Article publié par
January 29, 2004, Volume 22, Issue 03
The most unlikely connection one can make in terms of the fascia is that between the testicles and the cranial
bones. I mention this to illustrate that the more you learn about the ubiquitous
fascial system of the human body, the more amazing it gets.
B.B. Gallaudet1 dissected 34 adult human bodies from 1913-1930 for
the sole purpose of examining the fascia in the human body. In the preface of
his book, he stated that the "planes of fascia in one region of the body are
directly continuous with the same planes in all other regions." He further
stated that previous texts had never emphasized the law of continuity of fascial
The Underrated Fascia
In November 2003, I spent four days with Guy Voyer, MD, DO, at Queens
University in Kingston, Ottawa. Dr. Voyer has dissected over 100 cadavers,
spending most of his time tracing the fascial connections of the body. During
this session, I and others spent most of the time watching him dissect and
explain the fascial connections in the abdomen and pelvis. A description of the
fascial connection between the testicles and skull was included.
The outer layer of the testicles contains three fascial layers: dartos,
scarpa, and Camper's fascia. These layers attach to a conjoined fascial
attachment of the obliquus externus and internus and the
transversalis fascia; to the thoracic diaphragm fascia; to the middle
cervical fascia; to the temporal bone. The middle cervical fascia fuses with the
posterior cervical fascia, which attaches to the occipital bone.2,8
It is well-established that fascia forms a continuum throughout the body and
surrounds and infuses with every muscle, bone, nerve, blood vessel, organ and
cell of the body. Fascial contracture restricts muscular elongation and joint
range of motion.3 When a relaxed muscle is physically stretched, it
is the connective tissue and sheathing within and around the muscle that offers
When any joint is restricted over time, it stands to reason that the
connective tissue fascia surrounding the joint, and often fascial tissue distant
from the joint, will increase its cross-linkage and lose its original
shock-absorbing qualities. The status of pre-accident soft tissue is an
important reason why some patients suffer for prolonged periods of time after an
injury unless the fascial system is released. If a vertebral or extremity
fixation does not free up in a reasonable amount of time, we must look to the
proximal and distant connective tissue. The fascial system represents an
essential element of the kinetic chains many of us look to when local treatment
over the painful area is unsatisfactory.
The Fascial Conspirators
Upon viewing the iliac and psoas fascia, I saw a direct connection from this
fascia to the peritoneum, diaphragm, kidney, spleen, liver, pancreas, duodenum,
sigmoid colon and bladder. In one cadaver, I also noticed the ureter descended
over the psoas belly. The iliac fascial connection to the Fallopian tubes may
have an indirect effect on the ovaries. There is a direct fascial connection
between the apex of the sacrum and the rectum. Tight gluteus medius
fascia that attach to the piriformis can cause compression of the superior
gluteal vessels and nerve against the piriformis muscle.
In a past article,6 I described lumbar compartment syndromes in
which the fascia surrounding the erector spinae restricted normal contraction,
resulting in ischemic pain on lumbar flexion or activity. Many times, as a
result, fasciotomies are performed.7 Becoming aware of our total
bodily connection is the first step in freeing some of us from the "tunnel
vision" to which we still adhere.
- Gallaudet BB. A Description of the Planes of Fascia of the Human Body.
New York, Columbia University Press, 1931(preface).
- Lewit K. Manipulative Therapy in Rehabilitation of the Locomotor
System, 2nd ed. Oxford, England, Butterworth/Heinemann, 1991:29.
- Casell C. Tensile force in total striated muscle, isolated fibre and
sarcolemma. Acta Physiol Scand 1950;21:380-401.
- Ramsey R, Street S. The isometric length-tension diagram of isolated
skeletal muscle fibers of the frog. J Cell Comp Physiol
- Hammer W. Posterior Spinal Fascial System. Dynamic Chiropractic
- Kitajima I, Tachibana S, Hirota Y, Kenichi N. Acute paraspinal muscle
compartment syndrome treated with surgical decompression: a case report.
Amer J of Sports Med 2002;30(2):283-285.
- Special thanks to publishers Williams and Wilkins for this superb image.
Warren Hammer, MS, DC, DABCO