HOW COULD FASCIA NOT BE CONTRIBUTING TO PAIN?

Exploring the science of fascia, the nervous system, fibromyalgia, and chronic pain syndromes

This is a question I believe we should be asking far more often, particularly when it comes to fibromyalgia and other chronic pain syndromes.

For decades, much of our understanding of musculoskeletal pain has centered around muscles, joints, nerves, and the structures we can readily identify through conventional medical imaging. Advances in neuroscience have expanded our understanding of pain, demonstrating that it is a complex experience involving communication between the peripheral nervous system, spinal cord, and brain. Sensory receptors throughout our tissues continuously detect mechanical, chemical, and thermal changes, sending information to the central nervous system, where those signals are processed alongside previous experiences, emotional states, and other biological influences.

Researchers have also identified mechanisms such as central sensitization, in which the nervous system becomes increasingly responsive to sensory input, potentially amplifying pain or producing pain in response to stimuli that would not ordinarily be painful. This is particularly relevant to fibromyalgia and other chronic pain syndromes, where altered pain processing can contribute to widespread sensitivity and persistent discomfort.

However, while we continue investigating how the nervous system processes and amplifies pain, I believe we must give greater consideration to the tissues providing sensory information to that system. The relationship between the nervous system and our connective tissues is dynamic, with each influencing the other through sensory signaling, movement, protective responses, and tissue adaptation.

This brings me to an extraordinary tissue network that I believe deserves considerably more attention in these conversations: fascia.

We have an extensive connective tissue network that surrounds, supports, separates, and connects our muscles, nerves, organs, blood vessels, and other structures. Fascia participates in movement, force transmission, tissue organization, and sensory communication. It responds to mechanical loading, adapts to the demands placed upon it, and contains an abundance of sensory nerve endings that communicate with our nervous system.

When we begin examining what researchers have discovered about fascial innervation, nociception, and pain sensitivity, I find it increasingly difficult to understand how we could investigate persistent pain without giving fascia a much greater place in the conversation.

I have believed for years that fascia is a major missing piece in our understanding of fibromyalgia and other chronic pain syndromes. What makes this especially compelling is that researchers have already begun investigating many of the mechanisms that could help explain why.

Fascia Is Far More Than the Tissue That Holds Us Together

Fascia has historically been described primarily through its structural roles. However, advances in anatomy, histology, and neuroscience have revealed that fascial tissues also have important sensory functions.

One of the most compelling publications is the 2022 systematic review Fascial Innervation: A Systematic Review of the Literature, authored by Suarez-Rodriguez and colleagues.

The researchers examined 23 studies investigating the innervation of deep and muscular fascia. Their findings documented a diverse population of nerve endings, including free nerve endings, Pacinian corpuscles, and Ruffini corpuscles. The review also highlighted differences in the density and distribution of sensory innervation across different fascial regions.

Particularly interesting was the observation that certain pathological fascial tissues demonstrated increased innervation, including nerve endings associated with nociception.

This is significant because it challenges the idea that fascia is simply a passive structural covering. Fascia is richly innervated, participates in sensory communication, and has the capacity to contribute to pain.

Fascia is increasingly recognized as one of the body's most extensive sensory networks, and I have long referred to it as our largest sensory organ because of its extraordinary distribution throughout the body and its extensive sensory innervation. Research continues to reveal just how richly innervated fascial tissues are, including their involvement in proprioception, mechanosensation, and nociception. Although researchers have not established a universally accepted measurement that definitively ranks fascia above every other sensory organ, its remarkable sensory capabilities are well documented. I believe these findings demand a much greater appreciation of fascia's role in how we experience movement, physical sensation, and pain.

Understanding the Receptors Within Fascia

To appreciate the potential relationship between fascia and chronic pain, we need to understand the sensory structures researchers have identified within fascial tissues.

Nociceptors are sensory nerve endings that respond to potentially damaging mechanical, chemical, or thermal stimuli. Their activation sends signals toward the central nervous system, where those signals may contribute to the experience of pain. Mechanoreceptors respond to mechanical forces such as pressure, stretch, and movement, helping the nervous system gather information about the physical environment of our tissues. Proprioceptive receptors and nerve endings contribute to our awareness of body position and movement, and fascial tissues participate in this sensory system, although the relative contribution of different fascial receptors continues to be investigated.

Researchers have identified specialized sensory structures, including Ruffini endings and Pacinian corpuscles, in certain fascial tissues. They have also identified nerve fibers associated with substance P and calcitonin gene-related peptide, commonly known as CGRP. These neuropeptides are particularly interesting because of their involvement in nociceptive signaling and neurogenic inflammation.

When we consider these findings together, we begin to appreciate that fascia is not simply responding to the physical demands of movement. It is also part of the sensory environment through which the nervous system receives information about the body.

If fascia contains the sensory structures involved in detecting mechanical changes, communicating tissue conditions, and contributing to pain signaling, how could it not deserve greater attention in our understanding of chronic pain?

Researchers Have Demonstrated That Fascia Can Generate Significant Pain

One of the most important studies supporting this conversation was published in the journal PAIN in 2014. Andreas Schilder and his colleagues investigated the pain responses produced by chemically stimulating different tissues in the lower back. Using ultrasound-guided injections of hypertonic saline, the researchers compared responses from the thoracolumbar fascia, underlying muscle, and subcutaneous tissue in 12 healthy participants.

The results were fascinating. Stimulation of the thoracolumbar fascia produced pain that lasted longer and spread over a greater area than comparable stimulation of the underlying muscle. Participants also reported differences in the quality and emotional unpleasantness of the pain. The researchers concluded that the thoracolumbar fascia was particularly sensitive to this type of chemical stimulation and could represent an important contributor to nonspecific lower back pain.

A subsequent study published in 2022 expanded on these findings by examining different volumes of chemical stimulation in the fascia and multifidus muscle. In this study involving 16 healthy participants, fascial stimulation produced 86% higher peak pain ratings and 65% larger pain areas than muscle stimulation under the experimental conditions.

Consider the significance of those findings. Researchers were able to stimulate fascial tissue and produce a measurable pain response that was more intense and more widespread than the response produced by stimulating muscle.

These studies do not establish that fascia is responsible for all persistent back pain, nor do they demonstrate that every fascial restriction generates pain. They do, however, provide direct experimental evidence that fascia can be a substantial source of nociceptive input. For a tissue that extends throughout the body and participates in so many of our physical functions, I believe that finding deserves far more attention.

The Nervous System Processes Pain, but What Is Communicating With It?

One of the most important developments in pain science has been our growing understanding of central sensitization. Central sensitization involves changes in how the central nervous system processes sensory information, potentially increasing responsiveness to painful stimuli and, in some circumstances, stimuli that would not ordinarily be painful. This is particularly relevant to fibromyalgia, where altered pain processing and nociplastic mechanisms are recognized as important features of the condition.

However, I believe there is another question we need to continue investigating: What may be contributing to the sensory information entering that system, and how might the body's tissues interact with an already sensitized nervous system?

Fascia contains nociceptive nerve endings, responds to mechanical loading, and participates in inflammatory and tissue-repair processes. Its mechanical properties can change in response to injury, movement, immobilization, and other biological influences. We also know that pain can produce protective muscular guarding and changes in movement patterns. Over time, those adaptations may influence how forces are distributed throughout the body.

I believe these relationships deserve closer examination, particularly in people who experience persistent pain, widespread tenderness, altered movement, and ongoing protective tension. The relationship is unlikely to be one-directional. Changes in tissue signaling may influence nervous system processing, while changes in nervous system activity may influence muscle activation, movement, and the mechanical environment of fascial tissues.

Pain is a complex biological experience, and this relationship between peripheral tissues and central processing is precisely why I believe fascia must be part of a broader investigation.

Fibromyalgia: Could Fascia Be a Major Missing Piece?

Fibromyalgia is one of the conditions that has continually reinforced my interest in the relationship between fascia and chronic pain. People living with fibromyalgia may experience widespread pain, tenderness, fatigue, disrupted sleep, cognitive difficulties, and increased sensitivity to sensory stimuli. The condition involves multiple interacting biological processes, and researchers continue to investigate the mechanisms responsible for its development and persistence.

Central sensitization and altered pain processing are important components of current scientific understanding. However, the possibility that peripheral tissues may also contribute to symptoms deserves consideration.

Interestingly, this is not a new scientific question. In 2010, physician and researcher Ginevra Liptan published Fascia: A Missing Link in Our Understanding of the Pathology of Fibromyalgia in the Journal of Bodywork and Movement Therapies. Liptan proposed that fascial inflammation and dysfunction might contribute to the peripheral nociceptive input involved in central sensitization. Her hypothesis explored the possibility that abnormalities within intramuscular connective tissue, inflammatory signaling, and altered tissue responses could participate in the development or persistence of fibromyalgia symptoms.

I believe fascia is a major piece of the fibromyalgia puzzle, and I would like to see considerably more research examining its mechanical properties, sensory innervation, inflammatory activity, and relationship with altered nervous system processing in people living with this condition.

Understanding central sensitization is essential, but investigating the tissues that may contribute to peripheral sensory input is equally worthy of scientific attention. These mechanisms can coexist, and understanding their relationship may help us develop more individualized ways of supporting people living with chronic pain.

What About Persistent Tension, Guarding, and Fascial Mobility?

Another area I believe deserves greater attention is the relationship between persistent muscular guarding, fascial mobility, and the mechanical demands placed upon the body. Our bodies continuously adapt to how we move, how we rest, how we breathe, and the physical positions we maintain throughout the day.

Consider someone experiencing recurring neck and shoulder tension. Their shoulders may remain elevated, their head may consistently move forward, and their breathing may become increasingly shallow during periods of stress or prolonged concentration. These patterns influence muscle activity and the mechanical loading experienced by surrounding connective tissues.

Over time, changes in movement, tissue loading, and protective guarding may contribute to discomfort and reduced movement variability. The precise contribution of fascial stiffness or reduced tissue glide to chronic pain varies and remains an active area of research.

This is where my work places considerable emphasis on looking beyond the location of the symptom. Someone may experience discomfort in the neck while also demonstrating changes in breathing mechanics, shoulder positioning, chest mobility, and movement patterns throughout the trunk. The location where pain is experienced does not always identify every structure or mechanism contributing to that experience.

My Fascia BluePrint Matrix explores these relationships by examining the body as an interconnected system rather than treating each painful region in isolation. I believe understanding these broader patterns can provide valuable information, particularly when conventional symptom-focused strategies have offered only temporary relief.

What Does Research on Myofascial Therapies Tell Us?

The relationship between fascia and chronic pain becomes even more interesting when we examine research involving interventions directed toward myofascial tissues.

A 2025 systematic review and meta-analysis examined connective tissue massage and myofascial release in people with fibromyalgia. The review included 10 studies and reported statistically significant pain reduction associated with myofascial release. However, differences in study methods, treatment protocols, and participant characteristics limit the certainty of these findings.

This research is encouraging because it suggests that interventions involving myofascial tissues may help some individuals manage fibromyalgia-related pain. At the same time, an improvement following a manual intervention does not establish that fascial dysfunction caused the pain or that the intervention worked exclusively by changing fascia. Manual therapies may influence multiple systems, including sensory processing, muscle activity, and the nervous system's response to touch and movement.

I believe this is an important distinction as we continue investigating which interventions help, why they help, and who may benefit most. The goal should be to understand these mechanisms more deeply rather than reducing a complex condition to one tissue or one treatment.

Why I Teach People to Look Beyond the Symptom

My work in has been shaped by years of exploring the relationships between tissue mobility, movement patterns, sensory responses, and the body's ability to adapt. I have consistently encouraged people to consider the possibility that where they experience discomfort may not represent the complete picture of what is contributing to it.

A person experiencing recurring headaches may also demonstrate persistent tension throughout the neck, jaw, and shoulders. Someone with hip discomfort may have changes in movement and loading patterns extending through the trunk and lower extremities. A person experiencing widespread pain may have multiple overlapping contributors involving sensory sensitivity, movement adaptations, sleep, stress, and tissue function.

These examples do not mean that every symptom originates in fascia. They demonstrate why understanding the body as an interconnected system can be valuable.

My approach emphasizes gentle tissue mobilization, movement awareness, and ongoing reassessment while respecting the complexity of each individual's health. I teach three foundational principles: Never Bruise. Never Force. Never Cause Pain.

These principles become especially important when working with individuals who experience heightened pain sensitivity. The intention is to respect the nervous system, avoid unnecessarily provoking symptoms, and support comfortable movement rather than attempting to force changes in tissue.

People living with fibromyalgia and other chronic pain conditions deserve individualized care that considers their medical history, sensory tolerance, physical capabilities, and overall health. I believe fascia-focused education and appropriately selected movement practices may have a valuable place alongside established medical care, rehabilitation, and other evidence-informed strategies.

Living Beyond Pain Does Not Mean Erasing the Damage

My belief in the importance of fascia is also deeply personal. My body has endured extensive physical trauma and damage over the years, and I know firsthand what it means to live with chronic pain and the limitations that can accompany it.

Today, through the approach I have developed and the way I care for my body, I am able to live most of my days without pain. That is something I never take for granted, particularly when I consider everything my body has endured.

However, I want to make an important distinction. Living without pain does not mean the damage to my body has disappeared, nor does it mean my body has regained every capability it once had.

There are physical limitations I still have to respect. I know that certain activities, movements, or demands can push my body beyond what it can comfortably tolerate and send me into a spiral of pain and dysfunction. My approach has not erased my medical history or reversed every structural injury. What it has done is profoundly change how I understand, care for, and respond to my body.

Through the fascia perspective, I have learned to recognize patterns, address areas of restriction and tension, support movement, and make decisions that respect what my body is capable of doing. I understand that caring for my body is an ongoing relationship, one that requires awareness, consistency, and an appreciation for both its extraordinary abilities and its limitations.

For me, the greatest transformation has not been getting my old body back. It has been learning how to live a life I genuinely enjoy in the body I have today.

This is an important part of what I want people living with chronic pain to understand. Improving your quality of life does not always require every underlying injury or condition to disappear. There can be meaningful progress in how you feel, how you move, how you manage your symptoms, and how fully you participate in your own life, even when physical limitations remain.

My experience is personal, and I recognize that everyone living with chronic pain has a different medical history, different contributing factors, and different possibilities for improvement. However, it is one of the reasons I remain so passionate about exploring fascia's role in pain and sharing what I have learned.

My body still carries the damage of everything it has endured, but that damage no longer gets to define the quality of every day. That, to me, is one of the most meaningful possibilities of approaching health through a broader understanding of the body.

We Need to Expand the Chronic Pain Conversation

The more we learn about fascia, the more questions emerge about its role in human health. We know that fascia is richly innervated, contains sensory structures involved in detecting mechanical stimuli and potentially harmful conditions, and can generate significant pain when experimentally stimulated. We also know that researchers have proposed connections between fascial dysfunction and fibromyalgia, and that some studies involving myofascial interventions have reported improvements in pain.

What we have yet to establish is precisely how much fascial dysfunction contributes to fibromyalgia and other chronic pain syndromes, whether identifiable fascial changes help distinguish particular patient groups, and which interventions can reliably improve long-term outcomes. These are important unanswered questions, and they deserve rigorous investigation.

I believe we are only beginning to appreciate how much information our connective tissues contribute to the nervous system and how these relationships may influence our experiences of movement, discomfort, and health.

For years, I have advocated for a broader understanding of fascia and its significance throughout the human body. As research continues to advance, I hope we see greater collaboration between fascia researchers, neuroscientists, pain specialists, rehabilitation professionals, and others working to understand persistent pain.

When we begin appreciating fascia for everything it does, rather than simply viewing it as the tissue that holds us together, we open the door to a much broader understanding of pain, movement, and human health.

So I return to the question that inspired this article: How could fascia not be contributing to pain?

The science has already established that it can. The next challenge is understanding how much it contributes, under which circumstances, and what that knowledge could mean for the millions of people living with chronic pain.

I believe fascia deserves a much greater place in that conversation.

Scientific References

1. Suarez-Rodriguez, V., Fede, C., Pirri, C., Petrelli, L., Loro-Ferrer, J. F., Rodriguez-Ruiz, D., De Caro, R., & Stecco, C. (2022). Fascial innervation: A systematic review of the literature. International Journal of Molecular Sciences, 23(10), 5674. https://doi.org/10.3390/ijms23105674

2. Schilder, A., Hoheisel, U., Magerl, W., Benrath, J., Klein, T., & Treede, R.-D. (2014). Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain. PAIN, 155(2), 222–231. https://doi.org/10.1016/j.pain.2013.09.025

3. Vogel, S., Magerl, W., Treede, R.-D., & Schilder, A. (2022). Dose-dependent pain and pain radiation after chemical stimulation of the thoracolumbar fascia and multifidus muscle: A single-blinded, cross-over study revealing a higher impact of fascia stimulation. Life, 12(3), 340. https://doi.org/10.3390/life12030340

4. Liptan, G. L. (2010). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of Bodywork and Movement Therapies, 14(1), 3–12. https://doi.org/10.1016/j.jbmt.2009.08.003

5. Ide, F. C., D'Oliveira, A., Vieira, E. P., Martins, T. B., Andrade, A., & do Nascimento, I. B. (2026). What are the effects of connective tissue massage vs. myofascial release on fibromyalgia pain? Systematic review with meta-analysis. Complementary Therapies in Medicine, 96, 103305. https://doi.org/10.1016/j.ctim.2025.103305

6. Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. PAIN, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

7. Kosek, E., Clauw, D., Nijs, J., Baron, R., Gilron, I., Harris, R. E., Mico, J.-A., Rice, A. S. C., & Sterling, M. (2021). Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system. PAIN, 162(11), 2629–2634. https://doi.org/10.1097/j.pain.0000000000002324

8. Schilder, A., Magerl, W., Hoheisel, U., Klein, T., & Treede, R.-D. (2016). Electrical high-frequency stimulation of the human thoracolumbar fascia evokes long-term potentiation-like pain amplification. PAIN, 157(10), 2309–2317. https://doi.org/10.1097/j.pain.0000000000000649

9. Fede, C., Petrelli, L., Pirri, C., Neuhuber, W., Tiengo, C., Biz, C., De Caro, R., Schleip, R., & Stecco, C. (2022). Innervation of human superficial fascia. Frontiers in Neuroanatomy, 16, 981426. https://doi.org/10.3389/fnana.2022.981426

10. Willard, F. H., Vleeming, A., Schuenke, M. D., Danneels, L., & Schleip, R. (2012). The thoracolumbar fascia: Anatomy, function and clinical considerations. Journal of Anatomy, 221(6), 507–536. https://doi.org/10.1111/j.1469-7580.2012.01511.x