“In rheumatology, the fascia is often the source of pain. There is a lot of manual work to be done on these tissues before considering other treatments such as injections. We certainly make a lot of diagnostic errors by forgetting to take them into account,” said Professor Françoise Laroche, rheumatologist at the Pain Evaluation and Treatment Department of Saint-Antoine University Hospital in Paris, France, while speaking at the recent French Congress of Rheumatology held in Paris.
She emphasised that fascia-related pain is common but is frequently misdiagnosed as other types of musculoskeletal pain.
Laroche and Cornelia Linke, a massage therapist based in Paris, highlighted the importance of recognising the fascia, which envelops and connects all body structures — muscles, bones, organs, and blood vessels. It forms a continuous network of superficial and deep tissues, providing mechanical and functional support.
“The fascia plays a role in support, movements, elasticity, and managing constraints such as static forces, pressure, and traction, as well as facilitating tissue gliding,” Linke summarised.
The fascia also contributes to fluid dynamics, healing, mobility, and organ elasticity and plays a significant role in somatosensory perception. It is considered “the largest sensory organ in our body, with six times more proprioceptive and nociceptive receptors than muscles.”
This explains why many musculoskeletal pains are of myofascial origin, linked to pressure-sensitive points resulting from prolonged poor posture, inappropriate muscle stress, chronic inflammation, or knee osteoarthritis.
Diagnostic Criteria
The International Association for the Study of Pain defines myofascial pain syndrome as musculoskeletal pain characterised by deep, constant local, and referred pain with the presence of myofascial trigger points in any part of the body. Diagnosis is suspected when at least three of the following criteria are met:
- Presence of a tight muscle cord in a skeletal muscle
- Presence of a hypersensitive point in the tense muscle cord
- Reproduction of referred pain upon trigger-point palpation
Confirmation involves six other criteria:
- Local twitch response upon palpating the tense muscle cord
- Presence of a jump sign (involuntary reaction to the palpation)
- Patient recognition of the referred pain pattern
- Predicted referred pain patterns
- Muscle weakness or stiffness
- Pain during stretching or contraction of the affected muscle
For instance, piriformis muscle syndrome (affecting the piriformis muscle) can be mistaken for sciatica or radiculopathy owing to similar symptoms. Diagnosis is guided by clinical examination, which may reveal painful contracture along the muscle, tenderness on palpation of the tendon (two finger widths above and behind the greater trochanter), normal lumbar spine mobility, and unrestricted hip movement. Several manoeuvres (Freiberg, Pace, and Nagle) may help confirm the diagnosis. Imaging is typically normal and is primarily used to exclude other conditions. Risk factors such as age, rheumatologic conditions, repetitive movements, and inactivity, along with comorbidities such as headache, neck pain, back pain, and pelvic pain, are often present.
Treatment Options
After the diagnosis, manual therapy is prescribed locally or systemically using painless and gentle techniques, explained Linke. Patients can also perform self-massages, myofascial release, muscle sanding, or stretching. Massage tools with spikes or rollers may be helpful. Physical activity, stretching, relaxation methods, hypnosis, or sophrology may complement treatment. In some cases, transcutaneous electrical nerve stimulation or botulinum toxin injection may be considered as treatment options.
This story was translated from Univadis France using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.