How the Body Responds to Trauma

The first response of the body to direct trauma is neuromuscular. Then for both direct and indirect trauma the body moves into the acute inflammatory phase. This phase is characterized by an inflammatory response involving pain, swelling, increased local temperature and redness.

The fascia at the site of the trauma is affected as follows: The input of energy from the trauma is more than the ground substance can deal with, the collagen and elastin component is stressed beyond its yielding point and the  three dimensional nature of the fascia is disturbed. The surrounding nerves and blood vessels are compromised which results at a cellular level in impaired metabolism and nutrition and oxygen exchange, and at a system level in reduced function. The disruption in the fascia matrix radiates from the site of the trauma as the fascia dissipates the energy from the trauma, giving rise to the feeling of pain and restriction. The myofilaments within the muscle react and the peripheral muscle fibres contract. Direct trauma may also result in a bruise forming as a result of damage to the capillaries and small veins in the area and the leaking out of red blood cells.

The extracellular environment is a medium for the autonomic system (oxygen, ion and water balance) to indirectly produce energy and the other conditions essential for the cell to survive. Homeostasis within the cell and its environment is maintained by the constant interaction of the cell with its environment, creating an integrated circuit of cellular, humoral and neural control. Therefore fascia is an organically vital medium and barrier between nerve and nutrition flow as well as being responsible for mechanical binding. When trauma impairs the functioning of the fascia, the defense system is subject to permanent stress and the defensive capability of the organism is reduced. The damaged cells release protein breakdown products which result in edema, tissue hypoxia and cell death. The process of phagocytosis clears the cell debris and edema. If the consequences of fascia impairment can be compensated for the body remains apparently healthy, however if the trauma exceeds the tolerance of the autonomic system functional disturbances and objective pathological changes will occur. This leads to further compensation, overwork and breakdown seen clinically as physiologic, neuromuscular and mechanical loss of efficiency and function.

The next phase of the wound healing process comprises of regeneration and repair. The reaction within the fascia at the site affected either directly or indirectly by the trauma, is that capillary budding occurs bringing nutrition to the area and the collagen and elastin components form cross links. At a cellular level the trauma affects the cell integrity resulting in spilling with loss of proteoglycans and water, this leads to the cell dehydrating and a build up of lactic acid, the extracellular matrix solidifies to a crystalline solution. This can be seen clinically as edema. This trauma and inflammation produces a signal of cellular shock that the cell function has been compromised and the repair process needs to start. The body switches on fibroblast production, and these cells synthesize scar tissue. The scar tissue consists of new connective tissue and new matrix constituents specifically proteoglycans. Where there is a lot of inflammation there is dehydration, resulting in the new tissue which is being laid down having an abundance of elastin and collagen but a dense and fibrotic matrix as the proteoglycans do not have enough water to absorb, resulting in lesions which can be palpated.

Non-mobilized scar tissue heals in an irregular formation. The mobilized tissue heals with parallel fibre arrangement which is more elastic and whose redundant folds allow mobility without irritation or pain. Radiating pain can be explained by the fact that fascial restrictions can create abnormal strain patterns, these can pull the bones out of proper alignment which results in joint compression which can result in pain and/or dysfunction. The restrictions can also trap nerves and blood vessels causing neurological or ischemic conditions. Asymmetrical posture can lead to uneven weight distribution, this in turn results in altered muscle spindle and joint proprioception and sensitivity. The end result being reduced range of motion, pain, stress and dysfunction.

The final stage of healing is the remodeling phase; during this phase cross linking and the shortening of the collagen fibers promote the formation of a tight strong scar. The collagen is remodeled to increase the functional capabilities of the tissues including muscle, tendon and fascia. The final aggregation, orientation and arrangement of the collagen fibers occur during this phase. Fibrous scar tissue slows muscle healing resulting in the regenerated muscle not being restored to its previous level. Scar tissue heals three dimensionally therefore the tissue does not fall back into place. Instead it reaches in the direction of the fascia and neighbouring muscle sheaths binding the tissues together. This can result in the loss of independent movement and the scar tissue limits the extensibility of the myotendinal unit. The muscles function and the limbs move, however the normal gliding in the fascia between neighbouring tissues is lost. This can lead to a low grade inflammatory process at the site of the decreased mobility. Scar tissue has a poor blood supply and is not as strong or resilient as the tissue it replaces.  In the long term these changes will be detrimental to the functioning and efficiency of the myofascial tissues.

Connective tissue is crucial for supporting the moving body and for generating biomechanically efficient movement. This movement depends on the connective tissue being functional and properly distributed. Trauma results in the protective tightening of the fascial system, and the fascial components loose their pliability, become restricted and are a source of tension for the rest of the body. As trauma causes the crystalline matrix of the ground substance to become dehydrated, this in turn affects the information transmission within and between cells resulting in false signals being produced. The molecular form of proteoglycan binds water, and thus creates the viscoelastic, shock and energy absorbing behavior of the extracellular matrix. Normal body temperature facilitates the optimal information conduction and storage between cells; it was hypothesized by Trincher in 1981 that false storage of information within the liquid crystals could be cancelled by increasing the temperature and piezoelectric events, thus transferring the extracellular matrix back to a homogeneous fluid (Barnes 1997). Ideally this process resets the ground regulation system and depolarizes the interstitial tissue, thus restoring efficiency of information transmission and elimination of false signals produced by the dehydrated crystalline matrix.  This explains why the introduction of a mechanical force (the hand or other body part) following the low load, long duration principle of myofascial release is sufficient to change the phase state of the ground substance, thus creating an extracellular environment consisting of a healthy and efficient gel.

In summary, the response of the fascial system to trauma encompasses adaptive responses of the morphologic and neuromuscular systems; it is a histologic, physiologic and biomechanic protective mechanism. The fascia loses its pliability, becomes restricted and is a source of tension to the rest of the body. The ground substance solidifies, the collagen becomes dense and fibrous and the elastin loses its resiliency. If this is not corrected, over time there will be poor muscular biomechanics, altered structural alignment and a reduction in strength, endurance and motor coordination. The end result is dysfunction and pain. The restoration of length and health to the myofascial tissue takes the pressure off the pain sensitive structures (nerves and blood vessels) and restores alignment and mobility to the joints.