Ep 550 – Something About Water with Rachelle Clauson and Nicole Trombley

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0:01:36.5 Rachelle Clauson: Hi everyone, welcome to the ABMP Podcast, a podcast where we speak with the massage and bodywork profession. I'm Rachelle Clauson.

 

0:01:45.4 Nicole Trombley: And I'm Nicole Trombley. Rachelle and I are longtime massage therapists and we write the Anatomy for Touch column for Massage & Bodywork magazine.

 

0:01:53.1 RC: When we aren't writing or massaging, we are busy studying in the dissection lab and teaching. We are the co-directors of Anatomyscapes, a continuing education company for hands-on professionals.

 

0:02:04.9 NT: We are easing into 2024, full speed ahead. We'll be here on the ABMP Podcast a bit more this year. We've got exciting conversations planned, including interviews with some of our favorite fascia researchers. So stay tuned.

 

0:02:18.1 RC: And early bird registration is open until April 15th with payment plans available for our Journey into the Matrix workshop and Dissection Lab Intensive, both of which are coming this fall. The Dissection Lab Intensive is already almost fully booked and Matrix is well on its way. So if this is your year to get to the lab with us, start planning your trip now. And if you live in Minnesota, this coming March 6th and 7th, we are the keynote speakers for the Massage Therapy Symposium at Northwestern Health Sciences University. We will be teaching two workshops on all things fascia, specifically for the IT band and thoracolumbar fascia. Registration is open if you'd like to join us there. But next week, we're heading back to Italy. In fact, by the time this episode drops, we'll already be back in Padua, visiting the birthplace of modern anatomy at the University of Padua, where great anatomists like Vesalius taught. We'll also be visiting the oldest anatomical theater in the world, where dissections took place hundreds of years ago. And so much of the current fascia research is being done right there in Padua with Carla Stecco's research team.

 

0:03:34.9 NT: I'm so excited, I can hardly stand it.

 

0:03:38.1 RC: But as we are getting ready to fly over the giant ocean to Italy, we are thinking a lot about water. Water in the body, water and massage. It's not a new thought, really.

 

0:03:50.2 NT: True. Massage therapists care a lot about hydration. How many little paper cups or those little baby bottles of water do we hand out each year, encouraging our clients to stay hydrated and drink extra water after their massage? We know that water is a critical part of the human body and that we feel better, we move better when we tend to our H2O.

 

0:04:14.2 RC: Well, it turns out that that little paper cup is only one way that massage therapists are helping their clients hydrate their tissues. Today we're talking about water and the human body, where it actually lives, and it's not just in the blood and lymph, and the special role it plays in the fascial system, why it matters for the work we do.

 

0:04:36.3 NT: We'll explore fascia and hydration and discover that hydration isn't just about drinking water. It's about how water is organized in the extracellular matrix.

 

0:04:47.4 RC: In our last episode, we talked about collagen, the fibers in the fascia story. Nicole, you said you were feeling a little dehydrated after all that fiber talk. So today we're going to take a look at the liquid part. So go refill that water bottle or pour yourself a cup of tea and let's dive into water. Let's talk about H2O.

 

0:05:09.4 NT: Water is one of the most important molecules on the planet. Life depends on water, and so much of our physiology as humans is about managing water and keeping it in the right places. Our physiological reactions and processes are so dependent on water.

 

0:05:28.0 RC: And for us as humans, water makes up roughly 50 to 60% of our body mass. That changes, of course, as we age. Babies are born with about 75% water. Those plump little juicy grapes of babies. Well, it quickly drops, believe it or not. By age one, it's down to just 65%. And by the time we are mature seniors, well, we've dried out to maybe only 45% composition. We go from grapes to raisins.

 

0:05:57.6 NT: But where is all that water? Is it just sloshing around inside of us?

 

0:06:02.0 RC: This is a great question, and it is true. H2O is everywhere in the body, but different tissues have different water content. Here are some estimates, which of course vary a lot depending on your age, body composition, muscle, adipose, sex, all of those things. But in general, a huge amount of water is in our lungs, which you wouldn't really consider unless you've seen lungs in the dissection lab with us and you know how soft that tissue is. 83% water in our lungs. Brain, heart, kidneys have a lot too, somewhere between 73 and 80% water. And the muscles, which actually surprises me, I don't know why, 79% water estimate.

 

0:06:43.3 NT: Oh, that's so interesting. Skin, I'm sure this varies by age, is 64% water. And this one I find really interesting, bones, 31% water.

 

0:06:50.0 RC: Amazing.

 

0:06:56.7 NT: Whereas teeth, which are not actual bones, only 8 to 10% water.

 

0:07:01.6 RC: Fair enough. And of course blood and lymph contain a lot of water, but we'll talk more about that in a minute. Here's something really interesting about tendons. Would you think that tendons are high or low in water content?

 

0:07:13.9 NT: I mean, that's a whole lot of collagen, right?

 

0:07:17.0 RC: Would you believe that tendons are up to two-thirds water? So think about that for a minute, listener, as you are standing, walking, sitting, wherever you are. If you have access to your Achilles tendon, go ahead and reach down and squeeze it a little bit. It's a pretty thick tendon on the body that's easy to feel just above our heel, but if you think about two-thirds of that tendon proper is water, it makes me think of when after you've had maybe fried chicken and then you don't do the dishes until the next day. And if you've ever looked at how much the more collagenous, tendinous parts of the chicken leg have shriveled, that's because it's mostly water. Two-thirds water means that your Achilles tendon's diameter, if it dried out, would be really small.

 

0:08:02.0 NT: That's so interesting. Okay, let's drill this down a little bit. Where in all of these tissues do we find all that water? Well, most of the water in our bodies is inside our cells, about two-thirds of our water. Water is so essential for the chemical and metabolic reactions that keep our physiology chugging along. That water content inside the cell is tightly regulated. Every cell is wrapped in a double layer of water-resistant fats to keep that water in and keep other water out.

 

0:08:37.0 RC: But that means that one-third of our body's water is outside the cells, the extracellular water, if you will.

 

0:08:43.9 NT: That's right. Extracellular water plays important roles in our immune system, transportation of nutrients, removal of waste, communication, and it serves as a reservoir for electrolytes, keeping us in homeostasis.

 

0:08:58.6 RC: The extracellular water also plays a mechanical role, providing lubrication where needed and helping keep tissues plump, creating cushioning. Some of the more obvious examples of where we find water outside of the cells would be the blood, the plasma, lymph, but also in specialized fluids like cerebrospinal fluid, digestive fluids, peritoneal fluid in our abdominal cavity, serosal fluid surrounding our lungs, and even the synovial fluid in our joints.

 

0:09:29.4 NT: There's also the ground substance, which is another major reservoir of the water in our body.

 

0:09:35.1 RC: But what is ground substance? You may have heard this term, but it's not so intuitive to really understand what it is by its name. What does it have to do with the ground, Nicole?

 

0:09:45.7 NT: Right. Ground substance is a gel-like matrix that we find throughout the body, particularly in our connective tissues like the skin's dermis, our fascia, tendons, ligaments. The ground part is kind of an awkward translation from the original German. It might have better been translated to fundamental or foundational.

 

0:10:09.0 RC: Oh, okay. That's actually making a lot more sense.

 

0:10:12.1 NT: It was... Yeah. It was meant to describe the foundational substance in which the fibers and cells are embedded. The ground substance is holding a massive reservoir of the body's water. If a person has, say, 11 gallons of water total in their whole body, three gallons of that is going to be in the ground substance in the extracellular matrix. That's three times more than there is in the blood, which has maybe not even a full gallon of water in it. We are juicy, and that is really significant for our work as bodyworkers.

 

0:10:50.1 RC: So let's zoom in on this ground substance and in particular the molecule that gives all that water its superpower, hyaluronan.

 

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0:12:25.3 RC: Let's get back to our conversation. Ground substance is water plus something called glycosaminoglycans and proteoglycans. Glycosaminoglycans is commonly just called GAGs, which is a lot easier to remember, and the most prevalent GAG is hyaluronan. Hyaluronan is in the news. It's in your skin care products. I've even seen it in shampoo. Hyaluronan is everywhere, including now being used even as injectables, not just for your face, but even for your knee for osteoarthritis, but what is hyaluronan exactly?

 

0:13:05.0 NT: Well, it's a big old macromolecule, and a macromolecule is really just what it sounds like: a really, really, really big molecule. And it binds water, and together, water and hyaluronan make a viscous gel. So I like to think of it this way. If you've ever soaked chia seeds, maybe make a little chia seed pudding, and you watch them turn into a gel, it's really similar to how hyaluronan works. Like hyaluronan, chia has sugars and carbohydrates that bind water and together create a gel. Chia can bind up to 12 times its weight in water. Hyaluronan can do the same thing, but even more powerfully. So get this, hyaluronan can bind up to 1,000 times its weight in water. So if chia seeds can transform a glass of water into gel, imagine what hyaluronan is doing throughout our full body's connective tissue.

 

0:14:05.3 RC: Okay, so where do we find HA in the body?

 

0:14:09.6 NT: It's a matrix molecule. Most importantly, it's in between our tissues, in our fascia, particularly in loose connective tissue.

 

0:14:21.5 RC: So let's talk about what hyaluronan does for our tissues when it's got a hold of all of that water. Because we move and ambulate, everything inside our bodies has to be able to move. Tendons need to glide as they move our bones. Nerves need to glide as they traverse through multiple tissues and travel along long distances. Muscles have to glide over one another every single time they contract. Hyaluronan provides the lubrication to reduce friction between all these tissues so we don't spontaneously combust from just taking a walk around the block or while we're just folding our laundry. All of our tissues are sort of like fabrics, but none more so than fascia, the fascia that covers our muscles like membranous skins and the larger sheets of fascia that contain groups of muscles. These fabrics not only have threads of collagen that make them kind of like a fabric, but they also have hyaluronan between the threads. So how supple or adaptable the tissue is has to do with how well those threads are able to move, too, and how much water there is mixed with that hyaluronan. Think of your favorite jeans and then what they feel like after you spill ice cream on them that has dried. The fabric can feel stiff because the fibers within the fabric can't move. Okay, what about stretch? Does hyaluronan affect how much things stretch?

 

0:15:48.5 NT: Yes, but not in the way that you might think. This glide that's within the fabric can also give you the illusion that the fabric is stretchy, even when the fibers themselves are not. It's in the weave. The arrangement of the fiber and the fibers gliding against each other can allow the fabric to adapt its shape, which gives it a kind of stretchy quality. When all is going well, hyaluronan binds water and creates the perfect gel for our tissues. Things slide, nutrients are diffused, immune cells can migrate, but the viscosity of that gel is what matters. Viscosity. Talk to me about viscosity.

 

0:16:27.9 RC: Well, viscosity is a liquid's resistance to flow. And the viscosity of the hyaluronan gels in our loose connective tissue impact how well our tissues can slide and glide. To better understand that, it's helpful to think about honey, another viscous fluid made of sugars and water. Now, if you warm that honey, it flows more smoothly. Its viscosity has decreased, but put it in the fridge, and it becomes harder to pour. It's more viscous. Well, hyaluronan's viscosity can change, too. We rely on hyaluronan to move our bodies. So stand up on tiptoe, and your gastroc's gonna glide over your soleus because of the slippery surface created by the hyaluronan-rich loose connective tissue. Now imagine that hyaluronan becomes more viscous, like that jar of honey we just put in the fridge, thick and sticky. Now, standing on tiptoe becomes more difficult. The layers don't glide as easily, but warm up that jar of honey, the viscosity decreases, it flows smoothly again, and the sliding becomes easier.

 

0:17:37.5 NT: So this really begs the question, what changes hyaluronan's viscosity? Hyaluronan is sensitive to what's happening around it. That idealized relationship with water can easily be interfered with based on temperature, pH, mechanical stress, and concentration of hyaluronan.

 

0:17:57.4 RC: Wait, what? So just having more hyaluronan doesn't help things glide?

 

0:18:04.8 NT: Exactly. It's kind of counterintuitive, but when the body spits out more and more hyaluronan, those hyaluronan molecules stick to each other instead of water, and we get back to a sticky situation. Scientists actually call this fascial densification. As massage therapists, we know that fascia is involved in our clients' pain and movement problems, but we've struggled to explain exactly where in the fascia the problem is and what has actually changed. Is it tight? Is it stuck? Is it adhered? Is it scar tissue? Densification gives us a more specific answer. It's a change in the water-filled, hyaluronan-rich loose connective tissue that we were talking about. The lubricating loose connective tissue that lets our nerves glide, our muscles slide over each other so that we can move.

 

0:18:59.4 RC: Densification is just one type of possible alteration to our fascia. It's different from fibrosis or scar tissue, where extra collagen gets laid down in the fiber part of the matrix. Densification is happening in the ground substance. So what triggers densification? Several things. Lack of movement is one factor, but so is inflammation, injury, and even repetitive stress or overuse.

 

0:19:26.1 NT: Bottom line, it's a disruption in the relationship between hyaluronan and water. The hyaluronan molecules aggregate, sticking to each other instead of water. The loose connective tissue gets stickier, glide is compromised, movement becomes restricted, and this is when people start feeling pain and stiffness.

 

0:19:45.3 RC: Which begs the next question. What makes hyaluronan less viscous? Well, interestingly, it's the same things that make it more viscous: temperature, pH, mechanical stress. But in this case, the temperature is heat makes it more liquid as opposed to cold, which can make it stiffer. PH, just a normal balanced pH is what's gonna work better than something that's out of balance. Mechanical stress, movement and massage. This is really good news. The change in hyaluronan viscosity is not permanent, and we can change it with really simple tools. This helps explain why when you wake up stiff in the morning, a hot shower or a brisk walk or a back rub helps take away that stiffness. These inputs are changing the viscosity of the hyaluronan. They are changing the relationship of the hyaluronan molecule and water.

 

0:20:39.9 NT: Yeah, this is really good news because researchers are speculating that densification, if it is not addressed, could eventually actually turn into something more permanent, including fibrosis. So early intervention is pretty key.

 

0:20:54.1 RC: Well, that was a lot. We've looked at where water is in the body and how it's organized there, and we've really explored this different aspect of hydration, which is not just about how much water we drink, but how that water is organized in the extracellular matrix at the molecular level. Turns out when it comes to tissue hydration, ground substance is where the party's at. That three gallons of water, more or less, is dancing with the hyaluronan, creating gels that let your tissues slide and glide. And our massage strokes might be providing the mechanical input to change that molecular relationship, how water and hyaluronan associate with each other. It's like warming up that jar of honey, helping restore fluidity to tissues that have gotten thick and sticky.

 

0:21:43.6 RC: So, the next time you hand someone that little cup of water, you're right, hydration matters. And now you know it's not just about quantity of water, it's about where it is and how it's organized, and our hands are making an impact. If you wanna know more about the hyaluronan water story, come join us in the dissection lab. It's a significant part of our journey into the matrix. Early bird registration is open until April 15th for fall of 2026 workshops. Just go to anatomyscapes.com/workshops. And for even more on the role hyaluronan might play in low back pain, check out one of our online courses, Understanding Fascia's Role in Low Back Pain, in the ABMP CE library. If you'd like to share your thoughts with us about this episode, please email us at info@anatomyscapes.com. Nicole and I would love to hear from you. That's all for now. I'm Rachelle Clauson.

 

0:22:43.7 NT: And I'm Nicole Trombley. Thank you for listening.

 

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