Understanding tissue glide sensation and myofascial care
Low back pain can affect how comfortably we sit, walk, bend and work. When it is described as “nonspecific”, this means that a particular disease or structural cause has not been identified to explain it. The pain is real, even when its source is difficult to pinpoint.
Fascia is one of the tissues researchers are investigating. Three papers by Casato and colleagues and Helene Langevin offer different perspectives on how fascial movement, sensory function and connections between body regions might contribute to back pain. Together, they encourage a broader assessment while leaving important questions unanswered.
Why the Thoracolumbar Fascia matters
The thoracolumbar fascia is a layered connective tissue structure in the back. It links with muscles and surrounding tissues, contributing to the transfer of forces during movement. Between its dense layers are looser connective tissue planes that allow relative movement, or glide.
Fascial tissues also contain sensory nerve endings, including fibres capable of signalling potentially harmful stimuli. Experimental research discussed in these papers suggests that fascia can contribute to pain, particularly when sensitised or inflamed.
This makes fascia a plausible contributor to low back symptoms. It does not mean that every painful back has damaged or restricted fascia, or that fascia explains the whole experience of pain.
What imaging tells us about tissue glide
In 2011, Langevin and colleagues studied 121 people: 71 with low back pain lasting more than a year and 50 without low back pain. They used ultrasound during controlled passive trunk movement to measure deformation between layers of the thoracolumbar fascia, called shear strain.
On average, this measure was approximately 20% lower in the back pain group. The finding suggests that fascial layers moved differently in people with chronic symptoms.
However, the study could not establish whether reduced glide preceded the pain, developed because of altered movement, or reflected a combination of factors. Within the pain group, shear strain did not significantly correlate with pain intensity or disability scores.
The distinction matters. A measurable tissue difference can help guide research without becoming a test that explains an individual’s pain. This study also did not test whether myofascial treatment restores glide or reduces symptoms.
Can treatment away from the back influence symptoms
Casato, Stecco and Busin’s 2019 paper, Role of fasciae in nonspecific low back pain, explored a different question. The authors described five people treated using the Fascial Manipulation® approach at selected points in the limbs rather than directly over the painful lower back.
All five eventually reported an immediate reduction of at least two points on a numerical pain scale following treatment. Four showed this from the first session; one did so at the third session. Follow-up outcomes varied: three maintained complete symptom and disability resolution, one retained part of the improvement and one relapsed.
These observations are interesting, but the study had only five participants and no comparison group. It could not separate treatment effects from natural recovery, expectations or other influences, nor demonstrate that a remote fascial restriction caused the back pain. Temporary local numbness and, in two cases, increased pain were also reported.
The paper studied a particular technique. Its findings should not be treated as proof for every approach called myofascial release.
Fascia and our sense of movement
Langevin’s 2021 review, Fascia Mobility, Proprioception, and Myofascial Pain, considered how tissue mechanics might interact with sensory information.
Proprioception is our sense of body position and movement. The review proposes that movement between fascial layers may influence sensory signals and musculoskeletal function. It also stresses how much remains unknown about these relationships.
Importantly, limited mobility is not the only issue worth considering. People with very mobile connective tissues can also experience pain and difficulties with body awareness. Increasing flexibility is therefore not an appropriate universal goal. Treatment needs to reflect the individual’s movement, health history and tissue characteristics.
What this means for Myofascial care
For me, these papers support curiosity about the person’s movement rather than an assumption that one painful spot contains the entire problem. It may be useful to assess how the hips, trunk and other relevant regions participate in a task, then review whether treatment makes that task more comfortable.
A broader assessment does not mean searching for a distant restriction and declaring it the root cause. Anatomical continuity provides a reason to investigate relationships between regions; it does not prove a particular chain of causation.
Likewise, a change in symptoms after hands-on treatment does not reveal exactly what changed biologically. These papers do not establish that treatment breaks adhesions, reverses fascial “densification” or permanently remodels tissue. Sensory processing and the experience of care may also contribute.
A useful clinical approach is to agree on a meaningful goal, observe the person’s response and connect any improvement with movement. If bending or walking feels easier after a session, the next question is whether that change helps with daily activity and persists beyond the appointment. Exercise and rehabilitation can be coordinated with appropriately qualified practitioners where needed.
A useful contribution to a complex picture
Fascia deserves attention in low back pain research because it has mechanical and sensory roles. These papers provide evidence of altered tissue movement and preliminary observations about treatment, alongside hypotheses that need stronger testing.
Their practical value is to encourage careful, individualised care. Myofascial treatment can be considered within that process, with outcomes judged by comfort, function and participation in everyday life. Understanding fascia can broaden our thinking while keeping the person’s experience at the centre of care.
References
Casato G, Stecco C and Busin R (2019). Role of fasciae in nonspecific low back pain. European Journal of Translational Myology, 29(3), 8330. https://doi.org/10.4081/ejtm.2019.8330
Langevin HM and colleagues (2011). Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskeletal Disorders, 12, 203. https://doi.org/10.1186/1471-2474-12-203
Langevin HM (2021). Fascia mobility, proprioception, and myofascial pain. Life, 11(7), 668. https://doi.org/10.3390/life11070668
For further information or to discuss any additional questions, please contact Muscle Medicine today or arrange a consultation with one of our experienced therapists. Muscle Medicine is located in beautiful Double Bay, Sydney. Feel free to contact us on 02 9252 9140 or book online.
Frequently asked questions
Can fascia cause low back pain?
Fascia is one of the tissues researchers are investigating. It has mechanical and sensory roles, including nerve endings that can signal potentially harmful stimuli, which makes it a plausible contributor. It doesn’t mean every painful back has damaged or restricted fascia, or that fascia explains the whole experience of pain.
What does “nonspecific” low back pain mean?
It means a particular disease or structural cause hasn’t been identified to explain the pain. The pain is real, even when its source is difficult to pinpoint.
What is the thoracolumbar fascia?
It’s a layered connective tissue structure in the back that links with muscles and surrounding tissues and contributes to the transfer of forces during movement. Looser planes between its dense layers allow the layers to glide relative to each other.
Does research show myofascial treatment fixes back pain?
No. The papers discussed here don’t show that treatment breaks adhesions, reverses fascial densification or permanently remodels tissue. One small report of five people had no comparison group, so it can’t separate treatment effects from other influences.
When should I see a GP about back pain?
See your GP promptly for back pain after an injury, or with fever, numbness or weakness in the legs, or any change in bladder or bowel control.
What happens at a first appointment at Muscle Medicine?
You’ll have a short assessment of how you move, agree a meaningful goal, and receive massage tailored to that goal, then a recommendation for follow-up. You can choose your therapist.