Fascial Tensions from a Massage Therapist’s Point of View

Always Huge Room to Learn

Part One

From the Author

For a little more than 30 years, I have been practicing massage therapy in the United States.

The matter of fact is that I did not find much material related to fascia, its importance, or the need to release and mobilize it—not only in massage publications, but also in physical therapy and chiropractic professional publications.

During the last 20 years, physical medicine fields have been conducting intensive research and rediscovering new evidence related to fascia and connective tissue. I remember reading material describing what was called something like:

For generations, healthcare professionals viewed fascia as little more than a passive wrapping surrounding muscles, tendons, ligaments, and internal organs. Anatomy textbooks described it as connective tissue that separated structures and provided mechanical support. During anatomical dissections, fascia was often removed simply to expose the muscles beneath it, reinforcing the misconception that it had little functional significance.

Over the past two decades, however, this view has changed dramatically.

Advances in anatomy, histology, biomechanics, rehabilitation medicine, sports science, and neuroscience have revealed that fascia is not an inert packing material, but a living, metabolically active, mechanically responsive tissue that participates in nearly every aspect of human movement and physiological function.

Today, many researchers consider the fascial system to be one of the body’s most important integrative systems.

This new understanding represents one of the most significant developments in musculoskeletal medicine in recent history.

Using this opportunity, I would like to set the record straight.

The Historical Foundation of Connective Tissue Massage

The importance of tension build-up in connective tissue and fascia, and its potential impact on chronic somatic and visceral abnormalities, was initially introduced to the medical community through the work of Austrian physical therapist Elizabeth Dickle in 1929.

As with many important discoveries, Dickle’s discovery was accidental.

For several years, she suffered from failure of arterial circulation in her lower extremities as a result of Thromboangiitis Obliterans. The disease progressed to the stage where amputation became a real possibility.

Dickle also experienced chronic lower-back pain caused by limping. While rubbing her lower back and attempting to relieve tension by grabbing and pulling the folds of skin, she noticed sensations of warmth and weak pulsations in her feet.

Intrigued by this finding, she started applying various techniques to her lower back. She noticed that the strongest sensations of warmth in her feet occurred when she pulled the skin on her lower back.

Powerful stuff.

Dickle shared her findings with Professor W. Kohlrausch. Their combined efforts, as well as later works by Professor N. Veil and Dr. Luebe in Austrian and German clinics, shaped a major method of somatic rehabilitation called Bindegewebsmassage, or connective tissue massage/fascial release and mobilization techniques as they are known throughout the world.

Since 1929, this method has been extensively utilized in inpatient and outpatient European hospitals, as well as private practices.

It has been proven to be a safe and powerful methodology of treatment. Most importantly, it has been clinically applied and evaluated for many years.

Fascia, Blood Supply, and the Development of Fascial Tension

Since I was in school, the theoretical concept was and remains:

Although fascia itself is not a highly vascular tissue compared with muscle, it receives nutrients and oxygen primarily through diffusion from nearby blood vessels and surrounding tissues.

Healthy fascial tissue depends on adequate circulation within the surrounding muscular and vascular environment.

When muscles develop chronic tension, increased tone, or prolonged contraction, several physiological changes may occur, including compression of local blood vessels and reduced microcirculation.

This creates a condition where tissues may receive less oxygen and fewer metabolic resources.

A common clinical observation is that fascial restrictions often develop together with underlying muscular dysfunction.

Chronic muscle tension can increase mechanical stress on fascial layers, while reduced circulation may contribute to changes in tissue elasticity, hydration, and the ability of fascia to glide freely between adjacent structures.

This creates a potential cycle:

From a clinical massage perspective, addressing only fascia without considering the condition of the underlying muscles and circulation may not fully resolve the problem.

Effective treatment requires understanding the relationship between:

• Muscle tone
• Vascular function
• Tissue hydration
• Nervous system regulation
• Mechanical stress

Techniques that improve soft tissue mobility, reduce excessive muscle tension, and support circulation may help restore more normal movement between fascial layers and improve overall tissue function.

Fascia should not be viewed as an isolated structure.

It is part of an integrated system where muscles, blood vessels, nerves, and connective tissues continuously influence each other.

Myofascial Syndromes and Clinical Reality

The reality is that myofascial syndromes can be crippling for a person.

In such clinical cases, including situations with radiating pain into the extremities, if MRI and other imaging examinations discover disc bulging, many patients undergo surgery.

We must remember that the build-up of chronic muscular and fascial tension cannot be directly visualized or measured by conventional MRI.

MRI is designed to detect structural abnormalities, whereas chronic muscle tension and myofascial dysfunction are primarily functional conditions that often occur without visible structural changes.

Our fingers, through soft tissue examination, can easily detect these differences. By applying specific spatial techniques, we can release this tension, restore function, and eliminate pain.

Please spend some minutes watching my video presentations.

A picture is worth thousands of words:

Continuing the Discussion: Chronic Stress and Long COVID

As a matter of fact, today’s writing is not about setting the record straight regarding the history of connective tissue massage, nor is it about treating painful myofascial disorders.

As you know, during the last five years, the main focus of my practice has been treating chronic stress-related disorders and Long COVID cases.

Every day, I successfully treat these complex multisystem conditions, including symptoms such as:

• Headaches
• Sleep disorders
• Brain fog
• Dizziness
• Short-term memory problems
• Other neurological and autonomic symptoms

It is amazing to observe how massage therapy protocols that stimulate the healing process allow people to regain their lives.

For those who missed my video presentation on this subject, you are welcome to review it again by clicking the link below.

However, I noticed that many patients, while reporting significant improvement, still experienced some degree of insufficient balance.

Dear colleagues, please keep in mind that many brain dysfunctions, including brain inflammation, insufficient brain fluid drainage, and autonomic irregularities—which I discuss extensively in my articles and video presentations—are reflected through measurable clinical changes.

We use specific demographic and functional tests to assess improvement.

Normalization of autonomic irregularity is expressed through clinical improvement. There is no other way to evaluate it.

A Conversation With My Mentor

I have a mentor who is 90 years old, a double board-certified neurologist and specialist in sports medicine and rehabilitation, with exceptional hands-on experience in medical massage.

He was also the head of a rehabilitation department and a researcher at a huge industrial complex hospital in the former city of Leningrad, where commercial, military, and passenger ocean ships were built.

More than 14,000 people worked there.

Approximately two months ago, during a long phone conversation, I explained to him my observations regarding minor balance deficits that remained after complete rehabilitation.

Patients were not complaining; they were simply reporting some remaining difficulty with balance.

Of course, I asked him what he thought about it.

My conversations with him are always like a test—he asks me questions.

My guess was:

He agreed and added:

During the first two days:

• Intravenous thrombolysis was provided when indicated.
• Antiplatelet medications were used.
• In some cases, anticoagulants were prescribed.

Starting from day three, patients received massage three times per day for 15 minutes in a sitting position, mainly focusing on the back area, using an inhibitory regime.

On the fourth day:

He explained that massage significantly increased blood fluidity, and therefore they sometimes adjusted medication dosages accordingly.

Usually, after two weeks of intensive rehabilitation, obvious clinical improvement was observed.

He incorporated passive and active movement therapy.

He explained that massage strongly stimulates the central nervous system, and in fresh cases this allowed faster restoration of function.

However, he said achieving sufficient balance was always very difficult.

The rehabilitation teams included many specialists, and they noticed that all patients who struggled with restoring balance demonstrated significant fascial tension throughout the entire body, especially in the lower extremities.

To Be Continued in Part Two

In Part Two of this article, I will explain their findings regarding poor balance and how it was not always related to brain dysfunction.

I will present the proposed protocol of fascial mobilization and release designed to improve balance.

For the last two months, I have been following the instructions I received from my mentor. The results were amazing, and improvements appeared much faster than expected.

My dear friends, for me this was a great clinical discovery, and it supports my philosophical view that I have expressed many times in my writings and videos:

I am living through one of the most fascinating periods of my professional life.

In Part Two, I will present the details I have learned.

Best wishes,
Boris