What the Research Actually Says About Myofascial Release and Fascia
If you’re a massage therapist, you’ve probably heard a lot of different claims about fascia.
Some people believe it’s the key to everything. Others believe it’s irrelevant and that manual therapy doesn’t meaningfully change tissue at all. The truth, like most things, sits somewhere in the middle.
I spent a lot of time digging through imaging research on fascia, specifically looking at the thoracolumbar fascia and its relationship to lower back pain, as well as what actually happens to that tissue when we apply myofascial techniques. What I want to do here is not overwhelm you with data, but help you understand what this research actually means for you as a practitioner.
Fascia and Lower Back Pain
One of the more consistent findings in the literature is that people with chronic lower back pain tend to present with changes in the thoracolumbar fascia (Casato et al., 2019; Suarez-Rodriguez et al., 2022). Several studies have shown that this fascia is often thicker in individuals with back pain compared to those without (Aslan et al., 2024; Lariviere et al., 2020; Pirri et al., 2023; Yerli et al., 2024). At the same time, these individuals also tend to have reduced trunk motion (Tomita et al., 2025; Yerli et al., 2024).
Now, it would be easy to jump to the conclusion that thicker fascia causes pain, but it’s not that simple. What we can say is that there is a relationship. The tissue appears different, and movement is often more limited. There are also changes in how that tissue behaves. Research suggests that fascia in people with back pain may be less elastic and more resistant to deformation (Tarmatosh et al., 2022; Tomita et al., 2025).
When you combine that with what we know about the nervous system, it starts to paint a clearer picture. Fascia is richly innervated and capable of contributing to pain perception (Langevin, 2021). Changes in the tissue could influence how movement is sensed and controlled, which may lead to protective strategies like guarding, stiffness, or altered motor patterns. Over time, that can become a cycle.
What Happens When We Apply Myofascial Techniques
This is where things get more nuanced. If the question is, “Does myofascial release change fascia?” the answer is yes, but we need to be specific about how. The research is not very strong when it comes to changing fascial thickness. Some studies show small changes, others show none (Devantéry et al., 2023; Sanchez-Vera et al., 2025).
So if your expectation is that you are physically remodeling or breaking up tissue in a permanent way, the current evidence does not strongly support that. However, where the evidence is more consistent is in changes to tissue behavior.
Myofascial techniques appear to:
Reduce tissue stiffness
Improve elasticity
Increase tissue deformation
(Sanchez-Vera et al., 2025; Tarmatosh et al., 2022; Tarmatosh et al., 2023; Wong et al., 2017)
In simpler terms, the tissue seems to move better after treatment.
There is also some evidence suggesting improved organization of fascial fibers after intervention, which may help explain changes in how force is transmitted through the tissue. And importantly, these techniques consistently reduce pain.
What This Means for Your Practice
This is where I think a lot of practitioners either oversell or undersell what they’re doing.
Manual therapy is not useless. It clearly has measurable effects. But it’s also not magic. You are likely not permanently restructuring fascia in a single session. What you are doing is influencing the mechanical and neurological environment of that tissue.
You are:
Reducing sensitivity (Devantéry et al., 2023; Tarmatosh et al., 2022; Tarmatosh et al., 2023)
Improving how the tissue moves and deforms
Creating an opportunity for better movement
That last point is the most important, especially for TheraPros. With the TheraPro Method, we understand pain as an experience that is very malleable to many factors outside of our control (clients’ past experiences, emotions, socioeconomic status, etc.), and therefore, pain CANNOT be our measure of success. We have to prioritize the improvement of movement as our metric of success.
The Role of Manual Therapy in the Bigger Picture
If someone comes in with back pain and limited movement, and you can reduce their pain and improve how their tissue behaves, you have created a window.
In that window, they can move better. And if they move better, they have the opportunity to reinforce that change through movement, strength, and exposure to load. If they don’t use that window, the system will likely return to where it was.
This is why manual therapy works best when it’s paired with some form of movement or exercise. The manual input creates the change, but the movement is what helps maintain it.
A More Useful Way to Think About It
Instead of thinking, “I am changing the structure of this tissue,” it’s more useful to think:
“I am changing how this system behaves right now.”
That includes the tissue, the nervous system, and the person’s perception of movement and pain. That shift in thinking doesn’t make what you do less valuable. It actually makes it more precise. Because now you can use manual therapy intentionally, not just as a default.
Final Thoughts
The research on fascia is still evolving, and there are still gaps in what we understand.
But what we do know is this:
Fascial tissue changes in the presence of pain.
Myofascial techniques can influence how that tissue behaves.
And those changes can reduce pain and improve movement.
Your role is not just to apply a technique, but to understand when and why to use it, and how to connect it to the bigger picture of movement, adaptation, and long-term outcomes. Because that’s where the real impact happens.
References:
Aslan, S.G., Uyar, S.K., & Gurcay, E. (2024). Potential role of thoracolumbar fascia in younger middle-aged patients with chronic low back pain. International Journal of Neuroscience, 134(11), 1198-1204.
Casato, G., Stecco, C., & Busin, R. (2019). Role of fasciae in nonspecific low back pain. European Journal of Translational Myology, 29(3), 8330.
Devantéry, K., Morin, M., Grimard, J., & Gaudreault, N. (2023). Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study. Bioengineering, 10(3), 332.
Langevin, H. M. (2021). Fascia mobility, proprioception, and myofascial pain. Life, 11(7), 668.
Pirri, C., Pirri, N., Guidolin, D., Macchi, V., Porzionato, A., De Caro, R., & Stecco, C. (2023). Ultrasound imaging of thoracolumbar fascia thickness: chronic non-specific lower back pain versus healthy subjects; a sign of a “frozen back”?. Diagnostics, 13(8), 1436.
Sánchez-Vera, M. A., Diaz, D. F. S., Casallas, J. K. C., Rodríguez, P. A. B., Schleip, R., & Alfonso-Mora, M. L. (2025). Effect of crossed-hands myofascial induction on thoracolumbar fascia stiffness, thickness, and alignment. Journal of Bodywork and Movement Therapies, 43, 338-343.
Suarez-Rodriguez, V., Fede, C., Pirri, C., Petrelli, L., Loro-Ferrer, J. F., Rodriguez-Ruiz, D., ... & Stecco, C. (2022). Fascial innervation: a systematic review of the literature. International Journal of Molecular Sciences, 23(10), 5674.
Tamartash, H., & Bahrpeyma, F. (2022). Comparative effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low back pain. Journal of bodywork and movement therapies, 29, 174-179.
Tamartash, H., Bahrpeyma, F., & Dizaji, M. M. (2023). Effect of remote myofascial release on lumbar elasticity and pain in patients with chronic nonspecific low back pain: A randomized clinical trial. Journal of Chiropractic Medicine, 22(1), 52-59.
Tamartash, H., Bahrpeyma, F., & Mokhtari Dizaji, M. (2023). Ultrasound evidence of altered lumbar fascia in patients with low back pain. Clinical Anatomy, 36(1), 36-41.
Tomita, N., Roy-Cardinal, M. H., Chayer, B., Daher, S., Attiya, A., Boulanger, A., ... & Bureau, N. J. (2025). Thoracolumbar fascia ultrasound shear strain differs between low back pain and asymptomatic individuals: expanding the evidence. Insights into Imaging, 16(1), 18.
Wong, K. K., Chai, H. M., Chen, Y. J., Wang, C. L., Shau, Y. W., & Wang, S. F. (2017). Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound imaging. Musculoskeletal Science and Practice, 27, 124-130.
Yerli, S., Yinanç, S. B., Yağcı, G., Erbahçeci, F., & Özçakar, L. (2024). Thoracolumbar fascia and chronic low back pain in idiopathic lumbar scoliosis: An ultrasonographic study. European Spine Journal, 33(6), 2469-2475.