A Summary: Architecture of Human Living Fascia By Jean-Claude Guimberteau

I’d like to share with you Dr. Jean-Claude Guimberteau’s text titled “Architecture of Human Living Fascia”.  Dr. G, as he will henceforth be referred to here, greatly influenced John Barnes’ understanding and teaching of the fascial system, and therefore, my understanding.  He was by far, my favorite speaker at the Fascial Congress (2015) and his work also influenced the naming of my company, Quantum Therapy, PC.

Dr. G is a hand surgeon who has used a high definition, high magnification endoscope (a tiny camera that can go inside the body) to study the world under our skin.  Rather than studying a tissue sample in a petri dish, or a cadaver in the anatomy lab, he has captured images and video of living tissue, during surgery.  His application of this new technology is really a breakthrough in the study of human tissue.  The appearance, texture, and behavior of tissue is so different when studied as is, “in situ”.  Dr. G’s ability to observe it at varying levels of magnification has aided in the understanding of the total continuity of it, from the macroscopic to the microscopic, from the surface of the skin to the level of individual cells.

Typically, when we think of the human body, we might describe it as follows: “Well, we have a layer of skin, then some fat, then a layer or two of muscles. Under that are the bones and organs, and then the spinal cord.  And then the nerves and vessels run around all over the place.  Those things are all made of cells.  And, oh yeah, here and there and in between all that stuff is the connective tissue that kind of holds it all together.  Dr G suggests a new way to describe the structural framework of the body, which calls into question current theory of embryologic germ layers and development.  He proposes a three-dimensional form consisting of a network of fascia (aka: connective tissue, extracellular matrix).  This fascia is a microscopic scaffolding of tiny volumes of fluid (microvacuoles) bound by fibers of collagen and elastin.  These tiny structures then aggregate to form larger versions of themselves, repeating in a fractal pattern that is ubiquitous and contiguous, leaving no empty spaces. It not only surrounds organs and muscles, it constitutes the organ or muscle. It is literally what we’re made of.  Groups of specialized cells are embedded and clustered within this network into distinct areas that we might call skin or quadricep or humerus or liver. But it’s all fascia.  And when we study this tissue in its intact, living form, we can better appreciate its possible holistic, dynamic function beyond inert packing material. (Note: As noted above, fascia is also called extracellular matrix.  As a prefix, extra means “outside” or “beyond”.  Extracellular, then, means outside, or beyond the cell.  So, if its not a cell, it’s fascia! Fascia is the immediate surrounding of every cell in the body).

It is important to note that nowhere in his book does Dr. G refer to “layers” of fascia.  (I remember sitting in his seminar at the Fascial Congress in 2015.  The audience members kept asking questions about this layer of fascia and that layer etc, until he finally almost shouts “THERE ARE NO LAYERS!”)  Instead, Dr G describes “areas of densification” that may lead to the appearance of layers that are not truly present.  He describes areas where microvacuoles are smaller, the collagen fibers shorter and more rigid vs areas with larger, more elastic microvacuoles.   The density and/or rigidity of the fascia varies according to its function.  For example, more rigid type fascia found surrounding the muscles prevents the dispersion of forces acting on it and directs them along the direction of the muscle fibers and tendon.  This creates a more efficient muscle contraction.  Whereas, the more supple fascia of the superficial tissue allows slack for nerves and vessels and is an area of increased three-dimensional mobility.  This tendency to see layers when there are none is also an artifact of studying fascia in the non-living or embalmed tissue of cadavers.  One can create as many layers as they’d like with a sharp scalpel in hand.  Another factor that contributes to this misconception of layers is the presence and color of the cells present within the fascia.  Fascial tissue itself is colorless, transparent, or white in color, whereas cells embedded in the fascia can be a range of reds, tans, and yellows.  For example, if there is an area of high density, yellow adipose (fat) cells lying adjacent to an area filled with reddish muscle cells, these may appear as separate layers. But the fascia in which these cells are embedded is continuous and uninterrupted. 

Let’s take a closer look at what Dr. G has named the microvacuole.  It is the basic building block of fascia.  It is comprised of collagen and elastin fibers, arranged in an irregular, chaotic crisscrossing fashion, and the three-dimensional volume bound by those fibers. These spaces are filled mostly with something called proteoglycan gel.  For simplicity’s sake, let’s just call it protein and water. What’s important to know is that it’s fluid.  For reference, one microvacuole can be as small as one cell and up to 10 times as big. And each microvacuole is sharing its fibrous borders with its adjacent microvacuoles, fitted together in a pseudo-geometric way that is very irregular.  (It’s tempting to imagine something like a honeycomb, except that a honeycomb has identical repeated shapes, whereas fascia presents in a variety of multisided shapes arranged chaotically.) 

It is the interplay of the fibers and the watery substance of the microvacuole that allows our bodies to respond to tensions and forces working in and on our bodies with such grace and efficiency.  The fibrillar aspect of the fascia, made of strands of collagen and elastin, vary in length, width, orientation and density.  They interconnect and interact, sliding along each other, lengthening or shortening, widening or narrowing, splitting or fusing, constantly in flux in response to the various forces they encounter.  The network is never at rest, constantly searching for efficiency and equilibrium as it absorbs tensions and forces large and small, from a heartbeat to performing a deadlift with 300 pounds. This sliding and splitting ability of the fibers is what allows for localized movement without disruption of nearby structures.  The fluid volume within the microvacuole, however, remains constant in the face of all this reconfiguration.  Like a shock absorber, tension and pressure are dispersed three dimensionally to adjacent microvacuoles and throughout the network.  Once the outside force is removed, the system returns to its original configuration. This indicates that the system is pre-tensioned or pre-stressed, adapting to the constant forces of gravity, electrical forces, intracranial, cardiac, and respiratory pressures as well as musculoskeletal forces, as we move about through our day. 

Dr. G has made some very interesting observations about the physical relationship between the extracellular environment (fascia) and the cells embedded within it.  Cell density found in different areas of the body is quite variable.  They can be found along the fibers of the microvacuoles in clusters that number anywhere from millions to just two or three.  Shape, position and orientation of the cells are affected by the changes in tension along the fibers to which they adhere.  Other well established in vitro studies have long shown that mechanical stimulation of the cell wall can influence the nucleus and other intracellular structures.  These observations taken together, begs the question:  Can external forces, via the fascial system, have an effect on cellular function?  We are on the cutting edge of learning about the potential role the fascial system has on the health and function of our bodies!

Earlier, I described how the fascial scaffolding maintains its structure in the face of the forces acting upon it by dispersing pressure and tension from microvacuole to microvacuole, and by reconfiguring its fibrillar links through lengthening, sliding and splitting the collagenous fibers making up its boundaries.  What happens when the system falters, when there is too much force applied to our tissues, such as in trauma?  In the case of a cut, incision, or other wound that causes an interruption of the skin barrier, a scar forms.  A scar is not a functional tissue, it simply serves to close the gap in the tissue. Various types of tissue are replaced with one homogeneous plug and the sophisticated structure of the tissues is lost.  The degree of functional recovery depends on many factors, including depth and extensiveness of the scar, age of the person, and delays or complications in healing.  Scars themselves are not painful and most regain enough mobility over time to avoid obvious functional loss. Sometimes, a scar may appear well healed, but adhesions are hidden under the surface, in adjacent tissues. Technically speaking, adhesions are not the same thing as scars, but a complication of scarring.  Fascial structure is still present in adhesions but the fibers are thicker, shorter and stiffer and mobility is lost.  Nerves and other pain sensitive structures can be compressed causing symptoms.  Other processes involved in trauma include edema (swelling), ecchymosis (bruising) and inflammation.  In these cases, excess fluid and/or blood leaking into the extracellular space creates increased pressure and distension of the microvacuoles.  Fibers are unable to redistribute tension or slide.  If this is short lived, the tissue can recover and return to normal.  But if inflammatory processes are prolonged and become chronic, the fibers begin to contract and thicken, and adhesions form.  Additionally, in chronic inflammation, Dr. G notes observable changes in the appearance of the liquid portion of the microvacuole, including trapped bubbles and decreased transparency. However, unlike scar formation, enough of the structural integrity of the tissue is usually retained such that adhesions are “amenable to change, for instance by manual therapy”. (pg143)

Most of Dr. G’s text focuses on the structure, makeup, and to some extent the behavior of fascial tissue as observed in vivo.  He does not extrapolate much into the realm of therapeutic interventions affecting fascia.  He does state one thing for certain: “…traction applied directly to the skin has a direct effect on the subcutaneous fibrillar network, and that mechanotransmission is likely in play.  It is also evident that manipulation in three dimensions seems the best way to influence the mechanical potentialities of the fibrillar structures.”  Dr. G repeats throughout his text that we are just on the brink of learning about the fascial system and that it is imperative as we move forward to study and describe it in its functional form, in the living human body.

I hope that Dr G’s more accurate and sophisticated rendering of fascial structure will aid the reader in envisioning it, not as an inert packing material, but as a truly holistic and dynamic system.  Future study may soon lead to better understanding not only of fascia’s structure, but it’s previously unrecognized function(s) in health and healing.  To be sure, I have not covered Dr. G’s text in totality.  I covered what I thought might be interesting to people coming across it on my blog, and what I felt I could fairly wrap my head around.  There are areas of considerable technicality and hypothesis that honestly, I found too difficult to summarize.  Having studied the text now in more depth, I have gotten past some of the more intimidating verbiage and can really appreciate the elegance of his observations and theorizations.  For those with scientific background and real interest, I encourage you to check out the book for yourselves.  There are beautiful photos throughout and even accompanying QR codes that link to live videos of the endoscope in action.  In addition, there are short commentaries from several leaders in the field (including our very own John Barnes!) after each chapter. These highlight how Dr. G’s work has influenced and related to the speakers’ own observations and work, which I found so interesting.