Manipulation, mobilization, nutrition, and exercise therapy are an essential part of my treatment, but I couple it with the intention not only to create freedom from joint restrictions, but release fascial problems as well. This method can allow patients to restore lost range of motion and improve movement function to have less pain and feel more youthful. Therefore, I talk fascia!
Fascia can respond to mechanical stimuli, as it is a continuous and interconnected structure that surrounds and integrates tissues and structures of the body. Fascia can refer to dense planar fascial sheets (such as the fascia lata), as well as joint capsules, organ capsules, muscular septa, ligaments, retinacula, aponeuroses, tendons, myofascia, neurofascia, and other fibrous collagenous tissues.
Fascia performs multiple functions and can affect relationships in posture, shock absorption, flexibility, ease of movement, pain, comfort, energy, strength, and well-being. You see why targeting fascia is a priority for me and my patients – and should be for you.1,5
It’s easy for muscles to become imbalanced from repetitive poor posture, e.g., slumped sitting, asymmetrical sitting or sports activities (cycling, swimming, overdoing bench press and biceps curls). Repetitive poor posture changes the length of muscles. It also changes facial movements, which then can cause increased viscosity (density) of the fascia itself.
Bordoni, et al., propose that reduced fascial sliding may alter collagen fiber orientation and promote collagen deposition, contributing to inflammatory change and abnormal mechanical tension in the extracellular matrix.2
I appreciate the importance of proper fascial gliding. Disruption would lessen the normal feedback to the CNS and muscle incoordination would occur – and continue to be perpetuated.
Muscle overactivity can result in increased fibroblast activity (greater collagen deposition). Thick, dense tissue that is stiff may be fascia with diminished sliding, and can be responsible for many conditions we treat: neck pain, back pain, hip pain, knee pain, shoulder pain, etc.
Helen Langevin, MD, did an ultrasound study showing that people with chronic or recurrent low back pain compared to no low back pain had 25% greater perimuscular thickness and echogenicity.3
In Anatomy Trains, author Tom Meyers describes scar tissue as a source of fascial restriction and altered load transmission within the myofascial system.4 I find scars can alter tissue stiffness, gliding, and mechanobiology, which may help explain pain and restriction.
Over my entire career (44+ years), I’ve embraced the notion that when there is a vertebral or extremity-joint subluxation or blockage, manual therapy coupled with soft-tissue therapy (now trending as fascial therapy) enhances the overall treatment.
Fascia is a collagen‑ and elastin‑rich tissue that combines tensile strength with elasticity and possesses its own contractile behavior. When muscle activity begins, mechanoreceptors such as muscle spindles relay rapid feedback to the central nervous system, and this requires fascia with healthy viscosity so that spindle cells, Pacini, and Ruffini receptors can deform and glide normally.1
Immobilization reduces interfibrillar mobility through loss of water and glycosaminoglycans, and promotes abnormal collagen cross-linking, contributing to increased passive stiffness and the clinical sense of tissue ‘“ticking.”4 On examination I perform passive range of motion with my patients and if I detect passive resistance to that movement, I ask the patient where they feel tension or “sticking,” and then I palpate that area. I often perceive this area as dense or fibrotic tissue.
In addition, fascia is not purely passive: Fibroblast and myofibroblast activity, including TGF-β1-associated contractile responses, may contribute to increased fascial tone, reduced range of motion and pain.1
We have many modalities that can help release dense fascia, such as laser, TECAR, vibration / percussion, and shockwave. But more important to me than devices is proper movement exercise for fascial stretching. The devices can help decrease hypersensitivity and help the sensory response to normalize. Mobilization and manipulation can improve joint and fascia pliability. Slow, deep soft-tissue work allows fascia to flatten out and induce glide. But slow, long stretches enhance movement and allow the brain to know it is safe to have that length again.
References
- Stecco C, Adstrum S, Hedley G, et al. Update on fascial nomenclature. J Bodyw Mov Ther, 2018;22:354.
- Bordoni B, Simonelli M, Morabito B. The fascial breath. Cureus, 2019;11(7):e5208.
- Langevin HM, Fox JR, Koptiuch C, et al. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic or recurrent low back pain. BMC Musculoskel Disord, 2009;10:151.
- Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 4th Edition. Edinburgh: Elsevier; 2020.
- Colonna S, Casacci F. Myofascial system and physical exercise: a narrative review on stiffening (part II). Cureus, 2024 Dec 24;16(12): e76295.
Editor’s Note: Look for a follow-up article on the topic of fascia from Dr. Tucker in the September issue: “Scars Are Fascia Events, Not Just Skin Events.”
