Q&A: Healing the Fascia for Pain Management with Dr. Hal Blatman

“When practitioners learn how to treat damaged fascia, they can help their patients get out of pain like theu never knew before,” said Hal Blatman, MD, at the Integrative Healthcare Symposium in New York City.

In his presentation, Dr. Blatman, a board-certified practitioner in integrative medicine and occupational and Environmental Medicine, discussed the importance of treating fascia for pain management. We caught up with Dr. Blatman before his presentation to discuss how pain originates from damaged fascia, how it gets damaged in the first place, and how to fix it.

Integrative Practitioner: What are you going to be talking about today? 

Dr. Blatman: What we were taught is, for the most part, not even relevant to what really causes pain. Your headache doesn't come from your head; the pain in your knee doesn't come from your joint. The headache is not an occipital neuralgia. It doesn't come from the nerve, and the pelvic pain is not pudendal neuralgia that doesn't come from the nerve either. Phantom limb pain is not central. It's peripheral. You're not making it up; it doesn't come from your brain. Almost all this pain in everyone's body comes from a lifetime. of injuries to the fascia that hold us together. And what needs to happen to make the pain go away? Is that the fascia cords that became kinked from injury need to unkink, and where that fascia anchors to hold you together, that anchor needs to be restored.

Integrative Practitioner: Okay, let’s take a step back; what is fascia?

Dr. Blatman: So, if you have a steak on the plate in front of you, and instead of cooking it and cutting it and eating it, you grab it by the edges, and you gently pull it apart. If you have a microscope, you'll see a thin film around every muscle cell and fiber. And with your naked eye, you can see the film that goes around and through the steak to hold it together. You can see the marbleized muscle fibers in between that stuff that holds them together. 

Well, those are strings of fascia. And they come together and coalesce to form the gristle that you don't want to chew into, and you cut off. That's your tendon, which doesn't attach to bone anywhere in your body. It weaves through the cover over your bone and continues in the next muscle with no interruption from head to toe.

It's one net. It’s what holds you together on the inside. It's what keeps your uterus and ovaries suspended in your pelvis. It's what keeps your heart in place and your intestines organized instead of falling through the floor of your pelvis. And there's a fascia that surrounds your gallbladder and holds it together and in place. And on the top of your hand, the fascia is loose on the bottom and palm. You don't have nearly as much play. It's constructed differently, so it holds together tighter.

Integrative Practitioner: Why isn't the fascia more well-known if it’s so important?

Dr. Blatman: When we were in medical school, we all did dissection. We took apart people who had passed away. And in doing so, we would clean off and cut away the fascia to get the things that were more important. Never realizing that what we cut away was one of the most important things we could have learned. We were taught to discard the fascia. And if you go into the operating room today, any fascia that gets cut out on the way to do whatever they need to do gets thrown away. I mean, it goes to the pathology lab on the way to be identified, but it's not retained, and it's not put back in the body and the connections. 

Integrative Practitioner: How does fascia get damaged?

Dr. Blatman: A lifetime of injuries from impact. Check your hand. Feel the ropes and cords in there as you go down and feel how tender they are in some places you didn't expect. Now, take your fingers and touch the top of your collarbone. Push in and down. And as you're pushing down, feel those little irregularities that are surprisingly tender. 

This is the injury that causes the kinks in those strings. And the first time you got that injury, you were an infant, and somebody picked you up by your shoulders and forgot to bring your head up. Another time, you were on the playground, and some little kid came up behind you and shoved you to the ground, which snapped your head back. That tore the strings and cords of fascia that go through this muscle and weave through the cover over this bone before they come down into your chest. 

Take your hand and get a big bite of the PEC muscle, running your thumb across that. Feel the ropes and courts in there. You got that injury when you did too many push-ups in high school or when you fell on your face and put your arms out to protect yourself. 

Integrative Practitioner: It sounds like you're going to get these injuries no matter what you do; we all grow up this way. So, when does damaged fascia lead to pain?

When you have that pain, some of those kinks are no longer ignorable. You don't need to be perfect and injury-free. All you need to be is 99 percent ignorable, all over your body, and that is achievable by almost everybody in pain. 

Integrative Practitioner: How do you go about treating this damaged fascia? 

Dr. Blatman: I have five rules:

1. You cannot believe the pain comes from where you feel it. Your headache doesn't come from your head, blood vessels, or nerves. The pain in your left arm could be your heart attack. You have no idea.
2. What you think the pain feels like is not important. Your brain can't distinguish between numbness, tingling, burning, itch, tickle, sharp, dull, achy, and stabbing. In clinical practice, we spend lots of time saying, "Hi, Mrs. Smith. Where do you hurt today? Oh, where does it burn? Where do you tingle?” None of it matters. They all come from the same issue. You can't even distinguish sexual arousal. The same nerves that go to the same part of your brain are the pain. 
3. At the end of the day, the only thing you can believe is what you can touch and feel. Where you are specifically tender millimeter by millimeter is where your strings are kinked and tightened.
4. The places where you are most tender represent the kings and injuries through your lifetime that generate most of the pain you are conscious of. That means the loudest ones get noticed, and the others are ignorable. 
5. More than 90 percent of the time, no matter how long you've had the pain and no matter what you think is your diagnosis, as quickly as you unkink and strengthen the strings well enough so you don't tear apart when you pull hard again, the pain you saw you had will already be gone.

Editor's note: This interview has been edited and condensed.