Therapeutic mechanisms of fascia manipulation: A scoping review

Background Fascia manipulation is gaining attention due to their potential benefits in pain management, neuromuscular function, and tissue healing. However, the mechanisms underlying these effects remain unclear, limiting treatment optimization. Objectives This scoping review (ScR) aimed to summarize current evidence on the physiological, structural, and neuromuscular mechanisms underlying fascia manipulation as a therapeutic intervention. Methods This ScR followed the Joanna Briggs Institute guidance. A comprehensive search of MEDLINE, Web of Science, CINAHL, Cochrane Central, EMBASE, Scopus, PEDro, ClinicalTrials.gov, and ICTRP was conducted in January 2025. Two independent reviewers selected studies and extracted data. Two independent reviewers selected studies and extracted data. Results Eleven studies were included: eight on humans and three on animals. In humans, manual therapy triggered a transient local inflammatory response, raising temperature without activating coagulation or thrombosis risk. It also reduced unbound water in deep fascia, aiding pain relief and mobility. Animal studies showed anti-inflammatory effects via cytokine regulation and adenosine receptor involvement, with caffeine blocking pain relief. Massage-like stroking produced opioid-independent analgesia. Fascia manipulation relieved pain from densification and improved proprioception. Neuromusculary, it enhanced reaction time, movement efficiency, and motor performance, lasting up to a week. Conclusions This ScR suggests that fascia manipulation exerts its therapeutic effects through a combination of anti-inflammatory cytokine modulation, mechanoreceptor stimulation, and improvement in fascial gliding and proprioceptive feedback. These mechanisms collectively support its role in pain relief and neuromuscular function. Further research using standardized protocols and objective outcome measures is needed to validate and expand upon these findings.