What a systematic review tells us about combining hands-on care with movement
When back pain persists, movement can become uncomfortable and everyday tasks can feel harder. Myofascial release may have a useful role alongside exercise for some people, particularly when the aim is to improve comfort and function.
A systematic review by Pirunthaban Narenthiran, Isabelle Granville Smith and Frances Williams, published in the Journal of Bodywork & Movement Therapies in 2025, examined whether adding manual therapy to exercise improves outcomes for chronic low back pain. Its findings offer an encouraging, but measured, perspective on myofascial release as part of rehabilitation.
The question behind the review
The researchers reviewed ten randomised controlled trials involving adults with low back pain lasting more than three months. These studies compared exercise with exercise plus manual therapy, sometimes using a sham treatment in the comparison group.
The hands-on approaches varied, including massage, spinal manipulation, muscle energy techniques, soft tissue mobilisation and myofascial release. Eight trials reported an additional benefit in at least one measured outcome; two did not. Because only two trials specifically examined myofascial release, the overall findings cannot all be attributed to MFR.
The most relevant question for this blog is therefore whether MFR contributed something useful when added to an exercise programme.
What the myofascial release studies found
In a trial by Ajimsha and colleagues, 80 nursing professionals with chronic low back pain received either MFR plus specific back exercises or sham MFR plus the same exercises. Treatment involved 24 sessions over eight weeks.
The MFR group reported greater improvements in pain and disability. At eight weeks, pain scores had fallen by approximately 53% from baseline in the MFR group, compared with 26% in the sham group. Disability scores fell by approximately 30% and 10%, respectively. Benefits were also reported at the 12-week assessment.
These are changes within each group, not a promise that an individual will experience the same improvement. The treatment schedule and the particular population also matter when applying the findings to routine care.
A second trial, by Ozsoy and colleagues, examined MFR added to core stabilisation exercises in older adults. Both groups improved. Adding MFR produced greater gains in spinal mobility and core endurance, but did not produce a statistically significant additional improvement in pain or disability.
Taken together, the trials suggest potential benefits, with different outcomes in different groups. They do not establish that MFR consistently improves every aspect of persistent back pain.
How this fits with a myofascial approach
Myofascial release is an umbrella term for hands-on techniques directed at muscles and associated connective tissues. Approaches differ in pressure, duration and application, so research using one protocol does not automatically validate every method described as MFR.
For me, the clinical value of a myofascial approach lies in careful assessment and attention to the person’s response. Changes in comfort or movement can be useful, but they do not prove that fascia was the sole source of pain or that treatment permanently altered its structure.
The review discusses several possible explanations for manual therapy effects, including changes in sensory processing and the experience of therapeutic touch. It did not directly establish which mechanisms produced the reported improvements. We can recognise a helpful outcome while remaining open about how it occurred.
Connecting treatment with meaningful movement
The evidence examined MFR alongside exercise. This makes the connection between hands-on treatment and active rehabilitation central to its practical interpretation.
My interpretation is that an improvement in comfort may create an opportunity to practise movement more confidently. That is a clinical possibility, rather than a pathway these trials proved. It should be assessed against what matters to the person: walking, bending, working, exercising or managing daily tasks.
For example, if someone finds bending uncomfortable, a useful review after treatment would include whether bending feels easier and whether that change helps them participate in their movement programme. Feeling different on the treatment table is only one part of the outcome.
A coordinated plan can connect a massage therapist’s hands-on care with exercise guidance from an appropriately qualified practitioner. The aim is to make any short-term improvement useful in everyday life and to review whether the combined approach is helping.
Keeping the evidence in perspective
The review summarised varied treatments and exercise programmes rather than providing one pooled estimate of MFR’s effect. Its search ended in November 2022, and only two included trials addressed MFR. Long-term benefits remain uncertain.
The findings support considering MFR as an adjunct for selected people with persistent low back pain. They do not identify a reliable test for who will benefit, establish an ideal treatment schedule or show that MFR is superior to other hands-on approaches.
This is a useful direction for myofascial practice: connect treatment with movement, measure meaningful changes and adjust care to the individual. Further research can help clarify when MFR adds value and how that value can be sustained.
References
Narenthiran P, Granville Smith I and Williams FMK (2025). Does the addition of manual therapy to exercise therapy improve pain and disability outcomes in chronic low back pain: A systematic review. Journal of Bodywork & Movement Therapies, 42, 146–152. https://doi.org/10.1016/j.jbmt.2024.12.004
Ajimsha MS, Daniel B and Chithra S (2014). Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. Journal of Bodywork & Movement Therapies, 18(2), 273–281. https://doi.org/10.1016/j.jbmt.2013.05.007
Ozsoy G and colleagues (2019). The effects of myofascial release technique combined with core stabilization exercise in elderly with non-specific low back pain: A randomized controlled, single-blind study. Clinical Interventions in Aging, 14, 1729–1740. https://doi.org/10.2147/CIA.S223905
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
Does myofascial release help chronic low back pain?
The evidence is encouraging but limited. In one trial of 80 nursing professionals, myofascial release plus exercises led to greater improvements in pain and disability than sham treatment plus the same exercises. In a second trial in older adults, adding it improved spinal mobility and core endurance but not pain or disability significantly. Results can’t be assumed for every person or every technique.
What is myofascial release?
It’s an umbrella term for hands-on techniques directed at muscles and associated connective tissues. Approaches differ in pressure, duration and application, so research using one protocol doesn’t automatically apply to every method.
Should myofascial release be combined with exercise?
The research looked at myofascial release alongside exercise, so the practical reading is to connect hands-on care with active rehabilitation, coordinated with an appropriately qualified practitioner where needed.
Does myofascial release permanently change fascia?
That hasn’t been established. A change in comfort or movement after treatment doesn’t prove fascia was the sole source of pain, or that treatment permanently altered its structure.
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.