What Is Fascia Manipulation?

By Vanessa Caceres for U.S. News and World Report.

Fascia often can get injured. Here’s how it’s treated and who treats it.

You know about your muscles and bones, but do you know about fascia? Fascia is connective tissue that covers everything in your body, including your muscles, bones and nerves. It’s made up primarily of collagen (a type of protein in skin and connective tissues), and it has multiple layers: superficial, deep and visceral.

“Fascia helps to hold everything together and provides a smooth pathway for tissue to slide and glide,” says Sara Mikulsky, a physical therapist, certified personal trainer and owner of Wellness Physical Therapy in New York.

Normal fascia is easily flexible and helps your body move properly. However, fascia also can get injured or torn. This can happen by:

• A sports-related injury.During an injury, you may damage a muscle and the surrounding fascia. Or, you may just damage the fascia itself. A 2019 meta-analysis of studies of athletic-related strains in the Orthopaedic Journal of Sports Medicine found that only 12.7% were actual muscle injuries, while 32.1% were fascia-related injuries (the rest were tendon strains).
• Having scleroderma. This rare autoimmune disease can harden the skin and connective tissues, affecting mobility.
• Improper body positioning.Say that you worked for a long time in an office with an ergonomically correct chair and with a laptop positioned at the right height and eye level. Then, you had to start working from home for a long time period, where you were cramped in the kitchen, using a laptop mouse that doesn’t quite fit right and sitting in a kitchen chair instead of an office chair. “Your fascia can get sticky and tight, and you may feel some kind of pain,” says Denise Smith, a certified manual physical therapist, certified running technique specialist and owner of Smith Physical Therapy and Running Academy in Crystal Lake, Illinois.
• Misuse or overuse.This can happen from improper movement or form, leading to a fascia injury. One common misuse injury is called plantar fasciitis, which affects the plantar fascia on the bottom of the foot.
• A sedentary lifestyle.Fascia works best with regular movement. If you’re sitting most of the time without stretching or physical activity, you’re more likely to have tight fascia.

Once an ignored area, there’s an increased interest now in the role of fascia among bodywork providers, says acupuncturist and yoga teacher Tiffany Cruikshank, founder of the educational training system Yoga Medicine and a teacher with Yoga Medicine Online in Kirkland, Washington.

What Is Fascia Manipulation?

When you have pain or tightness in the body, you may seek help to treat it from a doctor, physical therapist or other bodywork professional. A trained professional can help pinpoint the cause of your pain.

As part of that work, you may have fascia manipulation, which refers to hands-on techniques that aim to improve the movement and the flexibility of the fascia, says physical therapist Diana Garrett, an outpatient rehabilitation supervisor at Providence Saint John’s Health Center’s Performance Therapy Center in Santa Monica, California.

There are different approaches to fascia manipulation, but they generally all have the same goal of improving movement and reducing pain. Some of those approaches include:

• Cupping. This is an ancient Chinese approach that creates suction on the skin with the use of cups. The practice is said to increase blood flow and stretch fascia. Olympic swimmer Michael Phelps was famously photographed with cupping marks on his back and arms at the 2016 Olympics.
• Myofascial release. This technique applies pressure on the fascia to help get rid of pain.
• Rolfing. This is a form of deep-tissue massage that aims to reorganize the fascia.

There is also a fascia treatment approach from Italy called Fascial Manipulation, researched by the Fascial Manipulation Association.

Practitioners who treat fascia may include:

• Acupuncture doctors: these are specialists in an ancient Chinese approach that reworks the body’s qi, or energy. Acupuncture doctors don’t specialize in fascia manipulation but usually are aware of how fascia works.
• Chiropractors
• Massage therapists
• Physical therapists

Before having fascia work done, your bodywork provider should ask first about your other health conditions. Fascia work is not recommended if you’re using blood-thinning medications because the fascia manipulation can potentially release dangerous blood clots in your body, Mikulsky says. You also should avoid fascia work if you have an open wound in the treatment area or you have weak bones or fractures.

During a treatment, the provider will assess any possible movement limitations associated with the fascia, Garrett says. Then, they will use their hands or special instruments to apply pressure to the fascia. This may take place for a few seconds or a few minutes depending on the extent of the injury and the type of injury. The provider also may use other approaches to treat the body, such as massage.

Sometimes, fascia manipulation can be uncomfortable or painful, especially if the fascia tension is deep and requires a lot of pressure, Mikulsky says. You may notice a decrease in pain and an increase in mobility after just one treatment. Other times, it takes several treatments depending on the injury itself.

Some side effects of fascia manipulation can include:

• Bruising
• Sensitivity
• Soreness
• Swelling

These side effects may last a few days, but they don’t happen in everyone. During that time, you also should start to notice a difference in mobility and pain in the area that was treated.

Is Fascia Manipulation Effective?

It’s hard to make a blanket statement about the effectiveness of fascial treatment because there are many approaches to it. A 2015 review of myofascial release clinical trials in the Journal of Bodywork and Movement Therapies reported that results were mixed but that there was encouraging evidence for its effectiveness. A 2017 trial published in the journal Spine that focused on nonspecific low back pain found that myofascial release helped reduce pain and disability.

Some people find fascia manipulation helps their pain and mobility. To be most effective, fascia manipulation should be supplemented with education on properly moving the body, muscle strengthening, flexibility exercises and better education on improving the posture, Garrett says.

Fascia Therapy at Home

It’s also possible to do some fascia work on your own, provided there’s not an injury that needs professional treatment. Some ways to take better care of fascia include:

• Using foam rollers.These rollers are commonly used now in sports, fitness and for self-myofascial release. There are videos online to explain how to use foam rollers, but it’s always best to ask a trained provider, such as a physical therapist, for more guidance, Smith says. That way, you find out how to use a foam roller for your specific body concerns. You also can use a tennis ball for fascia release.
• Yoga.The stretches held in yoga help keep the fascia flexible, Cruikshank says.
• Gentle massage.Massage performed by a partner can keep fascia healthy. “It helps keep the tissues moving,” Smith says.

If you have a specific injury or significant pain, see a health care provider experienced with fascia therapy instead of going the do-it-yourself route, Cruikshank cautions. You don’t want to end up self-treating something and making it worse.

Finding a Provider Who Offers Fascia Work

There are a few tips to keep in mind if you want to find a provider who treats fascia:

1. Read their bios and qualifications.See if they mention fascia experience and training, Cruikshank advises. If they don’t, ask them about their background treating fascia and their approach.
2. Don’t be afraid to try a different modality. One approach to fascia manipulation may work well for you while another approach may not. If you have the flexibility through your insurance or can afford it, try different approaches to find the one that fits best. “It can be like trying on shoes,” Cruikshank says.
3. Ask friends and family for recommendations. Find out about physical therapists or other bodywork providers who most effectively helped their patients’ injury or pain, Smith advises.