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I recently spent a fantastic weekend in Houston training with Fascial Manipulation Specialists Colleen Whiteford, PT and Judy Noteboom, PT who were some of the first people to practice FM in the United States. I took my first FM course in 2023 and instantly saw the potential of this method to treat chronic pain, my area of interest. Having worked with the RedCord® method for years, my mind was already focused on myofascial chains. However, I knew there was something lacking in purely using a movement approach to resolve disturbances in the myofascial chain, and it was FM!
FM provides a method of locating and resolving the physical site of the myofascial dysfunction in order to improve neuromuscular control and mobility and decrease pain. The technique is not well known in the United States due to the lack of access to training in the past, but my suspicion is that it will gain in popularity in the coming years as American patients are exposed to this unique and effective method for treating a variety of conditions, from acute/chronic pain to headaches to urinary incontinence.
What is Fascial Manipulation?
The Fascial Manipulation by Stecco (FM) method is a manual method for the treatment of fascial dysfunction and myofascial pain. FM was developed by Luigi Stecco, PT, in collaboration with his children Carla Stecco and Antonio Stecco (both MDs, PhDs), over the last 40 years. The FM model couples the intelligence of Traditional Chinese Medicine’s meridian system with extensive research on the anatomy and physiology of the fascial system to create a holistic system for treating pain and internal organ dysfunction.
The goal of FM is to improve biomechanics, increase mobility, normalize organ function, and decrease pain through treatment of dysfunction in deep fascia. FM is particularly effective in treating hard-to-treat, chronic conditions due its ability to look at the body as a whole, not just where it hurts. Many approaches target only the main complaint in treatment; however, this symptom-focused mindset often falls short as it may overlook the actual cause of the complaint, which may be located elsewhere in the body. The Stecco methodology can explain how multi-pain sites and ‘random’ pains can be potentially linked to old internal or musculoskeletal injuries. Treatment to release the fascial tissue along lines of tension helps restore muscle balance and clears pain.
What should I expect during the assessment and treatment?
Your therapist will begin the assessment by taking a thorough history of current and previous pain and injury. She will use this history to form a hypothesis on the root cause and how it has evolved. There will be a strong focus on old injuries that may have created an original myofascial insult causing compensation patterns. Your therapist will perform a quick movement screening of the relevant areas followed by manually assessing various myofascial points of the body. Assessment of the deep fascia on points of the body called “Centers of Coordination” or “Centers of Fusion” is performed in order to identify “densifications” - or areas where fascia is rigid and not properly gliding. This may be performed in supine, prone, sidelying, or seated. Do not be surprised if these areas are far from the site of pain, as the body is connected from head to toe by myofascial chains that, if interrupted, can cause a disturbance further up or down the chain. These may feel like muscle knots or sharp trigger points. At times the pain may radiate to other parts of the body or reproduce your symptoms. You will be asked to provide feedback on pain level during palpation of these points and if there is any radiating or familiar pain. Treatment will be directed on areas with the most densification. Your therapist will use fingertips, knuckles, elbows, or fascial tools to resolve densifications. Each area may be treated from 2-10 minutes, depending on the stubbornness of the densification. Older densifications may take longer to treat. About four to six areas may be treated each session. Treatment can be painful, however as the densification resolves the pain level should decrease quickly. If appropriate, dry needling (with or without electrical stimulation), heat, or percussive devices may be used to assist the process.
How should I prepare?
Wear loose-fitted clothing, such as shorts with an elastic waistband and loose shirts. Ladies may wish to wear a sports bra, as you may be asked to remove your shirt in order to better access to the fascial points. Please do not wear tights. On the day of your treatment, avoid applying oily lotions/creams or wearing makeup, as some areas of the face and around the eye may be treated.
Please bring a written history of your previous injuries, surgeries, traumas, fractures, and movement dysfunctions to your appointment. This history should include the injury/pain location, date (month/year) of initial onset, mechanism of injury, current/min/max pain levels on a scale of 1-10, and resulting movement limitations, if any.
What should I expect after the treatment?
The treated areas may be sore and tender for a few days following treatment. Try to avoid anti-inflammatory medications (unless prescribed) as these may reduce the effectiveness of the treatment, which is intended to stimulate inflammation in order to break down the areas of densification. Following treatment, do not engage in novel or strenuous activity. Try to rest the body and perform normal activities. It is important to stay hydrated and get enough sleep.
If there is an increase or change in pain, this needs to be communicated to your therapist and can be resolved by improving treatment balance next session.
How many sessions will it take to fix my issue?
It is difficult to estimate how many treatments are required to resolve your issue. Acute injuries (less than 1 month since initial onset) may resolve quickly in just 1-2 sessions, while more chronic, complex, or multi-site cases may require a longer period of treatment to resolve. Exercises may be recommended in order to maintain results and sustain balance and flexibility across the myofascial chains.
Dr. Angel Young, PT, DPT, is a physical therapist and owner of Bodylove Physiotherapy & Pilates, specializing in 1-on-1 physical therapy in Bastrop, Texas using Clinical Pilates, Dry Needling, Stecco Fascial Manipulation, Manual Therapy, and RedCord. She is working towards completing her education in Fascial Manipulation to become a certified Fascial Manipulation provider. She is passionate about helping people feel strong, capable, and wonderful in their bodies.