Bio 246

The Anatomy of Human Movement

Peter Smith DPT, ATC
www2.sunysuffolk.edu/smithpr

The Skin and Fascia
The role of skin and fascia is often overlooked
in the rehab setting.
We will explore their roles and clinical
applications.
When dissecting in lab it is important to
respect this tissue and take time to inspect it.

Overview of the Skin
Largest organ of the body (15% of body weight)
Skin thickness variable, normally 1-2 mm
Protection
chemical barrier (waterproof)
physical barrier (tough)
immune system activator
Body temperature regulation
blood flow through the skin
sweat glands
hairs
Sensation
sense touch, temperature and pain
provides information outside of the body
Functions of the Integumentary
System
Largest organ of the body
Protection chemical, physical, and mechanical barrier:
Stratified layers of keratinized cells create a tough barrier
impermeable to most foreign invaders.
Body temperature regulation is accomplished by:
Regulation of blood flow to skin: dilation (cooling) and
constriction (warming) of dermal vessels
Increasing sweat gland secretions to cool the body
Cutaneous sensation receptors sense touch and pain and
temperature
Skin (Integument)
Assessment of Skin Color
Cyanosis is a bluish discoloration of the skin or mucous
membranes
caused by lack of oxygen in the blood.
Yellowish color
may indicate cirrhosis of the liver due to accumulating bile
pigments in body tissue
Pallor or Blanching:
can be sign of anemia or emotional or physical stress

Black and Blues:
Bruises caused by blood escapes circulation and clots
underneath the skin.
Red color( erythema)
indicate fever, allergy, infection inflammation and
embarrassment.


Whats Under Your Skin?

The Dermis
Dermis
Second major skin region containing strong,
flexible connective tissue.
Cell types include
fibroblasts, macrophages, and occasionally mast
cells and white blood cells
Composed of two layers papillary and
reticular
Dermis

Papillary layer




Reticular layer
Layers of the Dermis: Papillary
Layer
Papillary layer
Areolar connective tissue with collagen and elastic
fibers
Its superior surface contains finger like projections
called dermal papillae which adhere to the basal
layer of the epidermis.
Dermal papillae contain capillary loops, Meissners
corpuscles ( light touch), and free nerve endings (
pain )
Layers of the Dermis: Reticular Layer
Reticular layer
Accounts for approximately 80% of the thickness of the
skin
Dense irregular Collagen fibers in this layer add strength
and resiliency to the skin
Elastin fibers provide stretch-recoil properties
Location of several types of glands: sebaceous( oil),
eccrine( sweat)
Has a rich blood supply
Contains hair follicles and associated nerve and arrector
pili muscle
Sensory: Pacinian corpuscles ( deep pressure, vibration
and proprioception)
Ruffinis end organs: (continuous touch or pressure).




Fascia
Connective tissues that plays an important role in
human function.
16% of total body weight and stores 23% of total water
composition
It connects all the tissues of the human body
together including the muscles, organs nerves and
vessels of the body.
Fascia is a type of connective tissue once thought as
a static that just supports for the body.
Newer research views it as a dynamic organ that
can change dependant on the stresses placed on
it.

Roles of Fascia
The fascia allows for the communication of information
throughout the body.
The fascia is a sensory organ that moves and reacts to
stimulation.
Embryology helps explain how all the fascial system is an extension of
the nervous system and a major mode for communication between
cells , organs and whole body systems.
The fascia is important for the nutrition and metabolism of
every cell in the body.
The fascia helps control movement and allows muscles to
function.
Provide a tensile support for muscles important to generate force.

Roles of Fascia
The fascia plays a major role in circulation of blood
and lymph.
Vessels travel throughout and with fascia
The fascia is the first line of defense in immune
function.
Many types of cells that combat infections.
Disruptions and restrictions within the fascia are
associated with disease and myofascial dysfunction.
Interrupts the flow of blood and lymph
Can cause pain and poor compensatory patterns.

Structural Elements of FASCIA
Fascia at a Cellular Level
Cells include:
Fibroblast: synthesize collagen, elastin, reticulum and
ground substance.
Fibrocyte: mature fibroblast that maintains connective
tissue.
Macrophage: cells active during inflammation and
infections to assist in cleaning up cellular waste products
and foreign antigens.
Mast Cells: secrete histamine (vasodilator) and heparin (
anticoagulant)
White blood cells : destroy antigens and produce
antibodies in response to infection

Connective Tissue Ground Substance
Viscous watery gel that provides a
scaffold that creates the
framework for collagen and
various cells.
Important for the diffusion of
nutrients and waste products.
Provides lubrication between
collagen fibers
Contains
glycoaminoglycans(GAGS)
helps maintain interfiber
distance.
Proteoglycans: assist (GAGS)
by binding water.
Superficial Fascia
Fascia can be divided
into different types.
Superficial : 3 distinct
layers :
Superficial layer is
mostly adipose
connective tissue.
Membranous layer is
formed by both
collagen and elastic
fibers.
Deep superficial layer
is loose connective
tissue anchors
superficial fascia to
deep fascia.
Light Passing Through Superficial Fascia
Connective Tissue Anchoring Superficial
Fascia to Deep Fascia

Deep Fascia
Deep : lies beneath superficial
fascia and creates a is continuous
connective tissue sleeve that
covers the muscles throughout
the body.
Fascia is integral to individual
muscle fibers
Epimysium
Perimysium
Endomysium
Fasical layering reflex postural
habits and stresses on the
body.

Deep Fascia
Note the deep fascial
alignment.

Dura Matar
The Fascial System Relation
to Cellular Structures.
Comparing human to cells:
The cell membrane is analogous to
the skin.
The cell membrane receives
sensory input through
receptors.
Skin also has receptors that
transmit information
Fascia is analogous to the
cytoplasm of the cell.
The cytoplasm is critical for
intracellular functions and
communication.
The fascial system plays a
similar role in both form and
function in the human body.
The Development of Fascia
We must look at the embryology of fascia to
understand its importance and how it
connects all of our cells together.
(Myers T)

The cells in early in development differentiate
into 3 germ layers.
Ectoderm: Give rise to the nervous system and the
skin.
Mesoderm: Give rise to the muscles fascial tissue
Endoderm: various internal organs and
endothelial linings.

(a) Zygote
(fertilized egg)
(b) 4-cell stage
2 days
(c) Morula
3 days
(e) Implanting
blastocyst
6 days
(d) Early blastocyst
4 days
(e)
(d)
Fertilization
(sperm meets
egg)
Uterine tube
Oocyte
(egg)
(a)
Ovulation
Ovary
(b)
(c)
Uterus
Endometrium
Cavity of
uterus
Embryology Leading to Stem Cells
Degenerating
zona pellucida
Blastocyst
cavity
Inner cell mass
Blastocyst cavity
Trophoblast
Trophoblast Differentiates Into 3 Germ Layers



Trophoblast give rise to
Ectoderm: skin, sensory
receptors and the nervous
system
Mesoderm: bone, muscles
and connective tissue,
Endoderm: respiratory
airway and much of the
digestive system.
Early reticular fibers
connecting the 3 layers will
eventually be replaced with
stronger collagen fibers .
Migratory Patterns of Germ Layers
The mesoderm
encapsulates the endermal
structures anteriorly and
nervous system posteriorly.
The space between the
layers is the various layers is
filled with connective tissue
such as fascia.
The fascia has sensory
receptors that project to
the skin. It also has its
own receptors located
within it
Fascial Mess Between Various Muscle Fibers
Fascia not only lies around
the epimysium of the
muscle.
Fascia lies deep within the
muscle.
Remember fascia is
connective tissue that
demonstrates the
continuity of this system.

Fascial Receptors
Fascia roles as a sensory organ was originally
postulated by A. T. Still in 1899. The sensory role is
critical for proprioception and giving the brain a 3
dimensional construct of the body.
Studies demonstrate there are 4 major types of
infrafascial mechanoreceptors. (
Schleip
)
Golgi
Pacini
Ruffini
Interstitial

Mechanoreceptors
Pacini: Respond to rapid pressure changes. They are located in
deep capsular layers, spinal ligaments, and muscle tendon.
They play a major role in proprioceptive feedback.
Stimulate them with high velocity adjustments, rocking,
shaking, vibratory tools and rhythmic joint
compression.
Golgi: located in muscle tendons, aponeuroses, ligaments and
joint capsules.
They are stimulated with slow sustained stretching close to
muscular attachments.
Myofascial release and active release techniques can
stimulate these recceptors
Mechanoreceptors
Interstitial : 50 % respond to high threshold pressure while the
other half respond to gentle stimulation.
They are the most abundant found almost everywhere.
They are highly concentrated in the periosteum.
Stimulation can promote vasodilatation and enhance
tissue nutrition. They are influenced by
neurotransmitters which may change in patients with
chronic pain.
Stimulate periosteum structures ,interosseous
membranes and other fascia associated with bones.
This may re-sensitize these receptors which may be
visible by looking for autonomic changes.

Mechanoreceptors
Ruffini : respond to lateral shearing.
Inhibit the sympathetic activity in the entire
body.
Located in ligaments of pheripheral joints,
dura mater, outer capsular layers.
Slow steady shearing pressure is needed
Fascial Tonicity
(
Schleip
)
Fascia appears to have smooth muscle located in it.
Found in ligaments, tendons, dura mater,
meniscus, intervertebral discs, visceral ligaments,
bronchial connective tissue and ganglia of the
wrist.
Pathological diseases such as frozen shoulder or
club feet may be facilitated by over excitation of
myofibroblasts.
These cells respond under tension.
Adrenaline has no effect while nitric oxide
appears to relaxes theses muscles.
Another reason to meditate and reduce stress.
Fascia Composition (
Schleip
) .
Comprised mostly of water. It contains materials in
the ground substances that is very hydrophilic to
bind the water.
Stretching studies show that when you stretch fascia
water initially is squeezed out but as it relaxes more
will enter.
The higher composition of water increases fascial
stiffness which may assist in the muscles to
generate more force.
It also tells us we need to move to rehydrate and
have healthy tissues.
Fascial Recoil
Can enhance sports performance by
contributing to a spring like effect that co exist
with muscles.
plyometric training takes advantage of the
recoiling properties of this connective tissue.
Myofascial Trigger Points
There may be dysfunction within the muscles and
their associated fascia.
Trigger points are discrete, hypersensitive nodule
within tight band of muscle or fascia.
Classified as latent or active
Latent trigger point
Does not cause spontaneous pain
May restrict movement or cause muscle
weakness
Become aware of presence when pressure is
applied
Active trigger point
Causes pain at rest and when applying pressure
Tender to palpation with referred pain helps
determine if its a tender point vs. trigger point
Found most commonly in muscles involved in
postural support
Develop as the result of mechanical stress
Either acute trauma or microtrauma
May lead to development of stress on muscle
fiber = formation of trigger points

Trigger Points Symptoms
Notice the variety of symptoms that are associated with
trigger points.
muscle tightness ,weakness and cramps :
localized sweating
eye tearing
poor balance
dizziness
nausea
tinnitus
runny nose
buckling knees
weak ankles
staggering gait
headaches

http://triggerpoints.net/ for more infomation
Perpetuating factors
Chronic mechanical stress and postural habits
The body lays down fascia based on repetitive use
patterns. Inefficient movement patterns trigger abnormal
muscle tonus.
nutritional inadequacies.
Proper hydration and key electrolytes such as Na, K,Ca and
Mg play important roles in muscle physiology
Processed foods are deficient in many of the nutrients
necessary for all types of cellular functions and enzymatic
functions including muscle and fascial functions!
overuse of a specific muscle group-
a tennis player's gets lateral epicondylitis ( tennis elbow)
psychological distress
SNS reduces blood flow to skin and fascia which may
contribute lead to lactic acid production and reduced NO
needed for smooth fascial muscle to relax.

Fibromyalgia
Keeping in mind the fascial
system is continuous and
greatly influenced by a
patients psychological
state.
We need to look at the
whole person and not treat
their symptoms.
Where it hurts is where it
works!
Look elsewhere for the origin
of the pain!!

Somatovisceral and Viscerosomatic
Somatovisceral pain syndromes: myofascial
restrictions can cause visceral dysfunctions.
Myofascial restrictions in the abdominal muscles
can cause changes in bowel and bladder
functions, vomiting and food intolerance.
Viscerosomatic pain syndromes: occurs when
dysfunctional visceral may cause myofascial
constrictions of somatic structures .
Appendicitis may cause the abdominal muscles to
go into spasm.

Acupuncture points
Acupuncture points appeared to correlate with
areas of greater amounts of connective tissue. These
points also are located where nerves artery and veins
collectively penetrate the fascia. (
Finando
)
Twisting the needle appears to manipulate the fascia
which help reduce pain.
Body work also appears to work in this way.
Bibliography
Finando, D, S :FASCIA: THE MEDIATING SYSTEM OF
ACUPUNCTURE, 2009
Hendley G,:Fascia Presentation Illustrations. Intergral
anatomy.com
Myers,T: Anatomy Trains Myofascial Meridians for Body
Workers 2
nd
ed. ,(Churchhill, Livingston Elseveir), 2009
Schleip, R: The Nature of Fascia A review of the discovers
DVD. 2008
Stecco,L. Fascial Manipulation- Practical part (Padova: 2009,
Piccin Nuova Libraria)