How Does Fascia Affect Our Pain and Mobility?

If you have musculoskeletal pain or mobility issues, you may have been told that your fascia is tight or that you have fascial adhesions. While this may be true, problems with fascia are most often the result of how we’re moving and using our body. In this article, you’ll learn:

  • What is fascia?
  • What is fascia made of?
  • The different types of fascia
  • Why do problems occur with fascia?
  • Why are there nerves in fascia, and what do they do?
  • How do we know if pain is caused by fascia or muscles?
  • Other ways to improve the health of fascia and reduce fascia-related pain

What is fascia?

Fascia is a type of connective tissue. It surrounds, separates, and supports everything in our body, including our organs, muscles, bones, joints, nerves, tendons, and ligaments.

Researchers don’t know everything about fascia yet, nor do they agree on a single definition. Several large groups of scholars have defined fascia in slightly different ways, and their definitions are discussed in this article. The broadest definition comes from the Fascia Nomenclature Committee:

“The fascial system consists of the three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissues that permeate the body. . .The fascial system interpenetrates and surrounds all organs, muscles, bones and nerve fibers, endowing the body with a functional structure, and providing an environment that enables all body systems to operate in an integrated manner.”

What is fascia made of?

Like other connective tissue, fascia is made mostly of collagen, the most abundant structural protein in the body. Fascia looks like a thin tissue, but it’s made of multiple layers of collagen. Between each layer is hyaluronan, better known as hyaluronic acid. Hyaluronan acts as a lubricant, allowing for smooth gliding between sublayers of fascia and between fascia and muscle.

Fascial adhesions

Fascial adhesions

The different types of fascia

Fascia is classified into different types based on its function and location in the body:

Superficial fascia: This layer of fascia is located right under the skin, separating the skin from the muscle below it. Superficial fascia insulates, stores fat, and surrounds blood vessels and nerves.

Deep fascia: This type of fascia is more dense and fibrous than superficial fascia. Deep fascia surrounds the bones, muscles, tendons, ligaments, and blood vessels. It connects and provides essential support for these moving parts of the body.

Neural fascia: Often grouped into the category of deep fascia, this includes the meningeal layers and the connective tissues that envelop the peripheral nerves.

Parietal fascia: Sometimes grouped into the category of deep fascia, parietal fascia lines body cavities such as the pelvis.

Visceral fascia: This type of fascia surrounds the organs in our thoracic and abdominal cavities. It supports the organs, such as the lungs, heart, and liver, and keeps them in place.

Why do problems occur with fascia?

Fascia responds to movement, becoming looser with more movement and tighter with less. So, lack of movement—a sedentary lifestyle—is one of the most common reasons that fascia becomes tight. Fascia also becomes thicker, drier, and stickier as it tightens, limiting movement and making movement less comfortable.

In a similar way, limited range of motion and poor posture can lead to fascia tightening. Even if you are very active, if your chronically tight muscles are pulling you into an unnatural posture or limiting your range of motion, fascia in certain areas of your body—the areas in which your muscles are tight and movement is limited—can become tight.

Repetitive movements that overwork certain areas of the body can cause fascia in those areas to become tight. This is partly because muscles in those areas become tight from the repetitive movements, limiting range of motion. In addition, repetitive strain on certain body parts may lead to fascial adhesions developing (see below).

Surgery or injury can cause immediate structural damage to fascia. If healthy movement is resumed after the trauma, fascia can heal successfully, and no lasting effect may be felt. But the more that movement is limited after the trauma, the more likely it is that fascia will heal in such a way that range of motion may be limited or pain may be felt.

Fascial adhesions are strands and sheets of fascia that stick to each other and/or to muscles, limiting movement and causing pain. They can occur as a result of any of the factors listed above: lack of movement, limited range of motion, repetitive movements, and trauma. In people who maintain a healthy level of activity, fascial adhesions are broken up and resorbed through movement. But a sedentary lifestyle allows adhesions to accumulate and worsen until range of motion and overall mobility is significantly restricted.

Adhesions limit the ability of the muscles to fully release and lengthen. Over time, they can cause muscles to become tighter and misalignment to develop simply because the muscles aren’t able to move through their full range of motion. However, it should be noted that most often fascial adhesions develop as a result of muscle tension and habitual body use, and not the other way around.

Why are there nerves in fascia, and what do they do?

There are many sensory nerve endings located in fascia. Some of these nerve endings, called proprioceptors, detect changes in body position and acceleration of parts of the body. This sensory information is then sent to the brain, helping to form our internal sense of our body position and movement: our proprioception. Since fascia is located throughout our body, surrounding every muscle, tendon, ligament, bone, and joint, it is a rich source of sensory information and plays an integral role in our sense of proprioception.

Nerve endings that send pain information to the brain, called nociceptors, are also present in fascia. It has been observed that there are more nociceptors in pathological fascia than in healthy fascia. In other words, as fascia becomes tighter, drier, and thicker, more nociceptors form, sending more pain information to the brain and increasing pain sensation. This makes sense from an evolutionary standpoint; our nervous system wants to make us aware that our fascia is becoming unhealthy due to lack of movement or trauma, so it increases the pain signals being sent to the brain.

Fascia is also densely innervated with a type of sensory nerve ending called mechanoreceptors, which detect touch, pressure, stretch, and vibration. Thermoreceptors, which detect changes in temperature, and chemoreceptors, which detect and respond to chemical stimuli, have also been found within fascial tissue. Other types of sensory nerve endings may be present in fascia as well. All of these sensory receptors contribute to our sense of the inner state of our body: our interoception.

How do we know if pain is caused by fascia or muscles?

Healthy fascia is soft and loose, and stretches as we move. It allows our muscles and joints to move freely and painlessly. Fascia can also absorb, store, and release kinetic energy, so it helps us move efficiently and powerfully. Since fascia is so integral to our ability to move, problems with fascia can often cause musculoskeletal pain.

But, chronically tight muscles result in the same symptoms as tight fascia: stiffness, limited range of motion, and pain. Why? Because the activity of our muscles and the fascia that surrounds them cannot be separated; they move together. Where our muscles are tight and our range of motion is limited, it’s likely that our fascia is tight as well, and vice versa.

In our daily practices of movement and self-care, we do not need to attempt to separate the activity or sensations of our muscles and fascia—we can treat them as one. They both loosen in response to movement and heat, and they both tighten in response to lack of use, overuse, and cold. They both can potentially heal well after surgery or injury, or develop scar tissue or adhesions that limit range of motion.

So, how do we know if pain is being caused by muscles or fascia? In many cases, it’s probably both.

One factor that causes increased pain in tight or injured muscle and fascia is pathological sprouting of nociceptors (the pain receptors described in previous section). This means that more nociceptors grow in response to the tissue being unhealthy. The more nociceptors we have, the more pain we feel.

Another factor that may be present in some cases of muscle and fascia pain is inflammation. Pro-inflammatory substances have been observed in both unhealthy muscle and fascia. These inflammatory substances activate nociceptors, causing pain.

Muscles that are chronically contracted are constantly using energy, and this process creates metabolic by-products. At least two of these, hydrogen ions and phosphates, can activate nociceptors and cause pain. When a muscle contracts and releases through its full range of motion and is not overused, these by-products don’t build up, and we don’t feel pain. It’s when muscles are fatigued during an intense workout or held in a state of chronic contraction that hydrogen ions and phosphates get a chance to build up, causing pain.

Sensitization of the nervous system also plays a role in both muscle and fascia pain. Sensitization describes changes that occur in both the central and peripheral nervous system when we feel pain for an extended period of time. Pain receptors become more sensitive, the spinal cord becomes more responsive to pain signals, and more neurons in the brain are recruited to respond to pain signals. Sensitization may affect muscles more than fascia, but researchers still have much to learn about fascia.

Other ways to improve the health of fascia and reduce fascia-related pain

We’ve established that movement is the best way to keep your fascia loose and healthy: stay active, keep your muscles loose, maintain proper posture and alignment, and avoid repetitive activities. But if your mobility is limited or chronic pain makes it difficult to stay active, what else can you do to improve the health of your fascia?

Fascia becomes looser in response to heat, just as muscles do. Research shows that a temperature increase in fascia of up to 104°F (40°C) causes fascia to become less stiff and to stretch more easily. And as expected, cooling fascia causes it to become more stiff.

We can produce the heat needed to loosen fascia ourselves, simply by moving. As our muscles move, they generate heat, which loosens the fascia that surrounds them. As both muscles and fascia become warmer, the muscles become less limited by any stiffness in the fascia, and range of motion increases.

When muscles are underused due to a sedentary lifestyle, muscle tissue gradually gets replaced by connective tissue. This limits movement and makes it harder to thoroughly warm up the connective tissue with movement. This can be the beginning of a vicious cycle in which fascia and other connective tissue becomes tight due to lack of movement, the tightness of the fascia then limits movement even further, and so on. Adhesive capsulitis (frozen shoulder) is one example of this cycle.

In situations such as this where a movement limitation or chronic pain prevents a person from warming up their own muscles and fascia through movement, external heat application can be very helpful. A heating pad, hot bath, or sauna are passive, accessible ways to heat up a specific area of the body or the entire body. Infrared light, which can be used in infrared saunas, panels, mats, body wraps, or hand-held devices, is proving to be an ideal source of heat. Infrared light penetrates into the muscle tissue and connective tissues, expanding blood vessels, increasing circulation, warming muscles and fascia, reducing pain and stiffness, and promoting healing processes.

Massage can also loosen fascia, albeit temporarily, just as massage temporarily loosens muscle tissue. This includes traditional styles of massage and myofascial release, both of which are performed by a trained therapist, and types of massage that you do to yourself (using a foam roller, rolling on a tennis ball, or using a hand-held massage tool).

Mechanoreceptors in fascia are responsive to manual pressure; so, pressure on fascia can lead to a temporary reduction in tension and increase in flexibility of the fascia.

But any pressure that is put on fascia is also unavoidably put on the muscle fibers that the fascia surrounds. Thus, any massage technique directed at the fascia is also massaging and temporarily loosening the muscle tissue below it.

If the massage is done fairly gently, then the muscles may feel relaxed and loose for a while afterward. This is due to a temporary reduction in gamma loop activity. Within 24 hours or less, the muscles will tighten back up as gamma loop activity returns to normal. If the massage is done quite deeply, stretching the muscles much farther than they can voluntarily lengthen, then the stretch reflex will be triggered quickly. You may feel muscle soreness, pain, or an increase in tension soon after a deep massage.

It is possible that you may be able to improve the flexibility and health of your fascia by practicing movement exercises (especially pandiculation!) right after gently massaging and/or externally warming a tight area, while the fascia and muscles in the area are still loose.* This could interrupt the cycle of fascia tightening and movement becoming more limited, as described above.

*Please note that most people do not need to take this approach when practicing Clinical Somatics exercises. I would only suggest using heat or gentle massage before practicing Clinical Somatics if you are dealing with a very tight area of your body that seems unresponsive to pandiculation on its own. If you do use heat or gentle massage to loosen an area of your body before practicing Clinical Somatics, be sure to practice your pandiculations extremely gently, as muscles can be more easily strained when they are in the temporary state of being abnormally loose.

In conclusion: How function affects structure

So, we’ve learned how the function of our muscles affects the structure of our fascia. When our muscles are contracting and releasing through their full range of motion, our posture and movement are in alignment, and we stay active with a variety of different activities, our fascia stays loose and healthy. But when we become sedentary, develop misaligned posture or movement patterns, or engage in repetitive activities, our fascia becomes tight and unhealthy.

We cannot consciously, voluntarily control the way our fascia moves, but we can control the way our muscles move. And when our muscles have become chronically tight or our posture and movement have become misaligned, we can use pandiculation to release our tight muscles and retrain our posture and movement patterns. As we do so, our fascia will adapt by becoming loose and healthy again.

While the health of our fascia is integral to our ability to move freely and without pain, don’t get sucked into the structural way of looking at your body, as convenient as it may seem. Tight, unhealthy fascia is typically just a symptom of improper body use and chronic muscle tension.

Attempting to treat tight fascia with various types of massage or massage tools will only yield temporary results. You must pandiculate your muscles and retrain your posture and movement patterns in order to address the underlying cause of your tight fascia and to maintain healthy fascia as you age.