Can Fascia Massage Relieve Pain?

According to the Fascia Research Congress, fascia refers to “a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs” (2). More simply, fasciae are soft tissue sheaths that surround muscles and separate them from their surroundings. They’re made of collagen, the same material that makes up ligaments and tendons. The myofascial system refers to the complete system of muscles and related tissues (3).

Acute muscle injury or strain can cause fasciae to become painful, as can strain on ligaments and tendons. According to practitioners of myofascial release, fascia can bind to tissue and can result in adhesions or scar tissue that stiffen joints or induce pain on movement. Conditions such as fibromyalgia, rheumatoid arthritis, muscle spasms, whiplash, and carpal tunnel syndrome may be connected to fascia adhesions (4).

Myofascial Release Basics

Myofascial release revolves around physical manipulation of the fasciae. When healthy, fascia is relaxed, flexible, and moves with ease. But injury or strain can cause fasciae to tighten, increasing pressure in the body. In order to counteract the pressure and restore health and flexibility to the fascial system, myofascial release applies gentle pressure to tight areas for longer durations than other forms of massage (5).‍

Myofascial Release Practitioners

Myofascial release can be administered by hands-on touch or by instruments like foam rollers (6). Physical therapists or chiropractors can perform the technique, as can some occupational therapists and massage therapists. Myofascial release can also be self-administered.

Self-Administered Myofascial Release Exercises

Many myofascial release exercises can be performed at home with a foam roller, which you can purchase online or at a sporting goods store. You should always roll slowly and pause to hold your position when you hit a painful, tender spot known as a trigger point (7). Foam rolling exercises include:

• Side-Lying IT Band Rolling: Lie on your side with a foam roller under your hip. Cross your upper leg in front of the leg that’s touching the foam roller and place the upper foot on the ground. Once you feel properly balanced, begin to roll the side of your leg up and down the foam roll. Move slowly and do not roll past your knee (8).
• Thoracic Spine Rolling: Place the foam roller on the floor, then lie down so that it’s positioned under your upper back. Cross your arms so that your left hand is on your right shoulder and your right hand is on your left shoulder. Gently lift your hips off the floor. Roll back and forth. If you find a spot that’s sensitive, hold that position for one minute (9).

Hamstring Rolling: Sit on the foam roller with your hands behind your body and planted on the floor. Slowly roll from your glutes to just above your knees. Hold tender spots for a minute if possible (10).

Research on the benefits of myofascial release is mixed. Some studies suggest that it carries significant benefits while other studies show little to no benefit (11). Myofascial release has had therapeutic effects for people who suffer from chronic lower back pain, but the improvement wasn’t enough to be considered statistically significant (12). Athletes have experienced increased muscle function due to myofascial release, and self-administered myofascial release can reduce muscle soreness while improving flexibility (13, 14).

Anecdotally, myofascial release can help with pain relief, but the literature documents much more conclusively the therapeutic effects of myofascial release in increasing range of motion (15, 16). Overall, the evidence in favor of myofascial release isn’t exceptionally strong. Myofascial release should be combined with traditional physical therapy approaches for better results.

The risks of myofascial release are low. However, it can cause internal bleeding or injury in rare cases. If you’re considering myofascial release as part of your pain management plan or exercise regimen, consider speaking to a trusted healthcare provider about the potential effects. Share your family medical history as well as your personal clinical history so that you and your doctor can find the best plan together.

At-Home Remedies

If myofascial release techniques aren’t working for you, there are some at-home remedies you may want to try for pain relief. Cold therapy (cryotherapy), for example, can reduce swelling and relieve pain. To try cold therapy, simply make a homemade ice pack, pull bags of peas from the freezer, or buy a cold gel pack over-the-counter at a pharmacy or online. You’ll want to wrap a thin towel around the cold object so that you protect your skin, then place the wrapped, cold object on the hurting area for up to twenty minutes a few times a day (17).

Heat therapy can also provide temporary pain relief. You can easily administer heat therapy yourself by taking a hot shower or bath, or by applying a heating pad or hot pack to the affected area. Similarly to cold therapy, it’s important to wrap any hot objects in a thin towel in order to protect your skin.

Over-the-counter painkillers like non-steroidal anti-inflammatory drugs (NSAIDs) may also provide pain relief. Common NSAIDs available at drug stores and online include ibuprofen (Advil) and naproxen (Aleve).  are available at pharmacies as well as online. Acetaminophen (Tylenol) is also available over-the-counter. It doesn’t reduce inflammation but it can reduce pain in some cases.

In general, cold and heat therapy have minimal side effects. Some people may experience skin irritations or burns, but limiting the amount of time that skin comes into contact with the hot or cold object should mitigate those risks. NSAIDs can cause gastrointestinal problems (stomach pain) and cardiovascular issues (heart problems). Liver damage has been linked to acetaminophen. Talk to a doctor if you have any family medical history or personal clinical history of stomach, heart, or liver problems. Overall, over-the-counter painkillers are a safe, temporary option.‍

Physical Therapy and Prescriptions

If myofascial release therapy isn’t working for you and you’ve already tried at-home remedies like over-the-counter painkillers, exercise, ice therapy, and heat therapy, you may want to consider visiting a physical therapist to talk about a treatment plan. Physical therapy entails regular recurring appointments in order to produce optimal effects. Before you choose a physical therapist, consider:

• Where is their office?
• Do their hours work with your schedule?
• How often will you need to attend appointments?
• Does your insurance company cover this physical therapy provider?
• If so, how many visits will be covered? What copays will be charged? 
• Does the physical therapist perform manual therapy, use machines, or some combination? 
• Are you comfortable discussing your pain and health with this physical therapist?

It’s important that you’re able to relax when working with your physical therapist, so ask the questions you need to ask in order to feel comfortable. Once you determine the right physical therapist for you, schedule an appointment have a detailed conversation about the type of pain you’re experiencing. Discuss the following questions:

• Is your entire body in pain? Or do certain areas hurt more or less than others? 
• Do you have chronic pain? 
• When during the day or night do you feel pain?
• What’s the consistency, or lack thereof, of the pain you’re experiencing? 
• Is there anything that has helped you feel better? Anything that has worsened your condition?
• What is your complete medical history? How about any pertinent family clinical history?
• What are the specific ways your pain affects you day-to-day? What are the normal tasks you currently struggle to perform? How has the pain affected your sleep and energy level?

Wear loose, comfortable clothing to your first physical therapy appointment and any following appointments. Physical therapy appointments typically last about 45 minutes and may be recommended as frequently as a few times per week. Your physical therapist will guide you through exercises, sometimes using equipment like an exercise ball, stairs, or ramps. They’ll likely give you exercises to perform at home between appointments as well. In some cases, your physical therapist may recommend imaging – such as x-rays – in order to better understand the source of your pain.

Your physical therapist may recommend that you try regular physical therapy appointments, at-home exercises, and a short-term course of prescription pain medication as you work toward healing. Prescription medications used for myofascial pain syndrome include (18):

• Antidepressants. These can work well for people suffering from fascial pain and fascia-adjacent conditions like fibromyalgia. They take a while to build up in your system, so optimal effects are typically not felt until after a week or more. In general, people experience moderate pain relief from taking antidepressants. The most common type of antidepressants used for pain are called tricyclic antidepressants, which include amitriptyline, doxepin, and clomipramine (19). Some people taking antidepressants experience side effects like blurred vision, dry mouth, and nausea.
• Sedatives like clonazepam. These can treat anxiety and poor sleep that may accompany myofascial pain syndrome. However, they cause sleepiness and can be habit-forming, so talk to a doctor about the potential effects.
• Muscle relaxants. These may be prescribed for people suffering from myofascial pelvic pain. These pills may be combined with other treatments such as physical therapy, oral neuromodulators, and pelvic floor muscle injections (20).‍

Injections

Cervical epidural steroids have significant positive effects on neck pain (21). Other forms of injections, such as anesthetic injections, can block nerve pain (22). Radiofrequency denervation (RFD), which is a form of heat-based injections, can often short term pain relief as well (23).

Myofascial release is a type of therapy based around massaging muscle sheaths. Evidence for fascial therapy is not very strong, however, so it shouldn’t be used as a primary form of treatment. In most cases, traditional physical therapy will more effectively treat pain. If you want to try myofascial release, consider combining it with at-home remedies like heat or cold therapy and with regular appointments to a physical therapist.