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

TLDR

The fascial system is a three‑dimensional connective tissue continuum whose injuries impair performance and may contribute to musculoskeletal disorders, warranting greater focus in sports medicine. The statement aims to advance knowledge of fascial adaptation to loading, injury, and aging by reviewing current evidence, summarizing responses, outlining assessment methods, and highlighting interventions to improve injury prevention, performance, and rehabilitation. It outlines the methods available to study fascial tissue, from molecular and cellular responses to mechanical properties, and summarizes how these methods assess responses to loading, injury, aging, and interventions.

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 high-performance 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.