Focusing on Fascia to Improve Chronic Pain

Recently, since the First International Fascia Research Congress held at Harvard in 2007,  fascia has emerged as an important topic of interest in the fields of physical medicine and rehabilitation, pain control, aging and sports. While this focus on the role of fascia in aging and sports is relatively new, many of us have been aware of the importance of fascia in the treatment of chronic pain for some time.

In a behaviorally oriented pain clinic in Northern California where I worked as a therapist and clinical director during the 1980s, our team was very focused on fascia, mainly due to the work of Janet Travell 1.

Janet Travell, MD was an early pioneer in recognizing the importance of fascia and described a syndrome that she termed the MyoFascial Pain Syndrome. Briefly, the MyoFascial Pain Syndrome was described as a pathological change in muscle tissue that involved tightness of fascia, shortening of muscle fibers resulting in pain and pathological muscle changes in various parts of the body.

Because short muscle fibers and shortened, tight fascia limited the range of motion of the muscle due to chronic tension  the muscle never got a chance to relax and over time the muscle fibers became progressively shorter, the fascia more constricted, the pain greater until, ultimately, trigger points in the muscles formed indicating severe pathology.

The working theory in our clinic was that muscles in various parts of the body (jaw, neck, shoulders, back, etc.) became shortened due to chronic tension resulting from trauma where injury led to protective bracing (e.g. whiplash, industrial or auto accidents) or habit (stress related muscular bracing). This tension resulted in shortened length of the muscle fibers due to chronic contraction and shortening of the enclosing fascial sheath surrounding the muscle tissue. Because of this shortened fascia the muscle could not then easily relax this both prolonged the abnormal levels of tension and continued the pain. And, to make matters worse, we often observed increased levels of pain when our patients tried to relax the affected muscles which invariably led to further tightening of the muscles to avoid acute stretching pain. Further tightening would often ensue. In fact, patients would report their pain and reduced mobility would increase dramatically over time so what started out as a minor irritation several years ago progressed to a major disability over time.

Dr. Travell described this syndrome in a wide variety of muscles but we most often focused on this progression of symptoms as they related to headaches, neck and shoulder pain, and back pain in our clinic.

What added dramatically to our insights and the effectiveness of our treatment was our use of surface ElectroMyography, also known as muscle monitoring or EMG as a biofeedback instrument. EMG muscle monitoring uses sophisticated electronics to measure the firing of the motor neurons in whatever muscle is being monitored.

When we took a baseline reading with our EMG instrumentation we would invariably find levels of tension greater than normal. A normal muscle at rest should have an EMG reading of 1 millionth of a volt (1 microvolt) and our patients would generally show chronic levels of tension greater than 6 microvolts and often as high as 20 or 30 microvolts. And, when asked to relax these muscles our clients were unable to do so because the fascia had shortened and prevented the muscles from relaxing. So we observed constant and chronic abnormally high levels of muscle activity in the muscles associated with our patient’s pain complaints.

The therapy was to monitor the EMG signal and display this signal on a computer screen for the client to observe. The client was given the instruction to relax the muscle which often involved a change of behavior, such as stopping the clenching of their jaw muscles (e.g. in bruxing). At first the EMG signal was reduced very little or not at all but over a few weeks the signal was able to be lowered down to normal levels indicating significant relaxation ability. During this time the client was asked to practice at home regularly and work on becoming aware of reducing the frequency of the tension producing behavior, i.e. stop clenching the teeth when clenching was detected or drop the shoulders when they were found to be tense. We also introduced gentle stretching exercises and whole body relaxation exercises.

This protocol worked very well in the office and we reported something like a 95% success rate with chronic headaches and neck and shoulder pain to the medical community which referred their otherwise “hopeless” patients to us.

We put this training protocol on the Internet in 1996 in the form of a course called Freedom from Headaches or Natural Headache Relief and a course to improve TemporoMandibular Joint Dysfunction and pain called Stop Bruxing Now.  Our participants report significant improvement. While we did our initial work using EMG muscle monitoring we discovered that the treatment protocol works well even without the use of EMG though some participants prefer the certainty of muscle monitoring as the make changes during the course and if that is the case we do have MyoTrac Home Muscle Monitors available for them.

We are gratified to see many of our working principles supported by the recent research on fascia and whole heartedly support the new research into this important and dynamic tissue which has been under valued for so long by the mainstream medical community.


1.  Janet G. Travell, M.D. & David G. Simons, M.D. (1983).   Myofascial Pain and Dysfunction. Baltimore: Williams and Wilkins

This entry was posted in Biofeedback.

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