Connective tissue is the tissue between organs and tissues and it provides structural and metabolic support for other tissues and organs. It links whole body together. All connective tissue consists of three main components: elastic and collagenous fibers, ground substance and cells. Cells are spread through an extracellular fluid. Variations of the fibers and ground substance determine the property of the tissues. For example, Bones, tendons, cartilages have specific forms of fibers and ground substance. There are three types of connective tissues: loose connective tissue, dense connective tissue and special connective tissue such as bone, cartilage adipose, reticular connective tissue and blood etc. Loose connective tissue contains many cells, a loose arrangement of fibers and moderately viscous fluid substance such as the tissue in lymph gland. Dense irregular connective tissue contains a dense network of collagenous fibers arranged irregularly, for example the tissues in joint capsules and muscle fascia are this type of tissue. Dense regular connective tissue which is a special connective tissue contains cells and all aligned fibers and it is found in tendons and ligaments.
Loose and dense irregular connective tissue provides a medium for oxygen and nutrients to diffuse from capillaries to cells and carbon dioxide and waste substances to diffuse from cells back into capillaries. They protect organs from stretching and tearing forces. Special connective tissue’s function depend on the types of the tissues.
Fascia is connective tissue made up with collagen. Fascia can be seen between muscles, bones, ligaments and other internal organs.
The deep fascia is a highly vascular structure with a superficial and a deep layer, each with an independent rich vascular network of capillaries, venules, arterioles, and lymphatic channels. The presence of mast cells in deep fascia suggests a protective role similar to other connective tissues. The deep layer has few elastin fibers but does have myofibroblasts, suggesting contractile ability. Any active contraction would need to be controlled by a nerve supply and, indeed, one finds myelinated and unmyelinated nerve axons and Schwann cells in these deep fascial layers.
Any active contraction would need to be controlled by a nerve supply and, indeed, one finds myelinated and unmyelinated nerve axons and Schwann cells in these deep fascial layers. The deep fascia is not just a tough barrier structure of collagen and elastin, but is a metabolically active vascular layer which provides gliding and protective functions(16). Deep fascia has parallel longitudinal collagen bundles and rudimentary elastic laminae, giving it both high tensile strength and elasticity. At the junction between the deep fascia and the muscle, without any special secretory cells, the fascia is able to maintain a lubricating layer of hyaluronic acid (hyaluronan) which, like a hydraulic fluid, allows sliding between the fascia and neighboring muscle. However, when the epimysium is disrupted in surgery, overlying fascia does not remain distinct and does not create a gliding layer over the scar(17). More recent findings show that while hyaluronic acid is a lubricant, breakdown products of this large molecule are themselves tissue irritants(18), and fragments from collagen, elastin, and laminins in the extracellular matrix also modulate activities of inflammatory cells
The architecture of the fascia allows continuity of nerves, blood, and lymph vessels between the sliding tissues. With trauma to the muscle, the overlying fascia no longer produces the sliding layer of hyaluronan. Restoring this natural sliding mechanism becomes the next task for the manual therapist.
Fascia, meridians and acupuncture
Under the skin there is a sheet of connective tissue called fascia. Fascia is mainly made up of collagens and it surrounds the muscles and other internal organs. It can be seen between muscles, bones, ligaments and other internal organs. There are three types of fascia, superficial, deep and visceral fascia. Fascia are flexible and are resistant to tension force, this is because the collagen fibers produced by fibroblasts in the fascia are arranged in a wavy manner. Because of the fascia flexibility, it can transmit mechanical force throughout the body and prevent the body from injury. Fascia also provides support to the nerves and blood vessels in the fascia. Fascia is innervated by sensory nerve endings. If fascia is damaged and/or inflamed, it will lose its wavy pattern and flexibility, fasical adhesion and scaring will cause stiffness and pain.
In Chinese medicine, there is a concept of meridians through which the energy will flow throughout the whole body, but the anatomical basis of meridians is not resolved. The recent research data from scanning connective tissue has suggested that fascia network is clearly matched with meridian network. Disruption of fascia can trigger local inflammation and block energy flow causing pain. Acupuncture can reduce inflammation and unblock the meridians improving energy flow.
Chronic pain recovery, fascia remodelling and acupuncture
Nerve endings are surrounded by fascia tissue and play an important role in pain regulation. Disruption of fascia can stimulate pain receptors and provoke inflammation. Recently chronic low back pain has been suggested starting from the fascia inflammation. Pain-related fear leads to a decreased movement, connective tissue remodeling, inflammation, nervous system sensitization and further decreased mobility. The Lumbar Fascia cross the entire lower back region, and is a key component. The lumbar fascia is thickened in patients with chronic low back pain leading to stiffness of the back. Fascia remodelling is a healing process of recovery. Application of acupuncture helps fascia remodelling and reversing the abnormality of fascia.
How the body heals itself
Tissue repair is involved in the healing process which allows restoration of injured tissue. There are four phases during the healing process: blood clotting, inflammation, tissue growth (proliferation) and tissue remodeling (maturation). Blood clotting is initiated within a few minutes of injury. Plate. The inflammatory phase begins with damage to the capillaries, which triggers the formation of a blood clot and the various recruited cells to migrate into wound, such as inflammatory cells (neutrophils and macrophages), fibroblasts and endothelial cells and damaged tissue and cells, bacteria and other debris are cleared out. In proliferation phase, new blood vessels are formed and new tissue cells are crawling onto the top of the wound bed. Meanwhile the wound contract by gripping the wound edge to reduce the size of the wound and bring the tissues closer; new capillaries deliver nutrients and oxygen for the development of granulation tissue and proliferation of fibroblasts. Fibroblasts differentiate to myofibroblasts which have contractile properties containing stress fibres. The last phase of healing is regeneration and scar formation which is involved in a progressive remodelling of the granulation tissue. In this phase many enzymes and their inhibitors play a major role. Vascular cells and myofibroblasts are reduced in numbers. In the final stage, there are two separate processes: regeneration and replacement. In regeneration process, the new tissue completely restored the portions of damaged tissue to their normal state. collagen is realigned and cells no longer needed are removed. In replacement type of healing, severely damaged tissues are replaced by connective tissue forming scarring.
The healing process can become abnormal. These abnormal repair processes are the result of an impaired remodelling of the granulation tissue. If there is the noxious stimulus, excessive extracellular matrix deposition and the continued presence of myofibroblasts is observed. This excess of extracellular matrix deposition leads to the development of organ fibrosis. The installation and persistence of fibrosis is the consequence of an imbalance between extracellular matrix synthesis and degradation by myofibroblasts.
Acupuncture can stimulate normal healing process and speed up healing process.
Ludovic Micallef etc Fibrogenesis & Tissue Repair20125(Suppl 1):S5
Yu Bai et al Evidence-Based Complementary and Alternative
Volume 2011 (2011), Article ID 260510, 6 pages
Yu Bai et al Evidence-Based Complementary and Alternative
Volume 2011 (2011), Article ID 260510,
Almeida Mdos S et al Acupunct Med (2014) 32:178-82.