The word "fascia" may not be a regular part of your vocabulary, but you’ve got plenty of it inside your body. Simply put, fascia is the loose connective tissue, made of densely packed protein fibers, that surrounds your muscles, bones, organs, and other body parts, encasing your entire body from the inside.
“Fascia sort of holds everything together,” says Stuart Kaplan, MD, chief of rheumatology at South Nassau Communities Hospital in Oceanside, New York. It helps to think of fascia as a highly sensitive, interconnected system — one that resembles a massive hammock of tissue fibers — that helps bind, support, and organize your muscles, organs, and other body parts so they stay suspended in their proper places.
While it may not seem like fascia would play a role in rheumatoid arthritis (RA), it actually does. For one thing, “any time you have pain and swelling in joints, it can affect the soft tissues [including fascia] around them,” Dr. Kaplan says. It’s an unfortunate ripple effect, and complicating matters, the effect can go the other way, too. In fact, “it’s now believed that inflammation of the fascia are involved in causing the stiffness and achiness people with rheumatoid arthritis feel, especially early in the disease," Kaplan adds.
Fascia is loaded with sensory neurons, so when it’s not functioning properly, or when sheets of fascia get stiff and stick together — from too much physical activity, such as overdoing it during a workout; or too little movement, such as sitting like a statue on a long plane flight — you can end up with pain and discomfort. “Often people with RA don’t realize where the pain is coming from,” Kaplan says. It could be from fascia, rather than the joints.
When it comes to fascia’s involvement in RA, the most commonly affected areas include the low back, the hands and wrists, the sides of the hips, and the bottom of the feet — particularly the heel. These are considered extra-articular manifestations of rheumatoid arthritis. Case in point: People with RA are especially prone to developing plantar fasciitis, inflammation of the thick band of connective tissue, called the plantar fascia, that runs along the sole of the foot from the heel bone to the toes.
In addition, sometimes people with RA have problems with enthesitis, or inflammation of the enthesis, the point where fascia, ligaments, or tendons insert into the bone, explains Ashira Blazer, MD, a rheumatologist at NYU Langone Medical Center in New York City. “Because people with RA have chronic inflammation, small blood vessels in the entheses can get inflamed and can cause pain.”
“There are inflammatory causes of fasciitis, and mechanical causes,” Dr. Blazer notes. For example, plantar fasciitis can result from excessive stress on the foot, particularly heel compression due to standing with most of your weight on your heels, pronation (when your feet roll inward excessively), or other abnormalities. Meanwhile, other forms of fasciitis more commonly stem from underlying inflammation, rather than mechanical stress.
If you have RA, “a lot of these [fascia-related] issues will subside once the arthritis is under better control,” Blazer says. This is another good reason to consistently take the medicines your doctor prescribes, particularly the newer disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies, which can better control RA and even put it into remission.
In the meantime, it helps to stretch your body and exercise regularly, to keep your muscles strong and prevent your tendons and fascia from stiffening. In fact, stretching the low back can decrease inflammation and pain sensitivity in inflamed connective tissue in the low back, according to research published in January 2012 in the journal PLoS One.
What’s more, physical therapy, including massage and myofascial release, can be beneficial. Myofascial release — a manual therapy that involves applying gentle, sustained pressure to tight connective tissue — is often used in massage, or it can be self-administered with a foam roller. “It can help you maintain laxity, which prevents tightening of the fascia,” Blazer explains.
If you experience significant pain in your fascia, taking a nonsteroidal anti-inflammatory drug (NSAID), such as Advil and Motrin (ibuprofen) or Aleve (naproxen), can reduce inflammation and discomfort, Kaplan advises. If you develop plantar fasciitis, see a podiatrist, who can prescribe specific exercises and support devices, such as a night splint to keep your foot flexed while you sleep.
If you suffer from severe plantar fasciitis or low back pain that isn’t relieved by other measures, Kaplan suggests talking to your doctor about whether you might be a candidate for steroid injections to relieve inflammation and pain in the soft tissue there.