Pain in the lower back isn’t always caused by disc issues or muscle strain. In some cases, it may be connected to how the layers of connective tissue—the fascia—are (or aren’t) moving.

Dr. Helene Langevin, a leading fascia researcher, has studied this using ultrasound imaging. In one of her most cited studies, her team found that people with chronic low back pain showed less movement between the layers of fascia in their back compared to people without pain.

This subtle loss of glide—often overlooked in standard imaging—may be a key factor in understanding chronic pain.

Dr. Helene Langevin is a physician and fascia researcher who directs the U.S. National Center for Complementary and Integrative Health (NCCIH). Her work explores how connective tissue responds to tension, movement, and therapies like acupuncture—and how these responses may relate to pain, inflammation, and healing.
Fascia & Pain: What Happens When Layers Don’t Glide?
Fascia surrounds and connects everything in the body—muscles, nerves, bones, and organs. In healthy movement, these layers are meant to slide and shift past one another, adjusting as we bend, reach, breathe, and walk.

This sliding motion is known as shear. It’s a kind of internal gliding between layers—imagine two silky sheets moving gently across each other.

But in some cases of chronic pain, this glide becomes restricted. Instead of sliding, the layers seem to stick. Dr. Langevin’s research shows that in people with long-term low back pain, this shear strain is reduced by about 50%. The tissues are moving together as a block—less adaptable, less responsive.
This video shows ultrasound imaging of the lateral thigh, highlighting the different layers of fascia and muscle. In the final section, you’ll see a comparison between tissue with healthy glide and tissue where the layers appear more stuck (reduced shear).
https://www.fascialmanipulation.com/en/
What the Ultrasound Shows
In Dr. Langevin’s study on lower back pain, researchers used ultrasound imaging to observe how the layers of fascia and muscle in the lower back (thoracolumbar) moved during passive motion created by a motorized table. This setup allowed for consistent movement—so differences in tissue behavior could be observed without relying on the participant’s muscle effort. They compared two groups:
  • 47 people with no back pain
  • 60 people with chronic low back pain (for over one year)
Thoracolumbar Fascia Layers in blue (lower back)
The key finding was that the people without pain had more shear—their fascial layers glided past one another smoothly. In those with pain, the layers appeared to move together as one, with significantly less separation or slide.

Even though both groups were performing the same movement, the tissues responded differently.
🟦 Healthy Example – No Low Back Pain
In this clip, you can see distinct motion between the different tissue layers. The fascia glides and adjusts as the person moves—creating flexibility, adaptability, and ease.
🟥 Chronic Pain Example – Over One Year of Low Back Pain
Here, the movement is reduced. The layers shift less, appearing to move together more like a solid block. This loss of glide is what researchers refer to as “reduced shear strain.”
The first image shows a schematic view of the ultrasound transducer placed over the lumbar region (around L2/L3) that created the ultrasound videos above. The second image shows the back with a red line marking the level the ultrasound was done. To the right of that shows what those layers look like in reality. The thoracolumbar fascia and overlying adipose tissue have been peeled back on the upper and right side, revealing the underlying muscle layers. The lower and left areas of the image still show the intact fascia and fat.
Watch the video below to hear Dr Langevin discuss this study
Link to Full Video
What This Might Mean
When fascia can’t glide freely, it can:
  • Limit how your body absorbs and adapts to movement
  • Create tension across wider areas
  • Reduce hydration and circulation between layers
  • Disrupt how the nervous system senses and regulates that area
Because fascia is full of nerve endings and helps your brain sense the body from within, even small restrictions can shift how an area feels or moves—sometimes contributing to ongoing pain or sensitivity.

What Can Help?
Improving glide between fascial layers can support comfort, coordination, and nervous system regulation. Helpful strategies may include:
  • Fascia-aware manual therapy that encourages subtle sliding and responsiveness between layers.
  • Movement practices that explore range, rhythm, and breath as a way to rebuild ease and awareness.
  • Slow stretching or mindful load, allowing the tissue to adapt gradually and reconnect with movement.
Key Research & Sources:
Compiled by Joe Liguori