Fascial Manipulation Method Is Effective in the Treatment of Myofascial Pain, but the Treatment Protocol Matters: A Randomised Control Trial—Preliminary Report

Therapeutic mechanisms of fascia manipulation: A scoping review

BackgroundFascia manipulation is gaining attention due to their potential benefits in pain management, neuromuscular function, and tissue healing. However, the mechanisms underlying these effects remain unclear, limiting treatment optimization.ObjectivesThis scoping review (ScR) aimed to summarize current evidence on the physiological, structural, and neuromuscular mechanisms underlying fascia manipulation as a therapeutic intervention.MethodsThis ScR followed the Joanna Briggs Institute guidance. A comprehensive search of MEDLINE, Web of Science, CINAHL, Cochrane Central, EMBASE, Scopus, PEDro, ClinicalTrials.gov, and ICTRP was conducted in January 2025. Two independent reviewers selected studies and extracted data. Two independent reviewers selected studies and extracted data.ResultsEleven studies were included: eight on humans and three on animals. In humans, manual therapy triggered a transient local inflammatory response, raising temperature without activating coagulation or thrombosis risk. It also reduced unbound water in deep fascia, aiding pain relief and mobility. Animal studies showed anti-inflammatory effects via cytokine regulation and adenosine receptor involvement, with caffeine blocking pain relief. Massage-like stroking produced opioid-independent analgesia. Fascia manipulation relieved pain from densification and improved proprioception. Neuromusculary, it enhanced reaction time, movement efficiency, and motor performance, lasting up to a week.ConclusionsThis ScR suggests that fascia manipulation exerts its therapeutic effects through a combination of anti-inflammatory cytokine modulation, mechanoreceptor stimulation, and improvement in fascial gliding and proprioceptive feedback. These mechanisms collectively support its role in pain relief and neuromuscular function. Further research using standardized protocols and objective outcome measures is needed to validate and expand upon these findings.

The effects of fascial manipulation on pain: a systematic review with meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to summarize the effects of fascial manipulation (FM) on pain alleviation in adults, providing valuable insights for future research and practitioners by addressing a significant gap in the existing literature.

METHODS

Systematic review with meta-analysis. Key databases, including PubMed, Scopus, and Web of Science, were searched for relevant studies. The eligibility criteria required randomized clinical trials involving adults (>18 years) with musculoskeletal pain, who participated in FM, and included either true control or active control groups as comparators. To assess the risk of bias, the PEDro scale was used, while the certainty of the evidence was evaluated using the GRADE scale. Out of the initial pool of 138 studies, 15 were determined to be eligible for inclusion in this systematic review.

RESULTS

Results showed significant favoring effect for the FM compared to the active-control group in pain-related outcomes (ES = -0.80, 95% CI -1.30 to -0.29, p = 0.002, I2  = 85%). The certainty of evidence, as determined by the GRADE assessment, was rated as very low.

CONCLUSIONS

Although the included studies provide evidence of very low certainty - given the small sample sizes, lack of blinding, and significant limitations in the intervention - the meta-analysis suggests that FM may potentially be beneficial in reducing pain associated with various musculoskeletal conditions. However, more robust research is needed to strengthen these findings, with a focus on increasing the number of blinded studies, reducing methodological heterogeneity, and further exploring the underlying mechanisms that may explain the observed trends in the evidence.

Fascial manipulation for musculoskeletal disorders: A scoping review

OBJECTIVE

To synthesize the available literature on myofascial manipulation interventions and adverse events to assess the knowledge gaps and select adaptations to determine the optimal approach.

METHODS

PubMed, CINAHL, Web of Science, Embase, MEDLINE, and the Physiotherapy Evidence Database were searched from inception to December 11, 2022. This review included patients with musculoskeletal disorders, pain, and dysfunction. Outcome measures included pain and disability. Studies that were interventional trials, observational studies, or case reports, with no restrictions on the region, race, sex, or language of the original paper were included. Author names, year of publication, title, purpose, review question, diseases covered, adverse events, journal type, subjects, disease stage, pain, and functional impairment ratings were summarized using Microsoft Excel.

RESULTS

A total of 4645 titles and abstracts were retrieved from the database. Twenty-six studies meeting the inclusion criteria were included in this scoping review. Fascial manipulation studies often have pain as an outcome, are commonly performed in Italy and India, and target the chronic phase of the disease. No serious adverse events were observed.

CONCLUSION

Research on fascial manipulation is gradually increasing but is still scarce. It is expected that more randomised controlled trials will be conducted in the future to compare the results with those of other manual and exercise therapies and to elucidate the underlying mechanism.

Do the fasciae of the soleus have a role in plantar fasciitis?

Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.

Effectiveness of Deep Cervical Fascial Manipulation® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial

BACKGROUND

This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP).

METHOD

Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken.

RESULTS

A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up.

CONCLUSION

FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Effects of fasciatherapy versus fascial manipulation on pain, range of motion and function in patients with chronic neck pain

BACKGROUND

Neck pain is among the common musculoskeletal problem that hinders a person's daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion.

OBJECTIVE

The purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain.

METHODS

A randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18-40 years with chronic neck pain of at least 3-6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied.

RESULTS

The mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p < 0.05). At the same time, the pair-wise comparison showed significant results (p < 0.05) for all outcome measures in both groups.

CONCLUSION

DBM fascia therapy improved cervical extension and side bending (right) more than the fascial manipulation group.It is concluded that DBM fascia therapy shows more improvement as compared to other group.

TRIAL REGISTRATION NUMBER

This study was registered at ClinicalTrials.gov ID: NCT05272111 on 09/03/2022.

Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease

Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results.