Understanding Muscle Pain, Fascia, and Myofascial Release
When it comes to muscle pain and stiff joints, you might have heard of the terms "fascia" and "myofascial." But what they mean might not be exactly clear. If you have tight muscles, painful knots, or struggle with stiff joints or lack of mobility, then you might find relief by focusing on tactics that work myofascial tissue.
Fascia 101: What is Fascia and Why is it Important?
Fascia is literally everywhere inside the body. It surrounds and holds every organ, blood vessel, bone, nerve fiber, and muscle.1 It's mostly made of collagen and elastin, and it contains nerve endings – which makes it sensitive.1,2
Fascia is often described as a sheet or web of connective tissue, but how it functions and appears in the body depends on where it's located. It can be thick, like the plantar fascia that supports the arch on the bottom of the foot.3 Or it can be slender and flexible – holding muscles to the bone or organs in their place while you run, walk, bounce, and kick.1,3
Fascia and Muscle Pain: What's the Connection?
The term myofascial tissue (myo = muscle; fascial = fascia) specifically refers to the fascia that wraps, connects, and supports muscles.
Fascia is made of multiple layers with liquid in between called hyaluronan (hyaluronic acid). When you move your body, fascia glides with the movement, allowing muscles to slide, stretch, and contract.1,4 For example, the fascia that surrounds the four muscles in the front of the thigh (quadricep) holds the muscle group together and enables them to independently slide on each other as you walk.
Myofascial pain or stiffness can occur from an impact or injury, a tough workout, repetitive motions, or simply from sitting too long and living a sedentary lifestyle.5,6
Myofascial Pain Syndrome: When Pain Becomes Chronic
Although nearly everyone has experienced muscle tension or pain, myofascial pain syndrome (MPS) is a chronic disorder. In MPS, pressure on trigger points causes pain – sometimes in seemingly unrelated parts of the body, which is called referred pain. MPS typically occurs after a muscle has been contracted repetitively. 5,6
Factors that can increase your risk of muscle trigger points and MPS include:5,6
Muscle injury. An acute muscle injury or continual muscle stress can lead to the development of trigger points. For example, a spot within or near a strained muscle can become a trigger point. Repetitive motions and poor posture also might increase your risk.
Stress and anxiety. People who frequently experience stress and anxiety have a higher risk of developing trigger points in their muscles. One theory holds that these individuals are more likely to clench their muscles, a form of repeated strain that leaves muscles susceptible to trigger points.
Research suggests that myofascial pain syndrome can develop into fibromyalgia in some individuals. Fibromyalgia is a chronic condition that features widespread pain. It's believed that the brains of people with fibromyalgia become more sensitive to pain signals over time. Some doctors believe myofascial pain syndrome might play a role in starting this process.6,7
Reducing Myofascial Pain
There are several strategies to help reduce and manage myofascial pain. You'll likely benefit from alternating among a few different modalities.5,6,8,9
Try Myofascial Release Therapy
This technique is often used in massage. During myofascial release therapy, a specially trained therapist locates myofascial areas that feel stiff and fixed instead of elastic and movable. These areas, although not always near what feels like the source of pain, are believed to restrict muscle and joint movements, which contributes to widespread muscle pain.
The focused manual pressure and stretching used in myofascial release therapy is believed to loosen up restricted movement, leading indirectly to reduced pain.
Work with a Physical Therapist
A physical therapist (PT) can devise a plan to help relieve your pain based on your signs and symptoms. Your plan might include specific stretches to reduce pain, and exercises that strengthen the muscles surrounding trigger points to avoid overworking any one muscle. Your PT might also recommend treatments like ultrasound. This type of therapy uses sound waves to increase blood circulation and warmth to promote healing in the affected muscles.
Explore Needle Procedures
To help with trigger points and manage myofascial pain syndrome, your doctor might inject a numbing agent or a steroid into a trigger point to relieve pain. In some individuals, just the act of inserting a needle into the trigger point breaks up the muscle tension. Called dry needling, a trained professional inserts a needle into several places in and around the trigger point. In addition, research shows that acupuncture can relieve myofascial pain syndrome for some individuals.5,6,8
Use a Foam Roller
Using a foam roller, also known as self-myofascial release, applies pressure to your muscles and myofascial tissues. This helps relieve sore and tight muscles, breaks up knots, and improves flexibility and range of motion. Learn more about using a foam roller.
Improve Your Posture
Improving your posture helps relieve myofascial pain, particularly in your neck.
Move Your Body
Sitting too long and living a sedentary lifestyle causes myofascial tissue to become stiff. This alone can create body aches and pain. Try these measures to increase how much you move.
- Take a break from sitting every 30 minutes
- Stand while talking on the phone or watching television
- If you work at a desk, then try a standing desk – or improvise with a high table or counter
- Walk with colleagues during meetings rather than sitting in a conference room.
Manage Your Stress
There's an abundance of research that connects stress and its negative impact on health.10 And myofascial pain is no exception. Try experimenting with various ways to reduce stress and find what works for you. You might try:
- Meditation. Research shows that meditation is remarkably effective for managing stress.10,11
- Journaling. Writing your thoughts and feelings is a good release for pent-up emotions.12
- Yoga. Studies show that yoga helps reduce stress and anxiety. It might also help relieve symptoms of several chronic conditions, such as pain, chronic obstructive pulmonary disease, asthma, arthritis, and insomnia.13
Physical activity is an important component of any treatment program for reducing myofascial pain. Walking, swimming, dancing, gardening, housework, biking – virtually any movement will help. In addition, one exercise session that gets your heartrate up has been shown to lower blood pressure, improve sleep, and lower anxiety on the day you do it.14 That's a win-win.
No conclusive evidence supports using one therapy over another to reduce myofascial pain. If your muscle pain is intense or interferes with your daily life, make an appointment with your doctor.
- Kumka M, Bonar J. Fascia: A morphological description and classification system based on a literature review. J Can Chiropr Assoc 2012;56(3):179-191.
- Svensson C, Sorkin L. Neuronal regulation of pain and inflammation. In: Firestein & Kelly's Textbook of Rheumatology. 11th ed. Philadelphia, Pa.: Elsevier 2017. https://www.clinicalkey.com. [Accessed June 12, 2021]
- Buchbinder R. Plantar fasciitis. UpToDate. https://www.uptodate.com/contents/search. Accessed June 15, 2021.
- DeStefano L. Principles of myofascial release and integrated neuromusculoskeletal technique. In: Greenman's Principles of Manual Medicine. 4th ed. Philadelphia, Pa.: Wolter Kluwer Health Lippincott Williams & Wilkins; 2011.
- Frontera W, Silver J, Rizzo T. Myofascial pain syndrome. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2018. http://www.clinicalkey.com. [Accessed June 12, 2021]
- Nasir U, Sayeed S. Myofascial pain syndrome. In: Ferri’s Clinical Advisor 2022. Philadelphia, Pa.: Elsevier; 2022. http://www.clinicalkey.com. [Accessed June 12, 2021]
- Langford C, Mandell B. Arthritis associated with systemic disease and other arthritides. In:Harrison's Principles of Internal Medicine, 20th ed. McGraw Hill; 2021. http://accessmedicine.mhmedical.com. [Accessed July 13, 2021]
- Fricton J. Myofascial pain: Mechanisms to management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311.
- Myofascial pain syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-causes/syc-20375444 [Accessed July 13, 2021]
- Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: A review. EXCLI J 2017;16:1057-1072.
- Bauer B, Kermott C, Millman M. Mind-body medicine. In: Mayo Clinic: The Integrative Guide to Good Health. Birmingham, AL: Oxmoor House; 2017.
- Stress and your health. U.S. Department of Health and Human Services. https://www.womenshealth.gov/mental-health/good-mental-health/stress-and-your-health. [Accessed June 12, 2021.]
- Yoga: What you need to know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/yoga-what-you-need-to-know. [Accessed June 12, 2021]
- Physical activity guidelines for Americans, 2nd edition. U.S. Department of Health and Human Services. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. [Accessed June 12, 2021]