Why Fascia May Be the Key to Alleviating Your Back Pain

Muscle gets all the glory. Occasionally, tendons get a shout-out. But nobody ever talks about fascia—the connective tissue that touches literally every component of your inner body. In fact, if you work out or play sports, fascia is the real MVP—and caring for it deserves a page in every athlete’s playbook. "If you're training with high loads and repetitive patterns and intensity, fascia transmits force across muscle chains. It’s also what supports, protects, and stabilizes our joints. So it needs to be hydrated and elastic so that that strength output is more efficient,” says Sue Hitzmann, MS, CST, NMT, an exercise physiologist, founder of MELT Method, and founding member of the Fascia Research Society.But pro athletes and Hyrox hopefuls aren’t the only ones who stand to benefit from healthy fascia. If you suffer from back pain—or almost any kind of pain, really—there’s a chance that it’s actually a fascia issue in disguise. “Fascia can mimic many other symptoms, like nerve pain, bone pain, and muscle pain,” says Sarah Cash Crawford, PT, DPT, COMT, CMTPT, a physical therapist and founder of Anchor Wellness Center in Cincinnati, OH.Here’s everything you need to know about fascia, according to the experts.What is fascia?You might think of your skin as what keeps all your inside bits together, but that’s actually fascia’s job. “The way I usually explain it to patients, fascia is this fibrous tissue that lies beneath the skin and above the muscle,” says Dr. Crawford. “Fascia’s primary purpose is to maintain structure”—and not just at the surface level, but all throughout the body, she says. “It wraps around every muscle, every nerve, every vessel, every bone, and every organ.”It’s hard to overstate the ubiquity of fascia throughout your body. Unlike muscles or tendons, which have clear start and end points, all of the fascia in your body is one continuous piece of tissue. “There is a theory that if we were able to dissect out all of the other tissue, muscle, skin, bone, nerves, tendons, ligaments, and organs, your fascia would remain intact, and it would look like you,” says Dr. Crawford. (Just in case you were running low on nightmare fuel.)But fascia is so much more than just scaffolding for your insides. "For years, we've been calling fascia a connective tissue, because it looks like it just connects everything, like a wrapping. But we're now understanding it's actually a mechanical, sensory, and metabolic network,” says Hitzmann. “It's not only affecting how we move, but also how we feel, how we age, and how we heal.”Could fascia be responsible for your back pain?When fascia becomes restricted—whether from dehydration, a sedentary lifestyle, or a combination of factors, which we’ll get to below—it can mimic the symptoms of poor mobility, muscle tightness, or even pain. Unhealthy fascia can also cause what’s known as a fascial adhesion—basically, when fascia sticks to neighboring tissue—and, because all of your fascia is connected, this can show up as pain in a totally different area of the body.“Imagine you're wearing a wetsuit and I took a lighter to your lower back,” says Dr. Crawford. “The wetsuit would kind of melt and get stuck to the skin underneath it. Now, if you try to bend forwards, what's going to happen? You're going to feel this yanking on the tissue down into your glutes or your hamstrings or the muscles on the sides of your spine. That's what happens when we get these adhesions.”In fact, according to Hitzmann, there’s a very realistic scenario where your back pain—whether in your low back, neck, or somewhere in between—has nothing to do with your back at all. “The pain connection between fascia and muscular disc issues is one of the most misunderstood,” she says. “For example, oftentimes, if you have neck pain, the problem isn't in your neck—I'll almost guarantee it. Even if you had an MRI and you saw a cervical issue, why is that cervical disc being compressed? It's probably from the lack of fascial elasticity, which is causing the misalignment.”How can you take care of your fascia?Before you groan at the thought of having to do a bunch of special exercises to keep your fascia healthy, here’s the good news: All the things that support healthy fascia are the same things that you should be doing anyway. “If you are active, healthy, moving your body, drinking water, sleeping, and eating a colorful diet, you are attending to your fascia,” says Dr. Crawford. “Really, the only time that we need to give our fascia special attention is when it is not optimal.”Staying hydrated is one of the best things you can do to maintain the health and flexibility of your fascia. “When fascia becomes dehydrated, it gets irritated on a cellular level,” says Hitzmann. “It gets compressed, and the fluid perfusion through the fascial matrix stops happening. That’s when you get this hard-to-pinpoint pain. A patient will say, ‘My leg hurts,’ and I’ll ask them to touch it. So they press it, thinking it's going to hurt more, and it doesn't. And it's because the problem isn't in the area they feel it.”Moving your body is just as important. “You can't be a sedentary person and not have fascial restrictions,” says Dr. Crawford. “If you aren't moving your muscles, you aren't moving your fascia.” Just like muscles, your fascia will also benefit from proper recovery and mindful nutrition. “Fascia is made up of all the same micronutrients that muscles, bones, ligaments, and tendons are made up of,” Dr. Crawford says. “So you also want to have good nutrition, good sleep, and all the other things that we would need to keep the other parts of the musculoskeletal system happy.”What should you do if you suspect fascia is the cause of your pain?Obviously, if you’re not already doing the basics—hydration, movement, sleep, and nutrition—then start there and see if things improve. To maximize hydration, Hitzmann recommends adding electrolytes to your water. “And then things that also cause cellular dehydration are things like alcohol, sugar, and processed meats, so try to stay away from those,” she says.If you’re already decently active and doing your best to stay hydrated, Dr. Crawford recommends doing some work with a foam roller. “Foam rolling is probably one of the best tools in the toolbox to address fascia, because it creates friction and moves lymph and other fluids, which is helpful in trying to reduce those adhesions,” she says. On days when you’re also working out, hit the roller before your session.Of course, not all pain is fascia related. If things don’t start feeling better after about a week—despite your best efforts to stay hydrated, move your body, and allow yourself ample time to recover—Dr. Crawford recommends consulting a professional for a proper assessment. “The role of the practitioner is to really figure out what's driving the pain—is it a fascial restriction or is it really a herniated disc?” she says. “That's the challenge. There are just so many different things that can cause pain.”