Chronic Muscle Pain That Won’t Heal? It May Be Your Fascia

Los Angeles is a city built on movement – trail runs in Runyon Canyon, tennis in Beverly Hills, long days hunched over a laptop in Century City, and the occasional weekend that ends in a pulled hamstring or a tweaked lower back. Most of the time the body sorts it out. But a surprising number of our patients arrive with the opposite story: an injury that technically resolved, yet a dull, nagging pain that simply won’t quit. Scans come back “normal.” Physical therapy helped, then plateaued. The pain moved in and stayed.

When pain outlives the injury that caused it, the problem usually isn’t the muscle. It’s the connective tissue woven through and around it – the fascia. This is the same territory our founder, Dr. Jacques Courseault, covered for our New Orleans flagship in “Your Muscle Pain May Actually Be Your Fascia.” Here, we’ve written it for our Beverly Hills patients – and for the LA runners, lifters, dancers, and desk-bound professionals who keep asking why a “healed” strain still aches.

Fascia is the continuous sheet of connective tissue that wraps and links everything inside you – muscles, bones, nerves, blood vessels, and organs. Picture a full-body internal webbing that gives your frame its shape and lets your parts glide past one another as you move. It’s also richly supplied with nerve endings, which is exactly why it can be a powerful source of pain: research on the thoracolumbar fascia of the lower back found it to be densely innervated with sensory and pain-signaling fibers.¹

Healthy fascia is supple and slick, sliding easily as you bend, reach, and run. Under the wrong conditions – a hard injury, months of sitting, repetitive load, dehydration, or chronic stress – it can thicken, dry out, and stick to the tissues it’s meant to glide against. Those sticky spots, called adhesions, tug on nearby structures, restrict motion, and produce a deep, hard-to-locate ache that feels for all the world like a muscle problem. That mimicry is precisely why fascia gets missed.

Here’s the piece most people – and plenty of clinicians – miss: you cannot strain a muscle without also injuring its fascia. Fascia isn’t just a jacket on the outside of a muscle; it runs all the way through it. Each individual muscle fiber is sleeved in connective tissue, bundles of fibers are wrapped in their own sheath, and the whole muscle is enclosed in another – all of it continuous with the tendon and the surrounding fascial network.

Because muscle and fascia are physically braided together, force actually travels through this connective-tissue scaffold, not just down the muscle belly. So the instant a muscle is pulled or torn, the fascia inside and around it tears at the same moment – and a large part of true healing is remodeling that connective-tissue framework, not merely patching the muscle cells.^2,3 This is the reason so many “muscle” strains never fully close the loop: the muscle recovers, but the fascia stays thickened, disorganized, or stuck – and keeps firing off pain and stiffness long after you expected to be back to normal. Addressing the fascia is what finishes the job.

When tight fascia starts compressing the muscle underneath, it can generate those stubborn “trigger points” – the spots that stay sore no matter how much you stretch or foam-roll. When this becomes a pattern, it’s often diagnosed as myofascial pain syndrome: chronic regional pain, tender knots in taut bands of tissue, and pain that can radiate to seemingly unrelated places. It’s common, frequently missed, and by definition “chronic” once it lingers past about six months.⁴

Real treatment isn’t about numbing the ache – it’s about getting the fascia to release and glide again. At FIT LA, that starts with finding exactly where the tissue is stuck. A Fascial Mapping™ exam is a systematic, ultrasound-guided assessment of the fascia across the body, so we’re treating the source rather than chasing the symptom. Where we find adhesions, Hydrofascia Release™ – our ultrasound-guided form of hydrodissection – can free scarred, glued fascial planes; Dr. Courseault first described this approach for stubborn hamstring pain in a 2019 sports-medicine paper, and an independent 2025 study reported the same technique resolving persistent post-strain pain with no recurrence at follow-up.^5,6 Depending on the case, we may also use shockwave therapy or HUMAN TECAR® therapy, which uses radiofrequency energy to drive deep, targeted heat into fascial tissue to improve circulation and recovery.

This whole approach – diagnosing and treating fascia as the tissue it is – is what we call Fascia Medicine. And when chronic, body-wide pain is paired with joints that feel loose or “bendy,” we also screen for the connective-tissue conditions covered by our Hypermobility & EDS program, since lax fascia is a common thread.

Chasing relief without results?

Let’s find out what’s actually driving your pain.

At The Fascia Institute of LA in Beverly Hills, we specialize in the stubborn, “everything’s normal but it still hurts” cases – especially when fascia is the missing piece. In-clinic and California telehealth consultations available; the Golden Triangle office is about 5-10 minutes from Century City.

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The Fascia Institute and Treatment Center® of LA · 415 North Crescent Drive, Suite 130, Beverly Hills, CA 90210 · (424) 378-3488

Medically reviewed by Jacques Courseault, MD, CAQSM, FAAPMR, founder and medical director of The Fascia Institute and Treatment Center.

References

1. Tesarz J, et al. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience. 2011. PMID: 21839150.
2. Järvinen TA, et al. Muscle injuries: biology and treatment. Am J Sports Med. 2005;33(5):745-64. PMID: 15851777.
3. Zügel M, et al. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med. 2018;52(23):1497. PMID: 30072398. doi:10.1136/bjsports-2018-099308.
4. Myofascial Pain Syndrome. StatPearls. 2024. PMID: 29763057.
5. Courseault J, et al. Fascial hydrodissection for the treatment of chronic hamstring pain. Curr Sports Med Rep. 2019;18(11):416-420. PMID: 31702723. doi:10.1249/JSR.0000000000000650.
6. Shiwaku K, et al. Ultrasound-guided fascial hydrorelease for persistent pain after hamstring injury. J Funct Morphol Kinesiol. 2025;10(3):318. PMC: PMC12371940. doi:10.3390/jfmk10030318.

This article is for general education and is not a substitute for individualized medical advice. If you have chronic or worsening pain, please consult a qualified clinician.