The connective tissue woven throughout your body is literally what keeps you together, and taking good care of it can help ease a lot of aches and pains. Here’s what you need to know.
BY MERYL DAVIDS LANDAU
Originally published in Prevention Magazine for February 2023
Erin Scott, a 43-year-old paralegal in Baltimore, was pleased when her Stage II breast cancer went into remission thanks to chemo, two surgeries, and radiation. But the treatments left her with a common post-surgical inflammation known as frozen shoulder: Erin felt such severe stiffness in her left arm that she couldn’t reach for a glass in the cabinet or put her coat on. Sometimes when her husband playfully grabbed her arm, she’d feel a sharp sting of pain. Massage, acupuncture, chiropractic, and physical therapy improved her pain and stiffness only slightly.
Frustrated, Erin finally turned to a different kind of practitioner, one who specialized in working the fascia, a spiderweb of connective tissue found throughout the body. During her monthly one-hour treatments, Erin’s therapist applied pressure not just to her shoulder but also to her leg, her lower back, and other seemingly unrelated spots. Soon after the first session, Erin had more range of motion in her shoulder, and after a few more she could move her arm freely again. “More than a year of other treatments gave me only incremental improvements, but this worked really fast,” Erin says.
Most of us know a bit about bones, joints, organs, muscles, and nerves, but we may not have considered how it all stays together. The fascia is the answer.
The fascia (pronounced like “fashion”) is a string of fibrous proteins (mostly collagen) that weaves its way throughout the body and binds everything in place, explains Tom Myers, a longtime bodywork therapist and the author of Anatomy Trains. Think of the fascia as Spanx you wear under your skin, pulling everything in toward your skeleton. Without the fascial netting, fluid would gather at your feet, your organs would sag and slosh together, and your muscles would be like hamburger, making coordinated movement impossible.
The term “fascia” was once used to describe a specific type of connective tissue, such as the bands at the bottoms of our feet. (When these are inflamed, it’s known as plantar fasciitis.) Now, though, much of our connective tissue—including tendons, ligaments, and that surrounding muscles and organs—is included in the fascial system. Some fasciae are thin, such as the pericardium (which surrounds the heart), while others, like the tough iliotibial (IT) band along the side of the thigh, are thicker.
And your fascia does more than hold you together—it plays a crucial role in many aspects of health, says Gil Hedley, Ph.D., an anatomy educator and a fascia researcher who is based in Colorado Springs. He says that fascia is not inert (as was once believed) but biologically and neurologically active, helping you perceive where your body is at a given moment—something scientists call proprioception—so your foot lands where it should when you walk, or so you hit the chair when you sit down. And while experts have long understood that our muscles contract when we lift a bag of groceries or go for a run, they now know that fascia doesn’t just support the muscles—the fasciae actively contract too. Keeping your fascia supple is as important as keeping your muscles toned. (See “Things Your Fascia Adores.”)
Another newly discovered fact about fascia: It is the body’s richest sensory organ, relaying a range of sensations from pain to pleasure. The fascial system has 10 times as many sensory receptors as the muscles have, Myers says. “Many properties that we ascribe to muscles actually come from the fascia woven in and around the muscle. After we exercise we say we feel ‘sore muscles,’ but what we’re actually feeling is an irritant released from the fascial fabric,” he says.
All this makes these tissues essential to any conversation about pain. Because all fascia is connected inside the body, when something is out of sync in one spot, that can cause problems in seemingly unrelated areas, says Hedley. If you walk with your pelvis tipped slightly forward, for example, or tilt your ankle a pinch because of an old sprain, that can tug at fascia in your back and cause pain there, he says.
THINGS YOUR FASCIA ADORES
The fascia has a good deal of collagen like your skin does, so drinking a lot of water to stay hydrated keeps it healthier. “You want your fascia to be slippery, not sticky,” Hedley says.
The fascia becomes more elastic with rhythmic exercise like walking or running, Myers says. Long, slow stretches also help, as they lengthen tissue that is too short.
3 STAYING LOOSE
Rolling body parts over balls or rollers relieves fascial tension, Miller says. Her book The Roll Model uses soft balls; other programs use harder balls or foam rollers.
The fascia is involved in lots of conditions—pain after surgery, for example. Because all scar tissue is tightly bound up fascia, Myers says, you can lessen restriction and pain through massage and by moving that body part after an operation rather than protecting it excessively, he says. Urinary incontinence involves the fascia too: When Brazilian researchers examined hundreds of women with the condition, they found that half had dysfunction in their pelvic fascia, which can put extra pressure on the bladder.
Myers says that the way we typically give birth can often leave distortions in pelvic fascia that are hard to fix through exercise alone; he recommends working with a bodyworker specializing in perinatal techniques (see “How to Find a Fascia-Focused Practitioner”) to help realign it. Even colds and flu have a fascial component—if the fascia in the chest is tight, it can be harder to breathe, says Jill Miller, a longtime fascia bodyworker and the author of Body by Breath.
OTHER CONDITIONS IN WHICH THE FASCIA PLAYS A STARRING ROLE:
CHRONIC LOWER-BACK PAIN Weakened fascia, not just poor muscle tone, is often behind back pain, Hedley says. Sometimes the misalignment is in the fascia near the ankles and hips, he says, which pulls everything off balance. Fascia practitioners use their hands along with tools like balls and rollers to shift fasciae toward their optimal tone and texture. Adding this to traditional physical therapy significantly reduced disability caused by lower-back pain, Chinese researchers reported in Complementary Therapies in Medicine.
PELVIC PAIN Fasciae abound in the pelvis, says Sallie Sarrel, a doctor of physical therapy in Hoboken, NJ, and Miami. What’s more, she says, all the fascial lines in the body ultimately run through the pelvis, so misaligned fascia anywhere can contribute to pelvic pain. If you see a fascia bodyworker, they will examine your alignment and range of motion and create a program of fascial manipulation and exercises you can do at home, Sarrel says. Some practitioners also use a transvaginal “myofascial trigger point wand,” so be sure to talk to your practitioner about what you feel comfortable with, she advises.
HEADACHES A common cause of tension headache is staring at screens—this action pitches the head forward slightly, possibly inflaming fascia in the neck. A more serious type of headache known as occipital neuralgia also has a fascial component, as Harvard researchers found when they examined patients undergoing surgery for this condition and found that most had thick, scarred neck fascia. Try this for tension headaches: Roll a soft ball around the back of your neck and on your chest, ribs, and jaw—all connected by fascia to the head, says Miller. To prevent screen-related headaches, raise your computer to eye level and lift your phone to your eyes to text or read.
HOW TO FIND A FASCIA-FOCUSED PRACTITIONER
Body work hat focuses on the fascia goes by a few names, including Structural Integration, Myofascial Release, and Rolfing. You can find practitioners through the International Association of Structural Integrators (theiasi.net) or the Dr. Ida Rolf Institute (rolf.org), named for the woman who pioneered fascial treatment a century ago. Some physical therapists, massage therapists, and osteopathic doctors also focus on the fascia. Therapists’ approaches can differ. Some treat just a specific problem, but others, especially Rolfing structural integrators, address the whole body over a series of sessions. Ask about their experience with problems like yours.
TAKE GOOD CARE OF YOUR BODY