Fascia - Rethinking the Missing Link
For years, fascia has been central to discussions about persistent pain, with many manual and movement therapists believing it holds the key to unlocking long term discomfort. The idea that pain can be traced back to fascial restrictions, and that treating fascia is the ‘missing link’ in traditional healthcare, has shaped many treatment approaches. It is an appealing notion. Fascia is everywhere in the body. It surrounds and connects muscles, organs and other structures, forming a continuous web that supports movement and stability. It plays a vital role in tissue communication, acting as a transport medium for fluids and chemical messengers. It is deeply involved in interoception, our internal sense of self that helps us feel what is happening inside us. Fascia also provides separation between tissues, creating a smooth, frictionless interface that allows movement to happen with ease
It seems logical to assume that if fascia becomes tight or stuck, it must be responsible for pain. But this idea is far too simple and, modern pain neuroscience questions this patho-anatomical perspective. Pain is not about structure. It is about perception, experience and context. Fascia certainly plays an important role in the body but despite its importance, fascia alone does not explain persistent pain.
The belief that fascia holds the answer to pain has led to a few common misunderstandings. One of the biggest is the idea that pain is caused by adhesions, restrictions or tightness in fascia. Often, the claim of fascia imposing 2,000lbs psi is quoted suggesting that this load influences pain sensitive structures. This quote comes from a 1961 journal paper describing the tensile strength of fascia to bursting point as 1.39 kg/mm2. This is equivalent to 6 x 23kg suitcases per cm squared that you take on holiday [1]. To stake the claim that fascia imposes this load on body tissues and is the reason why people have pain needs careful consideration.
- This paper is over 60 years old when studies were not as robust and it is 4 pages long.
- The tissue samples included the ilio-tibial band (ITB), the fascia cruris (FC) and the fascia lata (FL). These samples cannot represent the entire fascial network.
- The tested tissue was taken from 4 fresh cadavers of men and women in their 30’s. This is a very small sample size to stake a generalised claim.
- The research assess the tensile load and strength of these 3 tissue types. Load represents the maximal elongation of tissues, and the tensile strength is the bursting point of tissues past their maximum load.
- Tissue samples are placed in a clamp-like device and loaded until elongation no longer occurs (load) and until they burst (strength). This does not represent what occurs in the living human.
- The paper states that their results may be age related and that they have only considered cadavers in their 30’s in this test.
- The perpendicular tensile load of ITB samples measured only 1/12th of the load of parallel testing. This highlights the important functional characteristics of the ITB.
- The perpendicular tensile load of the FC and FL is approximately 1/3rd as strong as in parallel testing. This shows the diversity of fascia and that its tensile load and strength relates to its function and anatomical position.
- The tensile strength of the fasciae, the lower limb fascia in this case, measured at 1.39±0.14 kg/mm² (139kg/cm2) for the direction parallel to fibres. This represents a load applied along the fibre direction until maximum load occurred and the tissues eventually ripped apart. This is not what happens in the living human.
- According to the paper, the tensile load of the lower limb fasciae measures 15% of its tensile strength (15% x 139kg/cm2). This is 0.209kg/mm2 or 209g. It appears that fascial loading (lower limb) is only approximate to just over 2 large bars of chocolate.
Additionally, a 2021 study of skin’s ultimate tensile strength along Langer lines (lines of natural tension) by dynamic loading to bursting point had an average of 277.36 kg/cm2 at 1.5-2 m/s [2]. It appears that skin has a much higher tensile strength than fascia. If the suggestion is that fascia-related therapy stretches, releases or melts fascial restrictions, this applied load needs to get through the skin first which research suggests is almost twice as strong as fascia. Are our hands strong enough to move 12 suitcases all weighing 23kg per cm2? Considering that many fascial-related therapies discuss applying light touch techniques of about 5g or less of pressure, questions need to be asked.
Consider that fascia is supposed to adapt to load; that’s its job. Fascial adaptation occurs when the main cell in fascia, the fibroblast, changes to a myofibroblast providing contractility to the fascial structures (myo meaning muscle). But what causes this cellular change? Fascia doesn’t have the ability to make this decision all on its own. Fibroblasts must be given this direction by cell receptor communication. Recently, fascia research has identified adrenergic receptors on fibroblasts which stimulate the production of TGFbeta-1, an immune system cytokine. TGFbeta-1 causes fibroblasts to adapt to contractile myofibroblasts [3]. Going one stage further, what causes the release of adrenalin and noradrenaline in the body? It would seem that we need to look more at the stress response as this causes changes in fascia rather than blessing or blaming the fascia itself.
The most important aspect to consider when discussing fascia and pain is that pain does not live in the body. Pain and nociception are not the same thing. There are no pain nerves or pain-sensitive structures. The view that pain is caused by dysfunctional fascia ignores other contributors to pain, such as changes in the nervous system that heighten sensitivity. It also overlooks the role of the brain and spinal cord in modulating pain perception. Pain is never as simple as one structure causing a problem. It is shaped by biological, psychological and social factors that influence how we feel and respond to life events.
Pain neuroscience has come a long way in recent years, giving us a deeper understanding of why pain persists. One of the biggest shifts has been recognising that pain is not a direct measure of damage. It is something the brain constructs in response to different inputs, including real-time sensory signals, emotional states and past experiences. This is why no two people experience pain in the same way. Another key insight is central sensitisation. When the nervous system becomes overly sensitive, it can amplify pain even when there is no ongoing tissue damage. This means pain can persist long after an initial injury has healed.
At In-Touch Education and MFR UK, we take this knowledge seriously. We are mindful of new and emerging evidence on pain, what it is and, just as importantly, what it is not. This is why we teach Myofascial Release (MFR) from an evidence-based perspective, dispelling outdated myths and highlighting the positive influences this approach can have. MFR has often been explained in ways that do not align with modern science. The old stories of breaking down adhesions, melting fascia or releasing restrictions simply do not hold up under scrutiny. That does not mean MFR is not effective, but it does mean we need to understand why it works from a different angle.
Rather than seeing MFR as a way to mechanically change fascia, we now recognise its influence on interoception, the body's internal sense of itself. Touch can create meaningful changes in the nervous system, shifting attention, altering perception and reducing threat signals. This may explain why people feel profound relief after therapy even when no structural changes have occurred. MFR also plays a role in downregulating the nervous system, promoting relaxation and helping to interrupt cycles of persistent pain.
By integrating these modern insights into our teaching, we ensure that therapists are equipped with the latest understanding of pain and touch. We move beyond outdated narratives and offer approaches that are both practical and scientifically grounded. Pain is complex, but when we work with the nervous system rather than against it, we can make a real difference for people experiencing persistent pain.
If you are a therapist who wants to know the current evidence on fascia and MFR and you don’t want to learn outdated unsupported claims, train with In-Touch Education to get fascia facts, not fallacy.
