Updated research on Chronic Pain

SUMMARY KEYWORDS fascia, chronic pain, pain, injury, pain receptors, nervous system, body, moving, massage, nerves, movement, skin, work, shockwave, interacting, superficial layer, stretch, physio, flight freeze response, pain reduction strategies For those of you who regularly take Yoga Orkney classes, discussion around fascia and chat around chronic pain is common. This is deliberate for a couple of reasons:

1 - that it is really, really common for people to suffer a bout of pain lasting 4 weeks of more or pain with no discernible cause and

2 - talking about it reduces stigma and can support reduction of pain experienced by people who have battled with pain for a while.

It is common to have chronic pain but because we don't really discuss it, it can make for a very isolating experience for people suffering with and from chronic back pain. It is also worth acknowledging here at the beginning that I know and understand that chronic pain is real and that it can be debilitating for many people. Not only this, chronic pain severely impacts not only on quality of life but longevity too.

What is fascia and what has that got to do with my back pain?

While there are lots off different experiences of chronic pain I will use back pain as the example here as it's the most common form of chronic pain. Around 85% of people with chronic pain have chronic back pain and so far there hasn't been a cure that is easy to replicate a reduction of symptoms from one person to the next.

In order to build a little understanding let's learn a bit about fascia in the body. You can see an example of what fascia is like when you're chopping a chicken breast up for your dinner, you'll see the white fibre like stringy substance that kind of sticks the skin or between the different parts of the chicken meat that get held together. Kind of Like a gooey spider's web.

Fascia - the gooey spider's web

Fascia is not reserved for chickens, we also have this fascia in our body too. We are still working out how fascia integrates into our bodies, while it's likely to be throughout, it helps to think of it in two or maybe three layers each type or layer is rich in nerves and has its own unique function in the body. We will discuss the deep fascia, which is the kind that holds the organs together and tells your nervous system where those organs are and basically keeps watch on what they're doing, where we are in space. This process is called nonioception which is essential for communication of pain. Then we can think of a more superficial layer, which just means closer to the skin, which helps skin move, keeps it nourished with fluid but also helps develop a sense of pressure, temperature and movement.

Research on fascia only began in earnest in the year 2000. There were a few studies already on fascial networks, particularly within research around massage and physio, but nobody had really looked into it in any detail or with a view to establishing what impact the fascia plays on our health and wellbeing.

Newer research from 2000 onwards has shown that fascia is made from collagen and elastin, which give the fascia both movement and elasticity. All the strands of fascia need to glide over one another and in relation to other tissues in the body like skin and muscles. in 2020 it was established that the gel like substance that helps this happen is hyaluronic acid (a wholly grail of anti-aging products) which is made by a cell we've just discovered called a fasciacyte as well as another cell we already new about called a fibroblast.

So that's what helps keep the fascia in good order and if your fascia is in good order, then it's fine, you probably won't really think too much about it. You might have done things like foam rolling, you might have heard of trigger points and if you have chronic case of pain or back pain or fibromyalgia then it seems likely that your fascia will play a big part in that pain.

So back to pain and another reminder, as a chronic pain sufferer myself, it is fundamental to understand that the pain is happening. The important thing about the research into fascia and how it relates to pain is that it changes how we think about the way chronic pain is caused and why it is so long lasting. It's not that the pain hasn't been caused by an injury because sometimes it is kicked off by an injury or virus or some other form of ill health but often the pain remains after the initial injury has long healed.

To help understand why the lower back might be so vulnerable to this type of chronic pain a clue lies in the kind of diamond shape of the muscles, connections and bone structures there. If you think about (or even trace with your hands) underneath your ribs down towards the lower back, many connections meet there in a big diamond shape above your butt (see the white shape in the picture to the left). We have lots of interacting muscles working there, we have lots of interacting ligaments, y