What is Fascial Manipulation, and Why do I love it for Hypermobile patients and Chronic Pain?

I've been treating hypermobility, Ehlers Danlos, and chronic pain for years, and some of the biggest leaps around joint stabilization, exercise modulation ave made huge changes for me in my own life, and for my clients.

Fascial Manipulation feels like the next game changer in terms of manual therapy for my clients, in its ability to identify restrictions, provide explanations for physical sensations of chronic and constant pain, and make long lasting change.

So, what is Fascial Manipluation? Fascial Manipulation is a manual therapy modality and system created by Luigi Stecco, and carried forward by his two children, Carla and Antonio Stecco. Luigi Stecco is an Italian born physical therapist, who wanted to dive in depth on a organ he saw little human study of, but saw all the time when processing rabbits, chickens, and other animals at home for meals, and address pain that was non responsive to other modalities.

(https://www.fascialmanipulation-stecco.com/)

Fascia is the rising star in body worker world, and movement world, and we're gaining an increasing awareness on how it plays a role in numerous functions, from sensory input and interoception, to autonomic regulation, to injuries and extracellular communication.

If you wanna nerd out about science, keep reading! If you wanna skip it, scroll on down!

I often think of fascia as the wrapping around our musculature, that doubles bags compartments, and our organs. It also sends fibers even to the nuclei of cells, creating 3D tension structures that make fascia. matrix of support that our cells and tissues are constantly supported by, and interacting with. (https://pmc.ncbi.nlm.nih.gov/articles/PMC7866861/). Specifically, our fascia is divided into superficial and deep fascia, creating a sliding system. This allows our tissues to slide and glide over one another, as we move around; think about the way your shirt moves as you bend and twist. If it didn't your movement would be severely restricted.

The Stecco's have demonstrated that this area between the superficial and deep fascia, is filled with ECM, extracellular matrix, goo and ions and all that good stuff, but it's also got something really nifty called Hylaronan, or Hyalouronic Acid. When HA binds to water, it's super slippery, helping those two layers of fascia slide and glide. But if we have an injury, or an inflammatory response, that area can get crowded, and HA stops binding with water, and binds to itself, and grows progressively more sticky. This stickiness then reduces the ability of the fascia to glide, and then our tissue is stuck.

That means that when we try to reach, bend, or twist, we're pulling on that restricted fascia, on those fibers that are stuck in the glue. And that's not going to feel great, because we're tugging on tissue that's been stuck down. One visual is, if you think about a rope that's anchored to a really heavy block, if you keep tugging on it trying to get somewhere, you might fray the rope before you move the block.

Fascia is also our 2nd most innervated organ, after our skin (https://www.frontiersin.org/journals/neuroanatomy/articles/10.3389/fnana.2022.981426/full#s3). This study specifically analyze the area of the hip, but the finding has been replicated in other regions of the body. This means that this organ that we historically cannot see on X-ray, or on MRI, is hugely innervated.

So, a tissue that can get stuck, restricted, and stiff, is hugely innervated, and isn't seen or identified in most imaging or diagnostics.

Sound like something that might be HUGELY relevant to our chronic pain baddies out there, or to our hypermobile humans who we KNOW have varying connective tissue? I certainly think so.

Start reading again here!

So, we know fascia is playing an enormous role in our movement, our perception, and our pain sensitivity.

What we're also seeing is growing evidence is that fascia behaves differently in hypermobile individuals. Shout out to the incredible Tina Wang leading this fascia research on the west coast, and who dropped a phenomenal paper earlier in 2025. (Her website, https://tupelopointe.com/, and the paper:https://pmc.ncbi.nlm.nih.gov/articles/PMC12193134/).

Dr. Wang found increased variation in stiffness and thickness in hypermobile individuals compared to controls, as well as changes in the gliding action of the fascia. That is to say, the fascia of hypermobile humans varies from our collagen typical neighbors. These restrictions in our fascia, its increased stiffness, all provide a scientific basis for the pain, tightness, and discomfort hypermobile individuals reports, even if they don't present with the limitations in ROM, or Xray variations, because the organ involved, isn't always going to show up on those tests. The restrictions of the fascia particularly, and it's high innervation, provide an explanation for the chronic pain and often "unexplained" pain people with EDS an HSD report.

I feel excited for the research on fascia; the more we learn about this incredible organ, the more we're able to provide a biological foundation to back up patient reports of pain and limitations. For so long, individuals with EDS have had their experiences invalidated, or been told their pain is in their head, but with this kind of research, we have evidence for a biological, body based mechanism, and a way to treat it.

That's right. With the Stecco method, a lot of those chronic pain, unexplained discomforts, can be treated. Fascial Manipluation has been shown to clinically reduce fascial stiffness, and improve fascial gliding, which is correlated with reductions of pain, increased motion (which is nice for collagen typical humans), and my patients report an increased sense of stability after the work.