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"My intuition tells me"

Writer: Sherry Routledge
Sherry Routledge
7 days ago
4 min read

Last month a meta-analysis came out on the thoracolumbar fascia and low back pain. Fourteen studies, a thousand people, published open access in Sports Medicine - Open.


Asaf Klaf Weisman shared it. His work is all about nociception, and his whole platform is that pain starts in tissue. He's loud about it. One of his headlines literally reads "I am not my brain." We don't agree with everything he says. We read everything he writes.


Here's what he posted:


"Interesting findings. Thicker thoracolumbar fascia IS moderately correlated with low back pain, but not its movement (sliding). With most data being cross-sectional it's unclear if it's a cause or consequence of long term altered nociception. My intuition and understanding tells me thickness is an adaptation and not a cause. Maybe in 20 years there will be longitudinal data that proves me wrong. Good luck to all the bodyworkers in reducing the thickness of the fascia. At least claiming to 'improving fascial movement' to reduce low back pain can be certainly declared as pseudoscience."


We replied in the comments. Part of what we said:


"Why assume the therapeutic goal would be to reduce the thickness of the fascia at all? The more interesting biology is that thickened or stiffer fascia changes the mechanical environment of the sensory endings embedded within it. The TLF is richly innervated with nociceptive fibres, including SP and CGRP-positive afferents. So a manual therapist does not need to 'thin the fascia' or permanently improve its sliding to change pain. If a specific mechanical stimulus changes afferent firing, nociceptor sensitivity, mechanotransduction, neuropeptide signalling, or the way the nervous system interprets load from that tissue, you could change pain and movement tolerance while the fascia remains exactly the same thickness."


Then we went and read the paper properly. There's more to say than fits in a comment box.


Start with the numbers he's leaning on.


The thickness finding came from twelve studies, and the authors rated the certainty high. The sliding finding came from two. Two studies, pointing in opposite directions, with a range of possible answers so wide it covered a large effect one way, a large effect the other way, and nothing at all.


That isn't a null result. That's a shrug.


"Not significantly associated" and "we don't know yet" are very different sentences. One is a finding. The other is a to-do list. The word pseudoscience got built on the second one.


And then there's the line in the middle of his post.


"My intuition and understanding tells me thickness is an adaptation and not a cause."


Intuition. On evidence he has just finished telling us is cross-sectional and cannot establish cause. That's a perfectly fair thing to say. Scientists run on intuition and then go and test it.


But watch what happens four lines later. His hunch about causation gets to be intuition awaiting longitudinal data. Our hunch about movement gets declared pseudoscience. Same evidence. Same paper. Same paragraph.


Pseudoscience is a claim about method, not about a mechanism nobody has confirmed yet. Astrology is pseudoscience because no result could ever change it. A testable idea sitting on two underpowered studies is an open question. So is his.


Now follow his own word: nociception. He named it. "A cause or consequence of long term altered nociception."


So let's follow it. Nociception is signal from nociceptors. Nociceptors are free nerve endings. Free nerve endings live in tissue. Which tissue?


A great many of them are in this one.


Schilder and colleagues injected hypertonic saline into three tissues in healthy volunteers: the thoracolumbar fascia, the muscle underneath it, and the tissue just under the skin above it.


Fascia hurt more. It hurt longer. The pain radiated further than pain from either of the other two, and it carried more emotional weight.


Look at how people described it. Burning. Throbbing. Stinging. That combination points to both A-fibre and C-fibre nociceptors firing. Fast sharp signal and slow spreading signal, out of the same tissue.


Same needle. Same solution. Different tissue. Completely different experience.


So a nociception-first argument is a fascia argument. It has to be. You cannot say pain starts in the tissue, name altered nociception as your explanation, and then wave off one of the most pain-sensitive tissues in the low back because one imaging measure came back inconclusive in two small studies.


For what it's worth, the authors of the meta-analysis wrote their own clinical line: therapists may consider the thoracolumbar fascia once other pathology is ruled out, including multidirectional mobilization.


So what does this mean for you on Monday?


We are not claiming to move a number on an ultrasound. We are working with a richly innervated tissue, with movement, within tolerance, and watching for change in what the person in front of us can actually do.


Which is where we left it in his comments, and where we'll leave it here.


The fascia may not need to move better.


The nervous system may just need to respond to it differently.


Til next week. Happy RAPID-ing


Sherry and Rob



Sources:

The meta-analysis he posted: https://doi.org/10.1186/s40798-026-01064-3


The rest as clickable links:

 
 
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