Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

Martina Zügel, Constantinos N Maganaris, Jan Wilke, Karin Jurkat-Rott,
Werner Klingler, Scott C Wearing, Thomas Findley, Mary F Barbe,
Jürgen Michael Steinacker, Andry Vleeming, Wilhelm Bloch, Robert Schleip,
Paul William Hodges

Br J Sports Med 2018;52:1497

Abstract
The fascial system builds a three-dimensional continuum
of soft, collagen-containing, loose and dense fibrous
connective tissue that permeates the body and enables
all body systems to operate in an integrated manner.
Injuries to the fascial system cause a significant loss of
performance in recreational exercise as well as highperformance
sports, and could have a potential role in
the development and perpetuation of musculoskeletal
disorders, including lower back pain. Fascial tissues
deserve more detailed attention in the field of sports
medicine. A better understanding of their adaptation
dynamics to mechanical loading as well as to
biochemical conditions promises valuable improvements
in terms of injury prevention, athletic performance and
sports-related rehabilitation. This consensus statement
reflects the state of knowledge regarding the role of
fascial tissues in the discipline of sports medicine. It
aims to (1) provide an overview of the contemporary
state of knowledge regarding the fascial system from
the microlevel (molecular and cellular responses) to
the macrolevel (mechanical properties), (2) summarise
the responses of the fascial system to altered loading
(physical exercise), to injury and other physiological
challenges including ageing, (3) outline the methods
available to study the fascial system, and (4) highlight
the contemporary view of interventions that target
fascial tissue in sport and exercise medicine. Advancing
this field will require a coordinated effort of researchers
and clinicians combining mechanobiology, exercise
physiology and improved assessment technologies.