Fascinated with fascia treatments? It’s time to face the facts

08/10/2019

Soreness, tightness, inflexibility – lately they’re often blamed on fascia, the thin layers of connective tissues that surround your muscles and organs.

Treatments for tight fascia have sprung up, purporting to reduce pain and increase mobility through techniques like massage, or even help you get rid of cellulite.

But does treating your fascia help with these problems? Probably not, experts say.

“When someone continually goes back every week to treat their fascia, there’s absolutely no evidence,” said Jackie Sadi, acting director of Western University’s school of physical therapy and a clinical specialist in musculoskeletal therapy.

All about fascia

Fascia is a type of connective tissue found throughout your body.

“Picture cellophane covering your meat,” Sadi said. “It’s that interconnected to our tissues.

“Fascia is an intermediary between muscle and another muscle. It’s on top of muscle. It’s on top of organs to protect it, between muscle and organs. So it’s a real passive structure. It in itself doesn’t move — it’s a covering.”

Some types of fascia help separate muscles and organs from each other or help muscles slide over each other more easily, or is even found within the muscle layers themselves, said Mark Driscoll, an assistant professor in biomechanical engineering at McGill University who studies the tissue as part of the Fascia Research Society.

Fascia injury

People’s habits might modify their fascia, Driscoll said.

“It would remodel based on mechanical demand,” he said.

If you don’t move much, he said, it’s possible that your fascia will reflect that, and overuse might also affect it.

People also might harm their fascia through trauma — like if they get hit with a hockey puck and bruised, Sadi said, though in those cases their muscles and skin would be hurt, too. Surgery and scarring can also modify the fascia, along with the surrounding tissue, as can severe burns and a handful of diseases.

But blaming fascia for more ordinary pain problems or stiffness is hard, she said, partly because it’s so closely connected to everything else.

“You can tell there’s a loss of range or some stiffness, but you can’t say it’s just the fascia or singularly just the tendon or one single muscle. You can say it’s all those things together.”

The most common type of injury involving fascia, Sadi said, is plantar fasciitis — a condition characterized by heel pain resulting from overuse of your feet.

“As we either get older or we’ve done a lot of loading through our foot, where that fascia attaches to the bone on the bottom of the heel, that can get really sore and irritated.”

But even then, it’s not just the fascia in your foot that’s injured, she explained, it’s also the muscles and tendons that attach to it. Treatment involves targeting the whole area.

“We know that heel raises and exercising through the foot has been shown to be successful in the research,” she said.

Fixing your fascia

So can you “fix” your fascia? That’s hard to say, according to both Driscoll and Sadi, as it’s connected so closely with everything around it that it’s hard to prove you’re doing anything to the fascia, as opposed to the muscle underneath.

“It’s quite difficult to say that you’re treating the fascia, because it would be like if I put cellophane really tightly around packaged meat,” Sadi said. “Saying, ‘I’m just moving the cellophane,’ without moving the meat below it would be really hard.”

A 2012 review of “myofascial release” techniques found that most studies were of poor quality, and “few conclusions” could be drawn about myofascial release therapy.

A consensus statement from researchers published in the British Journal of Sports Medicine said that injuries to fascia can affect sports performance and may contribute to chronic problems like lower back pain. But, the authors concluded, “while commercial and other interests often favour the promotion of premature positive conclusions about specific fascia-related treatments, strict application of scientific rigour is essential for the development of this promising field.”

Driscoll said the research points to a “potential” to modify fascia, but he didn’t want to say much more.

“We’re trying to remain as scientifically accurate as possible. But then you have the fitness and rehab industries and optimistic people who take it further, who often point to a paper and claim you can cure cellulite,” he said.

“There are fascia blaster devices for cellulite, but it’s a load of — I don’t want to swear — but there’s a lot of stuff out there that you have to be careful about in this field.”

The pain relief and extra flexibility you might gain from massage or foam rollers is real, but won’t last, he said.

“How often you have to actually do it to sustain that increase has not yet been proven.”

Massage has its place and can help short-term, Sadi said.

“If you’re going for a massage and you’re thinking that it’s just going to help relax you, great. But when you name something and you tell somebody, ‘Oh, your fascia’s really tight,’ now you’re making a claim that would be almost impossible to state.”

While some people might indeed have tightness, she said, it could be due to any number of things, including just age or genetics.

“Some people are born flexible, some are born a little stiff and that’s our architecture. So to try and change some of that is a lot greater than just working the fascia.”

She worries that some people might be told they have a problem with tight fascia and focus too hard on treating it, rather than simply exercising and moving more — which she believes could have much more benefit in terms of flexibility and pain relief.

When it comes to fascia-targeted treatment, she said, it’s “buyer beware.”

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