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Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics
  1. Martina Zügel1,
  2. Constantinos N Maganaris2,
  3. Jan Wilke3,
  4. Karin Jurkat-Rott4,
  5. Werner Klingler5,
  6. Scott C Wearing6,
  7. Thomas Findley7,
  8. Mary F Barbe8,
  9. Jürgen Michael Steinacker1,
  10. Andry Vleeming9,
  11. Wilhelm Bloch10,
  12. Robert Schleip11,
  13. Paul William Hodges12
  1. 1Division of Sports Medicine, Ulm University, Ulm, Germany
  2. 2Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  3. 3Department of Sports Medicine, Goethe University, Frankfurt, Germany
  4. 4Department of Neurosurgery, Ulm University, Ulm, Germany
  5. 5Department of Anesthesiology, BKH Günzburg, Günzburg, Germany
  6. 6Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
  7. 7Department of Physical Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
  8. 8Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
  9. 9Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Medical University Ghent, Ghent, Belgium
  10. 10Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
  11. 11Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
  12. 12Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Professor Paul William Hodges, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia; p.hodges{at}


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.

  • injury
  • consensus statement
  • tendon
  • soft tissue

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  • RS and PWH contributed equally.

  • Funding PWH is supported by a research fellowship from the National Health and Medical Research Council of Australia (NHMRC; APP1102905). Partial funding was provided by the Ida P Rolf Research Foundation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at 2018 consensus statement from the Second International CONNECT Conference, Ulm, Germany.