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Massage.
Physiology of massageDraft

Fascia

Fascia is the connective tissue web that wraps and links muscles and organs; the popular idea that massage physically "releases" or stretches it is not supported, and felt changes are more likely due to the nervous system.

Evidence
limited

Reviews of myofascial release trials are mixed; one found encouraging but variable results, and a more critical review found the evidence insufficient for chronic musculoskeletal pain. A modelling study found the forces needed to deform dense fascia (fascia lata, plantar fascia) are far beyond what hands can apply, and a 2026 meta-analysis of 25 trials found massage did not acutely change muscle or tendon stiffness. The felt "release" is best explained by nervous-system changes, not by tissue being physically reshaped.

Effects

  • Clients often report feeling looser and moving more freely after massage
  • Small short-term gains in flexibility have been measured after massage
  • Therapists often feel tissue "soften" or "release" under the hands during slow sustained pressure
  • Laboratory and modelling studies do not show that hand pressure changes the length or stiffness of dense fascia or muscle

What fascia is

Fascia is connective tissue made mostly of collagen fibres. It forms a continuous three-dimensional web through the body:

  • Superficial fascia sits just under the skin, mixed with fat.
  • Deep fascia is denser. It wraps muscles and groups of muscles, for example the tough fascia lata around the thigh.
  • Fascia also surrounds individual muscle fibres, bundles of fibres, nerves, vessels and organs, and helps transmit force between neighbouring muscles.

Fascia contains many sensory nerve endings, so it is part of how we sense movement, position and pain.

What massage probably does and doesn’t do

A common claim is that massage “breaks down adhesions”, “melts” or “lengthens” fascia. The evidence does not support this:

  • A modelling study calculated that very large forces, far beyond normal hand pressure, would be needed to change dense fascia such as the fascia lata or plantar fascia by even 1%. Softer, superficial fascia deforms more easily.
  • A 2026 meta-analysis of 25 trials found massage did not acutely change the stiffness of muscles, tendons or the muscle–tendon unit.

So why do clients feel looser, and why do therapists feel tissue soften? The most likely explanation is the nervous system: pressure and stretch change muscle tone and how the brain interprets sensations from the area (see Muscle tone and flexibility and Pain, the pain gate and the nervous system). The tissue feels different because the person is holding it differently, not because it has been reshaped.

Myofascial release

Myofascial release (MFR) is a beyond-scope technique using slow, sustained pressure and stretch. Trial results are mixed: one review was encouraging, while a stricter review of chronic musculoskeletal pain found the evidence too weak to recommend it.

How to talk about it with clients

  • Say: “Slow, sustained pressure like this often helps an area feel less tight.”
  • Avoid: “I’m breaking up your adhesions” or “your fascia is stuck.”

Sources

  1. Zügel M et al. (2018). Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med 52(23):1497
  2. Chaudhry H et al. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc 108(8):379–390
  3. Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA (2015). Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther 19(1):102–112
  4. Laimi K et al. (2018). Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil 32(4):440–450
  5. Löbell R et al. (2026). Short-term effectiveness of massage techniques on myotendinous structures' stiffness: a systematic review and meta-analysis. Res Sports Med (online ahead of print)
  6. Wikipedia: Fascia