeletal reeducation. When properly aligned, the body is free of pain and can perform optimally.[1]

CONCLUSION
Just like the military jet, we are architecturally modeled unstable for faster response, mobility and freedom, making the health of the fascial system essential. Fascia is a tough connective tissue that surrounds and fills everything and every space of the human body. It is made up of a protein called collagen. Collagen is visco-elastic and cannot be loaded continuously; therefore, a static yoga pose does not exist. Instead, even in stillness, a yoga pose is dynamic and constantly being modified within. Due to fascia’s tensile force, fascia has a tendency of entering a cycle of contraction, which causes asymmetry. However, myofascial release can counteract the tensional imbalance. When myofascial release and movement therapy, like yoga, are coupled, new neural pathways are enforced. This is called neuromusculoskeletal reeducation.

REFERENCES
1. Titus, Stuart W., PhD, “Heal Us Now,” retrieved August 5, 2012

2. Gracovetsky, Serge, Ph.d, “Is Fascia Necessary,” a lecture given at the first International Fascia Research Congress held October 4-5, 2007 at Harvard Medical School in Boston, Massachusetts

3. Wikipedia, Poisson ratio, retrieved August 6, 2012.

4. Wikipedia, visco-elastic, retrieved August 6, 2012. Meyers and Chawla (1999): “Mechanical Behavior of Materials,” 98-103.