Fascia is whatever it is… which, if the philosophers and theorists (including Martin Heidegger, Annemarie Mol, and Udo Krautwurst, for example) are right, will probably be much more marvellous than what all of us presently know of it.
There are many ways that fascia can be perceived and explained by people – few of which have been, or can reasonably be expected to be, entirely commensurate or in agreement with each other. (Remember the story about the blind men describing an elephant)
This happens because humanity’s knowledge of fascia is (and always has been) generated, interpreted, and used by people within the context of the worlds they live in. The variably associated with this has resulted in fascia being conceptualised in a variety of ways – not just the ‘scientific’ ones many of us are currently familiar with.
In this sense, our knowledge of it is ‘bio-socially constructed’ – fascia is ‘a thing’ (an observable biological phenomenon) that can be understood in a variety of ways – all of which are influenced by their social (i.e., cultural, and societal) surroundings. In other words, whatever we do in the laboratory to ensure our research is ‘scientifically pure’, our work and research results are not somehow magically free from the influence of our university’s financial resources, research priorities, and ethics policies, for example, or our country’s current political, economic, religious, education and health system structures.
Peoples’ diverse and developing understandings of biological phenomena – including fascia, and ‘the body’ it exists in – are shaped by many factors, including their ideas about the ‘right’ ways to learn about and do research about such things. Until now, fascia has predominantly been described from the empirical standpoint of science – yet this, or any other, way of describing it can only tell us some things about it.
What we are able to see of and know about it basically boils down to our choice of:
… None of which remains the same – or in fashion – forever!
Fascia is a non-specific anatomical term that is now being widely used to refer to the body’s soft connective tissue elements. My research shows that fascia is probably a Latinised version of the ancient Greek word ταινία (taenia) (Adstrum, 2015; Adstrum & Nicholson, 2019). In the days of ancient Greece and Rome, both words generally related to thin, strip-like objects, such as bandages, architectural surfaces, headbands, sashes, ribbons, strips of land, strips of cloud, tapeworms, and certain types of long, thin fish (ibid). It has yet to be established whether either word was, at that time, also ascribed with anatomical meaning. Nowadays, fascia is similarly applied to the naming of, for example, the flat surface of an advertising sign, a band of colour on a bird’s plumage, a row of holes on a seashell, the removable front surface of a mobile phone, and even the web of subtle connections that exist between people and (in Murray, 2009) the world they live in.
Anatomists have long been aware of the stuff that is now known as fascia, although their various ways of thinking about it have evolved over a period of several millennia (Adstrum & Nicholson, 2019; Adstrum, 2021) – a situation that is likely to continue far into the future. The ways fascia has been conceptualised and explained have always been (and still are) in accordance with, and are inseparable from, and the ‘how, why and when’ it was studied.
In ancient Greece and Rome, for example, the practice of medicine was governed by a combination of spiritual and secular medical doctrine. The body’s physical constitution, functioning, and health were explained in terms of humoral theory. The physicians practicing this style of medicine needed to have a relatively sound knowledge of the structure, location, and workings of the parts of the body that were then known to materially control the body’s humoral balance and health. This meant that they need to know something about the organs (e.g., liver and spleen), fluid-secreting membranes, and fluid-carrying vessels in the body’s abdominal, chest, and head cavities … which, according to the texts that they wrote, just happened to be the parts of the body that most interested that era’s anatomists. Human dissection was generally frowned upon as being sacrilegious (and strictly prohibited after c. 200 CE), so anatomists learned what they could about the body’s interior structure by looking through their patient’s wounds and surgical incisions, and dissecting animals. Microscopes hadn’t been invented, so they could only examine what they could see with their naked eyesight. A warm climate and an inability to effectively preserve the tissues they were examining meant they had to work fast – i.e., before the body’s flesh, including its fragile and mostly transparent (see-through) fascial tissue, rotted and broke down.
The ancient Greek medical writing that has survived the passage of time and translation reveals that that era’s ‘Hippocratic’ anatomists were aware of, and distinguished between, the membranes surrounding organs (including, for example, those covering the brain, the heart) and the unborn fetus, as well as ligaments and tendons (Adstrum, 2015; Adstrum & Nicholson, 2019). What and how much they specifically knew about these ‘fascial’ body parts is largely unavailable to us as many of their handwritten texts (along with most hand copies of them) were destroyed or lost by the end of the Dark Ages. We also don’t know the terms they used to discuss it, as they have not (yet) been authoritatively reported on in English.
Galen of Pergamon (130-c. 216 CE), a Greek-born Roman physician and anatomist, also knew about these body parts. He originally wrote about them in Greek, and the ones that survived the ravages of time were, many centuries later, translated into English – via a series of Latin, Arabic and/or German renditions. Goss’s (1963) translation of Galen’s ‘On the Anatomy of Muscles for Beginners’ text repeatedly uses the word fascia when describing the origins and insertions of muscles. It also suggests that Galen routinely applied a variety of terms – including aponeurosis, membranous aponeurosis, membranous fascia, fascial tendon, membrane, membranous process, and membranous tendon – to a range of ‘fascial’ structures (Adstrum, 2015, 2021). Galen’s original interpretation of, and distinction between these terms is unclear, which raises questions about the possibility of their transposable use. We are also unsure whether Galen used these exact words, or if they are instead just the ones that Goss thought were the best ones to use (i.e., his 20th century word preferences may have inadvertently introduced some translation bias).
The ways anatomists conceptualise fascia has fluctuated and changed quite a lot since Galen’s lifetime. I intend to carry on with my story about ‘the construction of fascia’ in some of my upcoming article posts.
If you’re interested, you can read some more about these things in my newly released book, The Living Wetsuit