Fascia thickness, aging and flexibility: is there an association?

Abstract

The morphology of the connective tissue may play an important role in locomotor mechanics. Recent research has revealed an association between increased fascia thickness and reduced joint flexibility in patients with chronic pain. The present study aimed to examine the relationship of both factors in healthy individuals, additionally testing the hypothesis that older subjects display a higher fascia thickness. Young (n = 18, 22 ± 1 years) and old (n = 17, 69 ± 4 years) healthy females were recruited for a quasi-experimental, cross-sectional trial. All participants underwent standardized ultrasound-based thickness measurements of the deep fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of fascia thickness and variable associations (i.e. fascia thickness and flexibility) were detected using non-parametric data analyses. Young adults exhibited higher fascia thickness of the anterior and posterior lower leg, anterior thigh and abdominal wall (+12.3-25.8%, P < 0.05). Conversely, older participants showed higher thickness in the lumbar spine (+40.0-76.7%, P < 0.05). Correlations of both body mass and fascia thickness (τ = 0.45-0.75, P < 0.05), as well as flexibility and fascia thickness (τ = 0.38-0.42, P < 0.05) were found. Age-related changes in fascia thickness may be a contributing factor of restrictions in joint range of motion. Further study delineating the cause-effect triangle of body mass index, flexibility and fascia thickness is necessary.

Keywords: connective tissue; hyaluronic acid; myofascial; stiffness.

Figure 1

Schematic drawing illustrating mechanical interactions that might restrict joint range of motion (ROM): superficial interactions are based on fibre continuity of two myofasciae, while deep interactions refer to the myotendinous connection between two articulating bones. Note that additional interactions are expected to occur between muscle and fascia.

Figure 2

Ultrasound examination of the deep fascia in the various regions of the body. On the left side: position of the probe; on the right side, ultrasound evaluation of the corresponding region. (a) Anterior region of the thigh. (b) Posterior region of the thigh. (c) Anterior region of the leg. (d) Posterior region of the leg. (e) Abdominal region. (f) Lumbar region.

Figure 3

(a) Scatter plot displaying the correlation between spinal extension and abdominal wall connective tissue (CT) thickness in both groups. Note the presence of outliers, particularly in the older participants. (b) Scatter plot displaying the correlation between spinal flexion and lumbar fascia thickness/lumbar fascia loose connective tissue (LCT) thickness in both groups. Note the presence of outliers, particularly in the right plot.