The deep fascia and its role in chronic pain and pathological conditions: A review

Flemming Kondrup, Nathaly Gaudreault, Gabriel Venne

First published: 13 April 2022

Deep fascia is a crucial type of connective tissue that envelops muscles, bones, nerves, and blood vessels throughout the body. Its significance in various chronic pain conditions has recently come to light, highlighting its role in the broader context of muscle and skeletal health.

We have identified five primary conditions that are linked to deep fascia, each associated with specific anatomical fasciae: chronic low back pain relates to the thoracolumbar fascia, chronic neck pain to the cervical fascia, Dupuytren's disease to the palmar fascia, plantar fasciitis to the plantar fascia, and iliotibial band syndrome to the iliotibial tract. Each of these conditions manifests unique symptoms that can significantly impact an individual's quality of life.

Research has shown that pathological changes in fascia often result in increased stiffness, which can be attributed to alterations in myofibroblast activity. This activity influences the extracellular matrix, particularly in the composition and arrangement of collagen fibers and the activity of Matrix Metalloproteinases (MMPs), enzymes that break down collagen. These changes can compromise the structural integrity of the fascia, leading to impaired function and pain.

Furthermore, there are notable changes in the nerve structure associated with pathological fascia. Specifically, the density of nociceptive (pain-sensitive) nerve fibers increases, and their sensitivity heightens, making them more reactive to stimuli. This heightened sensitivity can lead to a dysfunction in the pain signaling pathways, resulting in chronic pain experiences even in the absence of acute injury or trauma.

In addition to nerve changes, the presence of inflammatory markers is commonly observed in pathological fascia. These markers include pro-inflammatory cytokines and various immune cells that contribute to the inflammatory response. This inflammatory environment can further exacerbate pain and discomfort, as it perpetuates a cycle of pain and tissue damage.

The pain arising from deep fascia is likely caused by a combination of factors, including increased nerve density, heightened sensitivity, and ongoing physical or chemical damage to the tissue. As a result, pathological fascia demonstrates significant changes in nerve structure, immune response, and tissue tension, all of which play a role in the development and persistence of chronic pain conditions. Understanding these intricate relationships can lead to improved treatment approaches targeting both the fascia and the associated pain mechanisms.