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1st Jan


Myofascial Pain and Function

I recently attended a large international conference on low back pain and pelvic pain, and several sessions were spent on discussing our myofascial system, and how it helps our function in so many ways, but also how it can cause much pain and disability.

We used to believe that muscles simply attach to bones, via tendons at each end, which creates joint motion (or in the face skin movement) as the muscle contracts. It has been recognized for a long time that there are also layers of connective tissue between and around muscles, called fascia and aponeurosis, but their importance has often been minimized by the medical community.

However, new fascinating research is showing us that this connective tissue system is extremely vast, and connects to all tissues including neighboring muscles, ligaments, tendons, nerves, blood vessels and it imbeds internal organs.

A French team lead by surgeon Jean Claude Guimberteau and scientist J.P. Delage have managed to beautifully film through endoscopy this fascinating network of fibers, which slides around and into all tissues.


The French team, and other researchers, have shown that when a muscle contracts, its force transfers both through its tendon attachments, and sideways via fascial fibers, to neighboring muscles and tissues. In this way, the effect of a muscle contraction can be quite complex.

As an example, when we tighten our deep stomach muscles, it creates an increased tension in multiple layers of fascia across the back, which in turn is closely attached to thick deep back muscles called multifidi, and to ligaments across low back joints and the pelvis. This creates increased stability in the back and sacroiliac joint, necessary for painfree function. In other regions of our body, movements and muscle contractions may have an effect on neighboring tissues that we are just starting to understand.


Exciting research with new technology has identified abnormalities in the vast fascial system when pain is present, which previously were hypotheses only. We can now see through ultrasound studies called elastography how layers of fascia and aponeurosis in the low back move back and forth in relation to each other during back movements. However, when there is low back pain, there is much less shearing motion between these layers, possibly due to scarring, or due to excessive muscle tension in the back.

We have also found cells in the low back fascia which indicate microtearing or inflammation, and embedded nerve endings and chemicals responsible for pain perception, as well as nerve endings which give us a sense of position and movement, not previously known.

Other researchers have measured changes in painful myofascial trigger points in the neck, and found substances seen in inflammation and pain production as well as reduced soft tissue pliability in these areas of the muscle and its fascia. This in turn is believed to be an important factor in causing a neurological mechanism called sensitization, where we experience excessive and intolerable pain, which may spread to neighboring and even distant areas in our body.


These research findings support our treatment approach of manual tissue mobilization of the myofascial system and involved joints, where mobility is lacking, and tissues may be irritated, hypersensitive, and weakened.

I also believe that our choice of specific exercise, Medical Exercise Therapy (also referred to as Scientific Therapeutic Exercise Progressions) is perfectly suited to treat these conditions, as the exactly measured tension applied can be light enough to allow for a large number of painfree movements, which effectively help improve mobility, and reduce tissue irritation and sensitivity. It can also be applied as a “shotgun” approach, to create vast physiological changes in large or multiple regions.

Please forward this letter to anybody who you think could benefit from the information.

Best wishes for a healthy 2011,


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