Understanding Fascia

Understanding Fascia: Its Role, Types, and Treatment in Physical Therapy

Fascia envelops and connects structures in the body; physical therapy assesses pain and limitations of movement to determine the appropriate treatment. Persistent tension, stiffness, or a tender spot can have several causes. So-called myofascial pain primarily affects the muscles and the tissues surrounding them. The criteria used to identify it vary across studies, making it difficult to determine its prevalence.¹

Fascia is a type of connective tissue—that is, tissue that supports and connects other structures. It plays a role in providing support, enabling movement, and transmitting certain forces. It also contains nerves that are sensitive to pressure and potentially harmful stimuli. Their activity can contribute to pain, though it does not, on its own, indicate the condition of the tissue.

Three aspects of fascia help us understand its role:

• Fascia supports and connects structures: its layers surround the muscles and allow for movement between tissues. Some of these connections transmit a portion of the forces.^{2, 3}
• Myofascial release refers to manual pressure techniques: the term describes a treatment approach, but does not, on its own, identify the cause of pain.⁴
• The fascia contains sensory nerves: some are involved in detecting movement, while others are involved in responses to potentially harmful stimuli. The number and type of these nerves vary by region.^{5, 6}

This guide explores the nature of fascia, its different types, how it functions in the body, as well as the issues that can affect it and the therapeutic approaches available to treat it. To learn more about our holistic approach, check out our comprehensive guide to physical therapy.

What is Fascia?

Fascia is a collagen-rich connective tissue that envelops, supports, and connects muscles and organs, among other structures. Collagen is a protein that gives the tissue its strength. Depending on the anatomical definition, the term “fascia” refers to specific membranes or a broader set of interconnected tissues.⁷

Fascia is a living tissue. It contains cells, collagen fibers, elastic fibers, and a water-rich substance that fills the space between these elements. The fibers provide strength; their arrangement and the amount of tissue where the fibers are less tightly packed influence flexibility and glide. The composition varies between the layer located beneath the skin and the deeper layers.⁸

Fascia form anatomical connections between different regions. A piece of tissue helps illustrate how tension is transmitted, but the body also contains joints, muscles, and nerves that modify this response. Research has identified certain connections and force transfers between neighboring muscles; however, this does not automatically allow us to attribute distant pain to fascial tension.^{9, 10}

The study of fascia complements that of bones, joints, and muscles. The term “musculoskeletal” refers precisely to these structures that support the body and enable movement. The nerves present in the fascia also contribute to its sensory function.¹¹ To locate these layers, you can refer to our article on muscles.

What are the different types of fascia?

Fascia can be broadly divided into four groups: superficial fascia beneath the skin, deep fascia surrounding the muscles, visceral fascia surrounding the organs, and parietal fascia along the walls of certain cavities. These categories are used to identify their location; they do not form four identical layers throughout the body.³

Superficial Fascia

The superficial fascia is located in the hypodermis, the region beneath the skin. It may form a fibrous membrane between a superficial layer of fat and a deeper layer. Its structure and thickness vary depending on the region. Its collagen fibers are interwoven with elastic fibers.⁸

The superficial fascia facilitates the movement of the skin and the passage of small nerves and blood vessels. The fat in this region stores energy and helps insulate the body against heat loss. This function is performed by the adipose tissue, rather than by the fibrous membrane alone.

Deep Fascia

The deep fascia forms sheaths around muscles and channels for nerves and blood vessels. Hyaluronic acid, a substance that retains water, is found in particular between the fascia and the muscle. Cells called fasciacytes produce it locally; this substance helps the layers glide past one another.^{12, 13}

Deep fascia is divided into two categories:

• Aponeurotic fascia: forms broad, strong membranes that cover groups of muscles. The fascia lata, which surrounds the thigh, is one example.
• Epimysial fascia: forms the outer layer of a muscle and is more closely attached to it. It is generally thinner than aponeurotic fascia.

These sheaths support the muscles and define their relationships with neighboring tissues. Their arrangement influences how certain stresses are transmitted.¹⁴

Visceral Fascia

The visceral fascia consists of the connective tissues that surround and support the organs. It helps anchor them in the thorax—which contains the heart and lungs—as well as in the abdomen and pelvis. It accommodates their movements during breathing and digestion.

Organs also have specialized coverings: the pleura surrounding the lungs, the pericardium surrounding the heart, and the peritoneum in the abdomen. Some of these coverings have smooth surfaces called serous membranes, which facilitate gliding. These membranes and the connective tissues that support them are closely related, but the terms do not refer to exactly the same thing.³

Parietal fascia

The parietal fascia lines the walls of certain body cavities, particularly in the pelvis. The term “parietal” refers to the wall, while “visceral” refers to the organs. This distinction helps to identify the tissues surrounding a given cavity.

These structural differences help us understand the functions of the fascia.

How Does Fascia Work?

Fascia supports the body's structures, transmits certain types of tension, and contains nerves that detect mechanical or potentially harmful stimuli. These functions vary depending on the specific type of fascia being studied. Comparisons of nerve density focus on specific tissues and regions.⁵

Structural Support and Shape

Fascial sheaths separate muscle groups and help support them. Their fibers resist traction—that is, a force that pulls on the tissue. They work together with muscles, tendons, ligaments, and bones to support the body.

A flexible sheath surrounding a group of muscles illustrates this role. It contains the structures while allowing for some movement between the layers. Bones provide rigid support; connective tissues provide attachments and sheaths of varying strength.

Transmission of Mechanical Forces

Some of the force produced by a muscle is transmitted through fascial connections to neighboring tissues. These observations are based on studies in animals, on cadavers, and in living humans. The amount of force transferred depends on the specific connection and the context being studied.^{2, 3}

Research distinguishes between anatomical connections, measured forces, and clinical effects:

• Studies have measured force transmission at certain junctions between neighboring muscles. The results vary depending on the connection being studied.⁹
• Myofascial chains are sequences of muscles connected by connective tissue. Some of these connections are well documented in anatomy; however, their presence alone does not determine their role in a movement or pain.¹⁰
• A loss of movement or strength requires an evaluation of the muscles, joints, nerves, and other tissues. The term “restriction” alone is not sufficient to identify the tissue responsible.

The iliotibial band is a thickening of the fascia on the side of the thigh. A model based on five bodies donated to science estimates that it can store and then release elastic energy while running, much like a spring. This estimate applies specifically to this structure and this activity.¹⁵

Sensory Function

A review of 23 studies on innervation—the presence of nerves in tissue—describes free nerve endings and specialized receptors. Three studies—two in humans and one in mice—report a higher nerve density in certain connective tissues than in the corresponding muscle tissues. In mice, the fibers studied were denser in the dorsal fascia than in the back muscles. In sixty healthy adults, they were denser in the connective tissue within the masseter—a jaw muscle—than near its muscle cells. In the human hip, the fasciae contained networks of small nerves; the muscles had fewer nerves but with larger diameters. The result therefore depends on the structure and the measurement method used. These comparisons do not represent all fasciae or tendons.^{5, 6} Two sensory functions are described:

1. Proprioception: Receptors help detect the body’s position and movement. The brain combines this information with input from the muscles, joints, eyes, and inner ear.
2. Nociception: Certain nerve endings detect potentially harmful stimuli, such as strong pressure. This nerve activity can contribute to pain; it is not pain itself.

Nerves in the fascia can contribute to pain, just as those in muscles, joints, or other tissues can. The absence of visible damage does not prove that the fascia is the source of the pain. Our guide on chronic pain explains how several mechanisms can contribute to persistent pain.

Facilitating Movement

The layers of connective tissue can slide over one another and over the muscles. Locally produced hyaluronic acid contributes to this sliding motion. Fasciocytes have been described in these transitional regions between tissues.^{12, 11}

When you move an arm, the muscles contract and the surrounding tissues shift relative to one another. A scar or other tissue change can alter this movement. Pain and protective responses can also limit the movement, even without evidence of a fascial block.

To better understand how pain can be linked to fascia, it's important to see how this tissue forms an interconnected system throughout the body.

Does fascia form an interconnected system?

Fascia connects various structures into a network of connective tissue, with connections that vary by region. Some junctions between muscles transmit forces. This anatomical continuity does not equate to a single cause of pain throughout the body.

Research describes continuities between certain muscle groups, particularly along the back of the body. These connections are not equally well documented for all proposed chains. Distinguishing a visible connection from an effect during movement prevents us from automatically attributing a role to them in every symptom.^{16, 11}

The implications of these connections must be interpreted in light of the observations:

• A voltage can be transmitted between adjacent structures: studies show that this transfer occurs at certain junctions. Its magnitude varies from one connection to another.⁹
• Movement involves several structures: muscles generate force, joints enable movement, and fascial connections transmit certain types of tension. The precise role of each fascial chain in coordination has yet to be determined.
• Pain can alter the way a person moves: a person may avoid a movement that causes pain or rely more on another area. This change alone is not sufficient to identify a fascial restriction.

The fascia helps transmit certain forces and contains sensory nerves.²Manual therapy treatments may involve treating an area adjacent to the painful site. One model suggests that the nervous system, tissues, and context all contribute to the responses to these treatments. The precise role of each mechanism remains unclear.¹⁷

An evaluation can therefore examine the painful area and the movements of the surrounding areas. Pain that moves around can also have several causes, including muscular or neurological ones. The path of the pain alone is not enough to determine a fascial treatment.

Stiffness can affect multiple tissues. The term “fascial restriction” therefore needs to be clarified before it is used to explain symptoms.

What is a fascial restriction?

A fascial restriction refers to a presumed or observed decrease in the mobility of a fascia or its gliding motion relative to neighboring tissues. A scar can alter these tissues, but a sensation of tightness alone does not confirm such an alteration. The evaluation must also take into account muscles, joints, nerves, and pain.

There are three situations that may accompany stiffness and guide the evaluation:

Conditions Associated with Stiffness

Mechanical overload: A significant or repeated increase in exertion can cause muscle pain and stiffness. The evaluation compares the usual load, recent changes, and recovery. Pain after exertion does not indicate that the fascia fibers have lost their normal orientation.

Immobilization or reduced activity: After a period in a cast or a prolonged restriction of movement, muscles may lose strength and joints may become stiff. Changes in connective tissue may also occur. A gradual return to activity should take the injury and care instructions into account.

Trauma or injury: A tear or surgical incision triggers the repair of connective tissue. The scar then changes as it heals; its strength and mobility evolve over time. A minor injury does not necessarily result in a lasting restriction.¹⁸

Symptoms to Distinguish

A tight muscle band is a section of muscle that feels firmer to the touch. It does not necessarily indicate an adhesion—that is, a scar-like connection between neighboring tissues. Symptoms to look for include:

• Pain or tingling, which may also be caused by an irritated nerve
• A decrease in range of motion, that is, the distance or angle a joint can move
• A modified way of moving to avoid a painful motion
• A decrease in strength or activity tolerance, which must be assessed during the evaluation

An X-ray primarily shows bones. Magnetic resonance imaging, or MRI, can show various soft tissues, such as muscles and certain types of fascia. No test is chosen based solely on the word “restriction”; the healthcare professional determines what to look for based on your symptoms and their evaluation. A normal image does not confirm a fascial cause.

A tender area may exhibit changes in range of motion, with or without pain. When an examination reveals regional muscle pain and tender points, it may suggest myofascial pain. This diagnosis involves more than simply identifying tight fascia.

What is Myofascial Pain?

Myofascial pain is localized muscle pain associated with tender areas—often described as trigger points—in a tight band of muscle. It can be acute or chronic. The term “myofascial” refers to the muscle (“myo”) and the connective tissues surrounding it.¹⁹

The diagnostic criteria for myofascial pain vary across studies. This variation undermines estimates of the number of people affected and makes comparisons difficult.¹ Several other muscle, joint, or nerve problems can cause similar symptoms.

A clinical review describes trigger points as possible sources of muscle pain. It also reports good reproducibility of palpation-based localization in recent studies: the examination yielded fairly consistent results when repeated. However, the diagnostic criteria have limitations, and results may vary depending on the muscles and the signs being assessed. Repeatability alone does not prove that the point found accounts for all the pain.²⁰

Characteristics of Trigger Points

Trigger points are highly sensitive areas found within a taut muscle band. A consensus among specialists identifies three characteristics for recognizing them: a taut band, a tender point, and referred pain upon stimulation. These clinical criteria are not a perfect test.^{21, 19} The examination may reveal the following findings:

1. Localized pain upon pressure: Pressing on the point causes pain. An “active” point reproduces symptoms that the person recognizes; a “latent” point is tender on examination but does not reproduce the person’s usual symptoms.
2. Local contraction: Stimulation can cause a brief, small movement of the muscle. In a study of 133 people with shoulder pain, inserting a needle into the muscle elicited this response more often than touch alone. The study focused on the infraspinatus, a muscle located at the back of the shoulder blade.²²
3. Referred pain: Pressure can cause pain in a location other than where the finger is pressed. Its location varies; it does not necessarily follow the same pattern in every person.

Pain felt near the shoulder may therefore originate in a nearby muscle. Headaches associated with the neck or pain radiating from the buttock down the leg also require an examination of other possible causes. Pain that radiates down the leg, in particular, warrants an examination of the nerves, as irritation of the nerves can cause this symptom.

Development and Risk Factors

The mechanism underlying trigger points remains a subject of debate. Muscle overload, injury, and certain changes in activity are among the proposed factors. The assessment also examines sleep, stress, and recovery, which may accompany or influence pain.^{23, 19} Issues to discuss include:

• Repetitive movements at work or during sports
• Staying in the same position for a long time at work or while using a computer, especially if that position triggers your symptoms
• Direct or indirect trauma
• Periods of stress, fatigue, or difficulty sleeping, which can affect pain and recovery
• Recent decline in business activity or period of inactivity

Muscle soreness following unusual physical exertion and myofascial pain are not defined in the same way. The former generally follows such exertion; the latter is based on a set of regional symptoms and physical examination findings. Persistent pain warrants evaluation, but its duration alone does not confirm this diagnosis.

Impact on Operations

Localized muscle pain can interfere with several activities:

• Difficulty performing certain movements or generating force
• Sleep disturbances due to nighttime pain
• Reduced ability to perform daily or work activities
• Changing the way you move to avoid painful activities

Back, shoulder, or neck pain may involve localized muscle pain. Physical therapy addresses the issues that limit your activities. Exercises are among the options considered for myofascial pain and can help reduce pain.²⁴

How does physical therapy help treat myofascial pain?

Physical therapy helps treat myofascial pain and mobility issues through assessment, tailored exercises, and treatments selected based on the specific problems identified. Progress is measured in terms of your daily activities, mobility, and pain levels. The name of a tissue alone is not enough to determine the appropriate treatment.

What is myofascial release?

Myofascial release refers to manual pressure and stretching techniques. Practitioners describe them as interventions on the connective tissues surrounding the muscles. Protocols vary, particularly in terms of the direction, force, and duration of the pressure.⁴

A model of manual therapy proposes that pressure or movement triggers local and neurological responses, which are also influenced by the context of care. This model is used to study possible mechanisms; it does not measure the relative contribution of each factor in an individual.¹⁷

The mechanisms underlying myofascial pain and how to select appropriate interventions remain a subject of debate. Different diagnostic criteria also complicate the comparison of treatments.¹

Objectives of the Physical Therapy Plan

The goals of a physical therapy plan are set in consultation with you:

• Relieve pain that interferes with a specific activity
• Regain functional mobility, such as turning the head or raising an arm
• Improve tolerance for physical exertion and repetitive movements
• Gradually resume the activities that matter to you
• Regularly assess progress to adjust exercises and other care

Described Myofascial Release Techniques

Descriptions of myofascial release include several ways to apply the hands:

Direct technique: The practitioner applies tension to the tissues in the direction where they perceive resistance, then holds the position. The perceived resistance guides this movement; it does not, on its own, indicate a lesion or shortening of the fascia.

Indirect technique: The practitioner positions the area in a direction that offers less resistance and maintains a comfortable position. The direction of the movement distinguishes this technique from the direct technique.

Sustained pressure on a sensitive point: The practitioner applies localized pressure for a moment. The person describes the sensation so that the pressure can be adjusted or stopped.

Cross-hand technique: The practitioner places his or her hands on an area and applies pressure in opposite directions. The name describes the position of the hands and the direction of the forces.

Other techniques described

Other methods combine a position, a movement, or an instrument with pressure:

Pressure combined with active movement: The method known as Active Release Techniques combines localized manual pressure with movement performed by the patient. The technique thus combines the practitioner’s touch with the patient’s voluntary contraction or movement.

Maintaining a Comfortable Position: The method known as the Positional Release Technique places the affected area in a position chosen based on the person's comfort. The practitioner holds the position for a moment.

Instrument-assisted pressure: The practitioner uses a tool to apply pressure or friction to the tissues. Instrument-assisted soft-tissue mobilization refers to this group of techniques. The tool applies force; it does not replace clinical assessment.

Exercises and Applications in Physical Therapy

Studies on myofascial release have focused on various pain and mobility issues.⁴ Depending on the assessment, a physical therapy consultation may be recommended for the following conditions:

• Persistent pain, such as fibromyalgia—which is characterized by widespread pain, fatigue, and sleep disturbances—or chronic lower back pain
• Resuming normal activities and capabilities after surgery, as directed by the surgeon
• Sports injuries
• Difficulty performing a precise movement
• Management of pain that has persisted or recurred for more than three months

A 2015 review on myofascial release highlights the variable quality of the studies and differences in their protocols.⁴ Barbero’s clinical review reports encouraging reproducibility for certain palpation tests, while highlighting the limitations of diagnostic criteria.²⁰ Regarding exercises, a meta-analysis of eight trials reports a short-term reduction in pain compared to little or no exercise. The studies are small, and the findings regarding difficulties with activities are less certain.²⁴ Another review reports a reduction in pain and increased mobility, without a clearly demonstrated improvement in activity limitations.²⁵

The programs studied include strength training, stretching, and active movements. A meta-analysis of 14 trials also compares the addition of exercise to other treatments with those treatments alone. It reports improvements in pain, mobility, and difficulties with daily activities. The varying quality and sample sizes of the studies limit confidence in these results.²⁶ The program should therefore be selected and tailored to the individual’s abilities and goals.

What to Expect During Treatment

During a physical therapy session for localized pain, your physical therapist may:

1. Assess symptoms, movements, strength, and sensitive areas, then determine whether a medical consultation is necessary
2. Work with you to choose exercises and other treatments tailored to your specific challenges and tolerance level
3. Teach you the exercises and coping strategies to use at home
4. Plan a progression and track changes in pain, mobility, and activity

Manual pressure may cause temporary discomfort. Please report any sharp pain, unusual worsening of symptoms, or any sensation that makes you uncomfortable enough to stop. The practitioner must be able to adjust or stop the procedure; severe pain is not a goal of the treatment.

To learn about the available approaches, see our guide on types of physical therapy. The following signs may indicate that you should have your condition evaluated.

When to Consult for Fascial Problems?

Persistent localized pain or difficulty moving warrants a physical therapy evaluation to determine the causes and select an appropriate course of treatment. A new lump should also be evaluated, especially if it grows larger. Not all of these signs indicate a fascia problem.

Signs Requiring Evaluation

The following situations should be discussed during an evaluation:

Chronic localized pain: pain that has persisted or recurred for more than three months. It may feel deep, dull, or persistent. Its intensity and its impact on your daily activities are also taken into account in the evaluation; you do not need to wait three months to seek medical attention.

Lump or tender spot: A spot that’s painful to the touch can have several causes. A lump that grows larger, lasts more than two weeks, or becomes hard and immobile requires medical evaluation. Avoid treating it yourself as a trigger point²⁷.

Difficulty moving: You may feel stiffness, tightness, or a sensation of being “stuck.” The assessment examines movement, strength, and associated symptoms to distinguish between muscular, joint, nervous, or other types of limitations. A lack of improvement after stretching is not sufficient to identify the fascia.

Persistent symptoms despite treatment: a lack of improvement warrants a reassessment of the assumptions, exercises, and the quantity, duration, and intensity of activities, as well as other treatments. A regional muscle problem may be part of the evaluation, along with other possible causes.

Referred pain: Pain may be felt in a location other than the structure causing the symptoms. Headaches associated with the neck or pain radiating from the buttock down the leg require an evaluation of the pain’s path, intensity, and tenderness. New or progressive weakness requires prompt medical attention.

Issues to Identify During the Assessment

Several conditions can cause muscle pain or stiffness, each requiring different treatments:

• Fibromyalgia: pain that affects multiple areas of the body, often accompanied by fatigue and poor-quality sleep. It is not limited to isolated tender points.
• Chronic low back pain : pain in the lower back that persists or recurs for more than three months. Several tissues and mechanisms may contribute to the symptoms.
• Sports injuries: pain following an increase in exertion, an impact, or a tear. The type of injury and its severity determine when to resume activity.
• Recovery after surgery: Scarring, stiffness, and loss of strength can limit activities. The program takes the surgery and the stages of healing into account.
• Pain related to the piriformis region: This deep gluteal muscle is located near the sciatic nerve. Irritation of this nerve can cause pain radiating down the leg; the evaluation must distinguish this from a problem originating in the back.
• Tension headaches : Headaches often described as a feeling of pressure or tightness. Muscle tenderness may accompany them, though it has not been proven to be the sole cause.

How do you develop a personalized care plan?

A treatment plan begins by identifying the limitations you face and the possible causes of your pain. Consulting with a healthcare provider helps you choose appropriate activities and determine whether further tests or treatment are needed. Chronic pain can still change over time; its duration does not dictate a specific number of sessions.

The plan can combine several resources depending on your situation:

• Active movement and progressive therapeutic exercises
  
• Adjustments to tasks and postures that trigger your symptoms, including taking breaks or varying your movements
• Stress management approaches, if applicable
  
• Explanations of the mechanisms of pain and how to resume activities

What to Expect During a Consultation

During your first visit, the physical therapist will discuss your symptoms and then assess your abilities:

1. He or she will take your medical history: when your symptoms began, factors that make them worse or better, any treatment you've already received, and how they affect your daily activities.
2. He assesses your range of motion: mobility, strength, positions you can tolerate, and response to touch. The tests are selected based on your symptoms, and a fascial restriction is not diagnosed based on a single pressure test.
3. He provides a clinical explanation: he correlates symptoms and test results to identify likely problems and determine which issues require further testing.
4. He proposes a treatment plan: measurable goals, home exercises, other treatments, and a schedule for reassessing progress.

The frequency of treatments varies depending on the severity of your condition and your individual response. Your physical therapist will adjust the schedule based on your progress rather than following a fixed schedule.

Progress is measured by concrete indicators: easier movement, a return to activity, less disrupted sleep, or reduced pain. Exercises can help some people with myofascial pain, but the extent of improvement varies. If progress remains limited, the plan should be reevaluated.²⁴

If your symptoms are limiting your activities, a physical therapy consultation can help assess your condition and determine the next steps. Severe, sudden-onset pain requires an evaluation in the emergency room. Swelling, loss of sensation, or a recent injury make this evaluation all the more important²⁸.

What are the most common questions about fascia?

Frequently asked questions about fascia concern its healing, how long stiffness lasts, sensations experienced during manual techniques, the frequency of appointments, and the connection to posture. Fascia can heal an injury, but the duration of stiffness and the choice of treatment depend on the specific problem being assessed. Manual pressure must be tailored to your tolerance, and body position alone is not sufficient to diagnose a fascial restriction.

Can fascia repair itself?

The fascia can repair an injury by forming and then transforming scar tissue. This biological process occurs during the healing process.¹⁸ A mathematical model also distinguishes between highly resistant fasciae—such as those in the thigh or the sole of the foot—and more flexible tissues. It predicts that extremely high forces, far exceeding typical manual pressure, are required to deform the former even slightly. This model result does not demonstrate that a treatment permanently alters a fascia, nor that all fasciae are impossible to deform.²⁹

How long does a fascial restriction last?

Recent stiffness following a period of immobility and an old scar do not necessarily follow the same course. The cause, the affected tissues, the healing process, and the resumption of activities guide the course of follow-up care. There is no single timeframe for a term as broad as “fascial restriction”; a worsening of symptoms or a lack of progress warrants a reassessment.

Does myofascial release hurt?

Myofascial release involves applying pressure that may feel intense. Tell the practitioner if the sensation is too strong, becomes sharp, or makes you uncomfortable. The technique can be adjusted or stopped. You don’t need to be in significant pain for a session to take place.

How often should you have myofascial treatment?

The frequency of sessions depends on the issue being addressed, your goals, and the progress made. A reassessment helps determine whether sessions should continue, be spaced out, or be discontinued. A monthly schedule of sessions is not necessary for everyone.

Is fascia related to posture?

The fascia helps support the body's structures during posture and movement. Body posture also depends on the bones, joints, muscles, and nervous system. The connections between fascial tissues do not allow us to conclude that a hunched posture is caused by a shortened anterior fascial chain.¹⁶ If a position becomes uncomfortable, vary it and adjust the duration of the task. The goal is to find positions and movements that are tolerable, rather than imposing a single alignment.

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