Deep Friction Fascia Manipulation for Pain-Free Movement

Moving effortlessly without pain or stiffness is something we take for granted in our youth. But as time marches on, the body’s structures succumb to internal and external forces that inhibit movement and cause pain. However, loss of pain-free mobility is not inevitable.

Much of reduced mobility can be attributed to the densification of fascia, a vast system of connective tissue that links and encases the body’s organs, muscles, bones and nerves. Fascia provides structural support to your body’s systems, allowing them to operate in harmony. The integrity of fascia relies heavily on hyaluronan (HA), a polysaccharide molecule that is ubiquitous throughout the body.

Learn about the properties of hyaluronan, its role in the human body, and how deep friction Stecco therapy can help reconstitute hyaluronan to restore the functional properties of densified fascia.

Hyaluronan and the Extracellular Matrix (ECM)

Hyaluronan (HA), sometimes called hyaluronic acid, is a polysaccharide molecule commonly found in vertebrates. Within the body’s tissues, hyaluronan has a high capacity to bind to water molecules, with the ability to retain up to 10X its dry weight, creating a viscous gel-like environment.

HA is a dynamic molecule with a rapid turnover rate, ranging from mere minutes within the bloodstream, to 12-24 hours in skin tissue. HA’s dynamic turnover rate makes it highly adaptable to the needs of various tissue types.

HA is found in varying concentrations throughout the body, with its highest levels found in:

  • Umbilical cord
  • Joint synovial fluid
  • Vitreous body of the eye
  • Skin (accounting for around 50% of total body HA)
  • Fascia

HA is an abundant component of the extracellular matrix (ECM) — the space between cells that regulates critical cellular functions such as motility, survival, proliferation, and differentiation. HA provides a matrix through which cells can migrate.

When initially discovered in 1934, HA was thought to merely be an inert space filler surrounded by water molecules, helping the body’s tissues to maintain their structure and preventing dehydration. We now know that HA is a critical element involved in a variety of biological and physiological processes.

Within the ECM, HA provides mechanical stability while acting as a water reservoir and lubricant. HA plays an active role in regulating inflammation, repairing injured tissues and healing wounds. HA is a key element in synovial fluid, lubricating joints and preventing friction during movement.

Hyaluronan’s unique properties are responsible for the elasticity of the skin and fascia, giving them the ability to stretch and glide as you move.

Fascia and Hyaluronon

Fascia is a thin tough sheath of connective tissue that encases and connects muscles and internal organs throughout your body, providing stability and enabling soft tissues, bones, blood vessels and neural bodies to glide freely during movement.

Healthy fascia is slippery, smooth and elastic. It is made up of collagenous layers and lubricated by hyaluronan, providing a fluid environment that enables it to stretch and glide as you move.

Fascia is generously embedded with proprioceptors — mechanoreceptors that communicate your body’s position to your brain. Fascia is also highly innervated, making it a significant pain generator. Fascia tissue is up to 5X more sensitive than muscle tissue. Fascia not only surrounds muscles, but it also engulfs the visceral organs and has a profound relationship to internal disease.

Multiple factors can interfere with the function of fascia tissue, including:

  • Aging
  • Surgery
  • Genetics
  • Lifestyle factors like diet and exercise
  • Trauma
  • Overuse
  • Metabolic disease

Fascia is considered a loose connective tissue that can become too lax or too stiff. At either extreme, fascia loses its integrity and its ability to stabilize and facilitate movement.

Causes of Fascia Densification

When HA concentrations in the fascia are altered, it changes the viscosity of fascia layers, causing them to become densified. Densified fascia is rigid and loses its ability to slide properly between muscle and deep fascia interfaces. Densified fascia is sticky and inelastic, sometimes adhering to other structures and entrapping nerves and blood vessels. Fascia densification can impact related muscles and organs, causing pain and impairing mobility.

Changes in fascia viscosity can be brought on by a variety of factors:

Poor nutrition

Fascia tissue is made up of collagen, a structural protein. A low-protein diet, such as a vegan diet, can deprive your fascia of the building blocks it needs to maintain its structural integrity. In addition, diets high in sugar and carbohydrates can lead to glycation of the fascia, a process where sugar molecules bind to fascia proteins, causing them to thicken and become stiff.

Chronic dehydration

A chief property of hyaluronan is its capacity to bind to water molecules, giving fascia the ability to stretch and glide. By some estimations, up to 75% of the adult population is chronically dehydrated, depriving the body of the fluids it needs to function at its best. Insufficient water intake can severely impact the biomechanical properties of hyaluronan and the gliding capacity of fascia. Drinking one ounce of plain filtered water per kg of body weight daily is recommended to optimize hydration.

Sedentary lifestyle

During physical activity, fascia helps to coordinate movement by stretching, gliding and stabilizing your body’s structures. Being sedentary deprives your fascia of performing its vital functions, leading to densification that further inhibits mobility.


Acute traumatic injuries can damage fascia and disrupt its fundamental properties. Strategies to rehabilitate injuries should include specialized fascia manipulation techniques to restore fascia integrity and function.


Repetitive overuse is a common cause of fascia densification, especially if efforts are not made to stretch tight tissues. Allowing adequate time for recovery from sports, exercise or occupational overuse is key for tissue repair.


Invasive surgery that cuts through fascia and muscle tissue generates scar tissue as part of the healing process. Fascia often densifies and adheres to scar tissue post-surgery, inhibiting movement of muscles and other structures, and sometimes entrapping nerves and blood vessels.

Obesity and Type 2 Diabetes

Obesity contributes to modifications in the ECM of fascia that alter the biomechanical properties of hyaluronan, contributing to fascia densification. Type 2 diabetes, a metabolic consequence of obesity, is thought to cause glycation and dysregulation of hyaluronan, leading to fascia thickening. Thickening of the plantar fascia is common among type 2 diabetic subjects, and may be a key factor in the onset of peripheral neuropathy.

Stecco Fascia Manipulation for Fascia and Hyaluronan

It is estimated that densified fascia and hyaluronan dysregulation are responsible for up to 50% of musculoskeletal pain and reduced mobility. Research shows that high-intensity therapies like focused shock waves and deep friction fascia manipulation can help to separate densified HA chains, fragmenting and disentangling them to restore their functional properties.

Stecco fascia manipulation is an evidence-based methodology for treating densified fascia. Stecco’s deep friction technique heats up fascia tissue and stimulates mechanical action by producing mechanical contact stress, fragmenting densified HA chains and triggering the production of new HA molecules.

When combined with other treatment modalities like shockwave therapy, Stecco fascial manipulation helps to release fascia layers and restore their fluidity and capacity to glide.

Get Stecco Fascial Manipulation Therapy in NYC

At NYDNRehab, Dr. Kalika is one of the few practitioners to combine Stecco diagnostic methodology with high resolution ultrasonography and sonoelastography. Ultrasound imaging allows us to view the fascia in motion, in real time. Sonoelsatography enables us to identify densified fascia tissue and quantify its elastic properties.

To restore fascia integrity and get back to pain-free movement contact NYDNRehab today

Request an appointment » map Our location: 11 West 25th Street 5th floor, New York, NY 10010

Dr. Kalika often combines Stecco deep friction therapy with shockwave therapy, fascia hydro manipulation, and ultrasound guided injection therapy – prolotherapy or platelet rich plasma (PRP) — to achieve positive results with some of the most difficult cases of fascia dysfunction.

If you suffer from musculoskeletal pain and dysfunction, your fascia is most likely a contributing factor. To restore fascia integrity and get back to pain-free movement, contact NYDNRehab today.


  • Caon, Ilaria, et al. “Cell energy metabolism and hyaluronan synthesis.” Journal of Histochemistry & Cytochemistry 69.1 (2021): 35-47.
  • Laurent, Torvard C., and J. Robert E. Fraser. “Hyaluronan 1.” The FASEB journal 6.7 (1992): 2397-2404.
  • Pratt, Rebecca L. “Hyaluronan and the fascial frontier.” International Journal of Molecular Sciences 22.13 (2021): 6845.
  • Stecco, Antonio, et al. “The Effect of Mechanical Stress on Hyaluronan Fragments’ Inflammatory Cascade: Clinical Implications.” Life 13.12 (2023): 2277.
  • Tamer, Tamer Mahmoud. “Hyaluronan and synovial joint: function, distribution and healing.” Interdisciplinary toxicology 6.3 (2013): 111.
  • Ugwoke, Chiedozie Kenneth, Erika Cvetko, and Nejc Umek. “Pathophysiological and therapeutic roles of fascial hyaluronan in obesity-related myofascial disease.” International Journal of Molecular Sciences 23.19 (2022): 11843.

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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