We can tell that fascia has finally achieved the fame it deserves now that the website, Johns Hopkins Medicine, is blaming it for back pain. At least they are recognizing its existence! On their website, they write, “You might attribute a painful neck or a backache to tired muscles or stiff joints. But these symptoms can also be caused by a part of your body you probably haven’t heard of: the fascia. Until recently, this network of tissue throughout the body received very little attention despite its major role in every move you make.”1 Now that fascia has tiptoed into the allopathic mainstream, practitioners involved in assessing and treating patients for pain should also learn more about what it is and why it matters. Most of us veterinarians remember our first fascial encounters in freshman anatomy when we were told to toss it in the trash. During dissections, it was always in the way, blocking our view and impeding our identification of what we needed to know for the test: muscles, nerves, bones, and vessels. We had to find out where they began and where they ended, along with what they did for the living dog. This was not the case for fascia. Even if we tried to identify origins and insertions, we would not have succeeded, as fascia forms an endless network, running through, inside, and along nearly every structure of the body. In contrast, for osteopathic students, the omnipresence of fascia is not an irritant–it’s an explanation. Encoded within fascia’s filamentous network exists a history of the body’s physical and, to some extent, emotional experiences, as well. In fact, osteopathic medical school curricula include required coursework in myofascial palpation as a diagnostic approach and myofascial release as a mainstay of osteopathic manual medicine treatment techniques. In so doing, we learn how fascial restrictions impede not only movement and healthful posture, but also interfere with internal bodily processes, such as digestion, respiration, immune function, and more. As such, the study of fascia in osteopathic medicine remains central and vibrant. As Bordoni et al. put it: “The osteopathic treatment of the fascia involves several techniques, each aimed at allowing the various layers of the connective system to slide over each other, improving the responses of the afferents in case of dysfunction. However, before becoming acquainted with a method, one must be aware of the structure and function of the tissue that needs treating, to not only better understand the manual approach, but also make a more conscious choice of the therapeutic technique to employ, in order to adjust the treatment to the specific needs of the patient.”2 Thus, in those early anatomy labs, little did we vet students realize that, in the process of tearing things apart, we were letting some of the deepest lessons of anatomy slip through our fingers. Namely, that the problems our future patients will present to us may be caused by fascia and typically do not just affect one muscle, one joint, or one organ. Dogs, cats, and horses are not like automobiles, where a muffler or radiator fails alone and on its own. Instead, their (and our) bodies exist as systems–relating and relying on multi-level signaling from top to bottom, inside and out, to maintain health and restore physiologic homeostasis after disease or injury. Fascia is not just a biologic plastic wrap that keeps our muscles and viscera in their places, nor is it tantamount to inert packing material. Instead, it offers clinically meaningful means of protection from impacts and overuse, distributing mechanical forces to reduce harm when moving and falling. Fascia supports, houses, and protects nerves that ferry proprioceptive signals from the periphery to the brain. It moves fluids and modulates their pressures in organs, vessels, muscles, and joints. In health, fascia fulfills its function seamlessly and without much notice. On the other hand, when tense, thickened, and restrictive, fascia inhibits motion, slows fluid distribution, and generates discomfort that spreads along its routes and throughout its reach. Fascia, when tense, is a physical medicine problem that requires physical medicine solutions. This is where integrative veterinary methodologies—acupuncture, massage, photomedicine, and more—bring fascia back to health better than any drug or surgery ever could. As integrative rehabilitators, we begin assessing patients with observation of movement and posture to examine how, where, and why our patients are struggling to rise, have imbalances in gait, and exhibit abnormalities in posture. We then proceed with palpation, ascertaining the amount of heat, tension, restriction, thickening, and tenderness in the myofascial, from head to tail, and topline to toe. We feel for warmth, which may indicate inflammation but might, instead, signal circulatory shifts driven by cellular signaling and autonomic dysregulation in a region that has lost touch with the body’s autoregulatory capacities. As we compile these findings and couple them with a patient’s history and relevant diagnostics, a picture emerges that frequently extends more broadly and affects the individual more profoundly than initially recognized. Careful and comprehensive analyses like these go far in keeping the whole patient in focus, providing insight on ways to proceed with safe and effective treatments that encourage restoration of form and function that align with the body’s intrinsic self-healing capacities. But first, we need to know more about what fascia is, what it does, and how to help it heal. The anatomy of fascia Much of the fascia in our bodies consists of sheets of connective tissue just beneath the skin. This subcutaneous, or “loose” (areolar) superficial fascia contains variable numbers of fibroblasts intermingled with loosely interwoven and disorderly collagen and elastic fibers. They live within the gelatinous extracellular matrix, saturated with glycosaminoglycans, proteoglycans, and polysaccharides. While visible grossly, the superficial layer does not stay at the surface. Rather, “it permeates the entire body, enveloping the organs and forming the stroma, the neurovascular branches, and the different fascia of the muscle districts, finally resting on the deep fascia…The various layers communicate by a microvacuolar system, which is in turn composed of the same structures as the superficial fascia; it is a microscopic web concerning vessels and nerves, in varying directions, and is highly deformable.”3 Deep fascia, in contrast, surrounds muscles, nerves, vessels, and bone. It typically has a more fibrous (and thick) nature with collagen fibers arranged in a more similar (parallel) direction with loads of hyaluronic acid. Then there are the fibroblasts. Again, from Bordoni: “The fibroblasts are the foundation of the fascial system. They play a fundamental role in conveying tension and can dynamically affect mechanical tension, rapidly remodeling their cytoskeletons, without turning into myofibroblasts; this mechanism can occur in a few moments, as the result of a physiological change in length sustained by the fascia. When the fascial tissue lengthens, the fibroblasts flatten themselves and expand, increasing their area of action. In this way, the fascia can sustain the tension without difficulty, as the flattening and lengthening of the fibroblasts result in a slighter and more sustainable strain…The fibroblast’s cytoskeleton is made of microtubules, namely, actin filaments and intermediate filaments; specifically, the flexibility of actin enables a more rapid adaptation of the fibroblasts in the presence of compressive forces, due to the lengthening of the fascia.”4 In addition to responding to mechanical stimuli, fibroblasts also serve as growth factor factories, secreting a panoply of soluble substances, including insulin-like growth factors, fibroblast growth factors, and hepatocyte growth factor, along with interleukins and nitric oxide. Further, in terms of the endocannabinoid system: “The cannabinoid receptor (CB1) is mainly housed in the nervous system, but it can be found in the fascial system and in the fibroblasts as well, particularly near the neuromuscular junction. This relationship is believed to better manage any inflammation and pain information originating in the fascial tissue, as the fascia undergoes continuous remodeling during the day.”5 Over the past two decades, researchers have delved more deeply into how and why fascial restrictions and other changes link to common pain and movement disorders. As an example, a paper by the osteopathic anatomist Frank Willard described the thoracolumbar fascia (TLF) in detail.6 As an aside, how many of us remember examining and reflecting on the thoracolumbar fascia in veterinary school, contemplating the ways in which it impacts posture, load transfer, and respiration in the living patient? Did we realize its complexity, given that its many layers of aponeurosis unite to form an endogenous back brace in the caudal back and pelvis? Were we informed about its role in supporting the back during static and dynamic postures, in addition to assisting with respiration? Perhaps it's time for an update? Even more surprising is the finding that fascia, particularly the TLF, possesses an impressive supply of sympathetic fibers. Willard et al. note: “The high density of sympathetic nerves in fascia is certainly intriguing and merits further exploration. Staubesand et al. (1997), as well as Tesarz et al. (2011), proposed that a close relation could exist between the sympathetic nervous system and the pathophysiology of fascial disorders. This could potentially explain why some patients with low back pain report increased intensity of pain when they are under psychological stress (Chou & Shekelle, 2010). Based on this information, it is feasible that the stimulation of intrafascial sympathetic afferents (e.g. via manual medicine therapy) may trigger modifications in global autonomic nervous system tone, as well as in local circulation and matrix hydration (Schleip, 2003).”7 The more we learn about the innervation of fascia, the better we will be able to design and specifically tailor our integrative rehabilitation approaches according to the needs of each patient. From Willard: “Clarification of the potential proprioceptive role of the TLF could have important implications, not only for surgery but also for clinical rehabilitation of patients with low back pain. Several studies have supported the concept of a mutually antagonistic relationship between low back pain and lumbar proprioception. The presence of low back pain tends to associate with reduced lumbar proprioception (Leinonen et al. 2003; O’Sullivan et al. 2003), and inhibition of proprioceptive signaling induces a strong augmentation of pain sensitivity (Lambertz et al. 2006). Such mutually antagonistic influences could occur via polymodal ‘wide dynamic range neurons’ in the dorsal horn of the spinal cord. Various treatments, such as manual therapy or exercise programs, have been proposed for increasing lumbar proprioception in patients with low back pain. An improved understanding of the proprioceptive capacity of human TLF could possibly increase their effectiveness. The inter-relationship between low back pain and abnormal proprioceptive sensory information has recently been reviewed by Brumagne et al. (2010).”8 Integrative rehabilitation excels at promoting proprioception. Research has verified the effects of acupuncture on fascial stiffness9 and the effectiveness of paravertebral nerve blocks.10 Massage11 and stretching12 reduce fascial thickness and stiffness, respectively, while laser therapy and extracorporeal shockwave therapy reduce pain and increase patient satisfaction in patients with plantar fasciitis.13 What’s the best part of all these approaches? They don’t destroy tissue, don’t permanently alter the anatomy, and have a relatively high safety record and patient acceptability. Another reason to try integrative medicine and rehabilitation first, instead of surgery. After examining hundreds of animals with pain, I observed a clear link between abnormal hair coat patterns (such as flattened or persistently erect hair) and underlying fascial restrictions. I observed that hair coat changes often corresponded to postural abnormalities. These two downloadable handouts describe my approach more fully: “How to See a Cat” and “How to See a Dog” Examples of hair coat changes in a painful cat appear in Figures 1 and 2. Lines have been added to denote borders between flattened, normal, and continually erect areas of fur. Learn more about Kayla, a 13-year-old feline patient of Lan Xiao, DVM, cVMA, whose case report is available online. Figure 1. Kayla’s hair coat is flattening from the lateral perspective, especially notable along the paraspinal region and over the sacrum. Photos courtesy Dr. Lan Xiao Figure 2. This dorsal view of Kayla’s hair coat further illustrates the paraspinal fur flattening along with banding along the cervical, caudal scapular, and mid-truncal locations. Subsequent radiographs revealed osteoarthritis of the hips and lumbosacral junction. The client reported that Kayla had difficulty rising after rest; her mobility was also declining, and she was no longer using the stairs. Further, “Kayla started to spend more time in just one room of the house and eventually spent most of her time hiding under the bed.” After three treatments of medical acupuncture, Kayla’s hair coat, posture, and mobility all improved. Watch the before-and-after comparison online. Narda G. Robinson, DO, DVM, MS, FAAMA, practices osteopathic medicine and veterinary medicine. Dr. Robinson taught science-based integrative medicine at the Colorado State University College of Veterinary Medicine and Biomedical Sciences for 20 years. In 2016, Robinson established her academy in Fort Collins, Colo., where she teaches medical acupuncture, integrative rehabilitation, medical massage, and other integrative medical approaches. Dr. Robinson plans to offer programs in Sidney, British Columbia, beginning in 2026. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. References Johns Hopkins Medicine website. Muscle pain: It may actually be your fascia. Accessed at https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia on 09-09-25. Bordoni B and Zanier E. Understanding fibroblasts in order to comprehend the osteopathic treatment of the fascia. Evidence Based Complementary and Alternative Medicine. Volume 2015, Article ID 860934, 7 pages. http://dx.doi.org/10.1155/2015/860934 Ibid. Ibid. Ibid. Willard, FH, Vleeming A, Schuenke MD, et al. Review. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221:507-536. Ibid. Ibid. Maemichi T, Matsumoto M, Meguriya S, Furusho A, Yamashita T, Tsutsui T and Kumai T (2024) Effect of low-frequency acupuncture on muscle and fascia stiffness: examination with or without intervention. Front. Rehabil. Sci. 5:1324000. doi: 10.3389/fresc.2024.1324000. Gao X, Wang C, Ni Y, et al. Clinical effect of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia: a randomized parallel-controlled study. JTCM. 2023;43(2):359-364. Chao Y, Huang X, Ying L, et al. Acute effects of percussive massage therapy on thoracolumbar fascia thickness and ultrasound echo intensity in healthy male individuals: a randomized controlled trial. Int J Environ Res Public Health. 2023, 20, 1073. Warneke K, Rabitsch T, Dobert P, et al. The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study. European Journal of Applied Physiology. 2024;124:2809-2818. Bidoki MZ, Nasab MRV, and Aghda AK. Comparison of high-intensity laser therapy with extracorporeal shock wave therapy in the treatment of patients with plantar fasciitis: a double-blind randomized clinical trial. Iran JMed Sci. 2024;49(3): 147-155.
