This picture caught my eyes few years back. It was published in The Washington Post back in 2014 and it nicely summarised the harmful effects of prolonged sitting from head to toe.

As a physiotherapist, I am constantly reminding my patients to take walking breaks if they have been sitting for more than an hour. Everyone knows how inactivity and bad posture could cause your back and neck to hurt. However, the harmful effects of prolonged sitting do not end there. The impact sitting has on cardiovascular health is not as direct, and would probably take years of accumulation to show up.

Prolonged sitting has been associated with elevated blood lipids (triglycerides) and bad cholesterol (low density lipoprotein; LDL), and decreased good cholesterol (high density lipoprotein; HDL) levels in the body. This increases the risk of cardiovascular diseases [2,3]. Additionally, reduced insulin sensitivity due to decrease in muscle contractions can also increase your risk of type 2 diabetes [2,3].

Hence, I frequently remind my sedentary patients: “Staying active improves all aspects of our health. It strengthens muscles in our bodies and prevents chronic diseases from developing.” I often thought, “How nice if everything can be summarised into a beautiful picture?” Until one day when I saw this awesome poster!

Yet, one crucial component is missing from this. Our Fascia.

What is Fascia? Why is it important?

Fascia is the connective tissue network that holds every organ, blood vessel, bone, muscle, and nerve in place [4]. Not only does it provide structure, it is also rich in nerve endings which allow us to sense and feel motion. Imagine fascia as a sticky greasy bodysuit you wear. This suit provides you with shape and structure, and keeps everything within its place. It is also able to accommodate all the movements in your body, and pick up information both internally and externally for your brain to process, and for your body to perform specific action(s). For example, your fascia allows you to break a fall to protect other more essential parts of your body or to reciprocate a comfort hug from a friend. The fascia is a vital, dynamic connection between our body and the environment. [5]

Invisible externally, this fluid fascia network exists between cells and comprises fibres (mostly collagen) and mucous (mainly water) [4]. Nutrients, via the circulatory system, need to pass through this fibrous-mucous network to get to the cell. Likewise, waste products from cells – think toxins – need to pass through this same network back into circulation.

However, this flow of nutrients and waste products gets congested when one’s fibres and/or mucous becomes too dense or dehydrated, respectively [4,6]. This can happen when we sit with a bad posture requiring muscles to be unnecessarily activated to maintain our pose (e.g. with rounded shoulders). Our body would be prompted to generate more muscle fibres that will arrange themselves along the line of stress to create a better “strap” to support itself. Unfortunately, these bulky dense fibres form a barrier, reducing circulation to muscle cells. In addition, waste products cannot be cleared away effectively from muscle cells. They can still survive, but will develop into malnourished muscle groups (choked with toxins) resulting in reduced function, potential trigger point pain(s) and weakness [4,6].

Luckily, changes to the fascia network can be reversed through movements (e.g. stretching and strengthening), and manual therapy. Think of our fascia as a sponge; movements squeeze out the waste, and following release, enables a “fresh” fascia to re-absorb nutrients and water molecules for maximum fuelling and hydration. Constant activity – akin to a back and forth flushing action – also restores fluid flow within the fascia, rehydrating the tissues cells and breaking up the dense, bulky fibres, while always keeping it clean and shiny! [4,6]

All About Fascia poster

Now, take a closer look at the poster and apply what you’ve learnt about the fascia… Do you see the dots connecting? Yes, exactly! Your fascia could very well have been the missing link to all your niggling issues all this while!

A habit as simple as sitting for extended periods can snowball, leading to impaired circulation. This, in turn, allows waste to be accumulated in our organs, blood vessels, bones, muscles and nerves, thereby restricting their ability to perform. Gradually, disease manifests and suffering comes knocking.

So, what can I do, you ask? The solution is simple (for those who haven’t already gotten it)! Don’t just sit there! Start moving! Keeping your fascia healthy is easy! Just remember these three simple steps:

Move around your workspace if you have been sitting for more than an hour to rehydrate your fascia. Drinking more water doesn’t exactly hydrate your fascia. That said, drinking is good for you. AND, it’ll make you want to stand up and go pee more often! That movement, is what your fascia needs to re-hydrate itself! Pro tip: Drink enough water so you’re going to the toilet at least once every hour. A win-win for your body!

If you REALLY have to stay seated for prolonged periods, try to maintain a neutral posture (see poster for tips).

Exercise regularly to train the fascia. A short brisk walk around your neighbourhood or a short HIIT session will be perfect. Remember, the key to success is consistency. Work the fascia frequently to keep them in prime condition! #blingbling

References:

1. Berkowitz, B. (n.d.). Reporting by Bonnie Berkowitz; Graphic by Patterson Clark. [online] Available at: https://www.washingtonpost.com/wp-srv/special/health/sitting/Sitting.pdf.

2. American College of Sports Medicine (n.d.). Reducing Sedentary Behaviors: Sit Less and Move More. [online] Available at: https://www.acsm.org/docs/default-source/files-for-resource-library/reducing-sedentary-behaviors-sit-less-and-move-more.pdf?sfvrsn=4da95909_2.

3. Katzmarzyk, P.T., Powell, K.E., Jakicic, J.M., Troiano, R.P., Piercy, K. And Tennant, B. (2019). Sedentary Behavior and Health. Medicine & Science in Sports & Exercise, [online] 51(6), pp.1227–1241. Available at: https://journals.lww.com/acsm-msse/Pages/articleviewer.aspx?year=2019&issue=06000&article=00018&type=Fulltext.

4. Myers, T.W., Graeme Chambers, Maizels, D. and Wilson, P. (2017). Anatomy trains: myofascial meridians for manual and movement therapists. Edinburgh: Churchill Livingstone/Elsevier.

5. Anatomy Trains. (2017). Anatomy Trains E-Magazine Issue 3 – Tom Myers Interview and Fascia. [online] Available at: https://www.anatomytrains.com/blog/2017/02/24/e-magazine-issue-3-is-out/.

6. Myers, T. (2018). What You Need to Know About Fascia. [online] Yoga Journal. Available at: https://www.yogajournal.com/teach/what-you-need-to-know-about-fascia.