OVERVIEW

What is fasciitis?

Fasciitis, also known as fibrositis, refers to aseptic inflammation of the fascia, commonly occurring in areas such as the lower back and soles of the feet. It is primarily caused by prolonged muscle tension without adequate rest (e.g., long-term heavy lifting, unloading, or maintaining a fixed posture). This condition can lead to various discomforts, such as pain, muscle tightness (tension) or weakness, and muscle spasms, with symptoms often worsening in damp or rainy weather.

During physical examination, doctors may detect cord-like changes in the affected area. Patients themselves may feel a long, hard lump, with noticeable pain upon touch ^[1-3].

What is fascia?

Fascia is a type of fibrous connective tissue that covers muscles and other tissues like a membrane. It is widely distributed throughout the body, with its fibers typically arranged in an interwoven pattern ^[4]. The continuation of fascia can form ligaments and tendons, which often attach to bony prominences.

Is fasciitis truly inflammation?

No.

The term "inflammation" we commonly refer to describes an inflammatory response triggered by infections such as bacteria, viruses, or fungi.

Although fasciitis is also an inflammatory response, its cause differs from typical "inflammation." It is not caused by infections from biological factors like bacteria or viruses but rather by non-biological stimuli such as overuse, similar to the wear and tear of machine parts over time. Medically, this type of inflammation is called "aseptic inflammation," and antibiotic treatment is ineffective ^[1].

What are the common types of fasciitis?

Fasciitis is generally classified by location, as certain areas are particularly prone to injury. Common types include ^[1,2,5]:

1. Cervicodorsal fasciitis: Occurs in the neck and upper back, often due to prolonged static postures (e.g., working for over 45 minutes without changing positions).
2. Lumbodorsal fasciitis: Affects the lower back, typically caused by repetitive heavy lifting or similar activities.
3. Plantar fasciitis: Develops in the soles of the feet, often due to ill-fitting shoes or running on hard surfaces.

Is fasciitis common?

Yes.

Fasciitis is a clinically common condition ^[1,2,5]. While there are no comprehensive statistics on its overall incidence, epidemiological studies show that plantar fasciitis alone affects approximately 11%–15% of the population. This means about 11–15 out of 100 people may suffer from it. Plantar fasciitis is more prevalent in middle-aged and elderly individuals (40–60 years old), with a slightly higher incidence in men, though the difference is minimal ^[5].

Is fasciitis the same as necrotizing fasciitis?

No.

Necrotizing fasciitis differs from the fasciitis discussed here, though the shared term can cause confusion. Key distinctions:

Fasciitis:

1. Nature: Aseptic inflammation.
2. Cause: Prolonged muscle strain without relief; unrelated to bacteria.
3. Triggers: Chronic poor posture, cold/damp environments, etc. ^[1].
4. Symptoms: Localized pain, muscle tightness, spasms, and restricted movement, often in the neck, shoulders, back, or soles.

Necrotizing fasciitis:

1. Nature: Rare infectious disease.
2. Cause: Bacterial invasion of subcutaneous tissue and fascia, causing acute necrotizing soft tissue infection.
3. Triggers: Insect bites, puncture wounds, burns, surgical incisions.
4. Symptoms: (1) Early stage: Tenderness, swelling, redness, warm skin. (2) Mid-stage: Skin turns pale, red, purple, or black; severe pain with fever, dehydration, vomiting. (3) Late stage: Blackened skin, sepsis, toxic shock, organ failure, unconsciousness; often fatal ^[6].

Are fasciitis and periostitis the same?

No.

Fasciitis:

1. Affected tissue: Fascia, a fibrous connective tissue covering muscles.
2. Common sites: Neck, shoulders, back, soles.
3. Symptoms: Localized pain, muscle tightness, spasms, palpable hard nodules or cords.

Periostitis:

1. Affected tissue: Periosteum, a connective tissue membrane enveloping bones, containing nerves and blood vessels ^[4].
2. Common sites: Tibia, fibula, metatarsals (legs); ulna, radius (arms).
3. Symptoms: Bone pain, tenderness, mild swelling, redness; uneven bone surface may be palpable in thin-skinned areas.

SYMPTOMS

What are the symptoms of fasciitis?

1. Localized pain: The pain can manifest in various forms, such as throbbing, burning, stabbing, or knife-like pain, and may persist or recur. It often worsens in the morning, with weather changes, after exertion or exposure to cold, and may improve with rest.
2. Muscle stiffness: The affected muscles may become rigid, like a wooden board, and sometimes hard nodules or cord-like structures can be felt ^[1,2,5].

What are the symptoms of neck and back fasciitis?

Patients mainly experience pain and soreness in the neck and back (the back of the neck and the upper back), with localized muscle hardening. Sometimes, hard nodules or cord-like structures can be felt.

What are the symptoms of lumbar fasciitis?

Patients primarily experience pain in the lower back. The pain may have the following characteristics:

1. Symptoms worsen in damp or rainy weather;
2. Stiffness and pain in the lower back upon waking up in the morning or after maintaining a static posture for a long time;
3. Pain worsens after prolonged bending or lifting heavy objects but improves with rest.

What are the symptoms of plantar fasciitis?

Patients mainly experience heel pain when bearing weight. The pain may have the following characteristics:

1. Upon waking up or after prolonged inactivity, standing on the heel causes pain, which intensifies with the first steps but eases slightly after walking a few steps. However, pain worsens with increased walking distance or prolonged standing.
2. The pain can manifest in various forms, such as throbbing, burning, stabbing, or knife-like pain. In severe cases, it may persist for months or even years. Activities like walking barefoot, climbing stairs, hiking, or carrying heavy loads can aggravate the symptoms.

What are the risks of fasciitis?

1. Impaired motor function: If left untreated, fasciitis may lead to limb movement dysfunction, manifesting as varying degrees of limitation in activities like dressing, eating, walking, climbing stairs, doing household chores, or personal care.
2. Mental health issues: Long-term fasciitis patients may develop psychological problems such as anxiety or depression due to the persistent condition ^[3].

CAUSES

Is fasciitis related to daily working posture?

Yes.

Maintaining the same posture for a long time can lead to fatigue and strain. For example, muscles begin to tighten after maintaining a fixed posture for more than 20 minutes, and soreness may occur after 45 minutes. If not rested in time, it may cause muscle spasms and stiffness, leading to fasciitis ^[1].

Therefore, try to avoid prolonged desk work, prolonged looking down, maintaining the same posture while watching TV or browsing the internet, long hours of driving, and prolonged bending for housework. In addition, ensure that work surfaces at home are not too low (the height should vary by individual, with no bending required).

Who is prone to fasciitis?

1. Those who maintain a single posture or bear weight for long periods: such as long-distance drivers or sedentary desk workers, as prolonged posture or weight-bearing may lead to local ischemia, soft tissue spasms, and eventually fasciitis.
2. Long-distance runners or athletes: mainly due to incorrect training methods, excessive training volume, running on overly hard surfaces, or wearing unsuitable shoes, leading to plantar fasciitis.

Who is prone to plantar fasciitis?

The following groups are more susceptible to plantar fasciitis:

1. People with congenital foot arch abnormalities, unequal leg lengths, insufficient elasticity of ankle fascia, or gastrocnemius contracture.
2. Obese individuals.
3. Those who overexercise.
4. Long-distance runners or track and field athletes.

Who is prone to lumbar fasciitis?

The following groups are more susceptible to lumbar fasciitis:

1. Those who suffer acute lumbar muscle sprains but fail to receive timely treatment.
2. Workers who maintain a single posture for long periods.
3. Workers with chronic lumbar muscle strain due to prolonged weight-bearing.
4. Athletes whose fascia is repeatedly subjected to external force.

Who is prone to cervical and dorsal fasciitis?

The following groups are more susceptible to cervical and dorsal fascia strain:

1. Those with poor working postures or prolonged desk work, such as computer workers.
2. Individuals who remain in the same posture for extended periods, such as working for more than 45 minutes without changing position.
3. Manual workers, engineers, assembly line operators, typists, embroiderers, seamstresses, and mahjong players.

DIAGNOSIS

How is fasciitis diagnosed?

When a doctor suspects fasciitis, they typically confirm the diagnosis through physical examinations (checking for tenderness, stiffness, etc. in the affected area), laboratory tests (such as blood tests for complete blood count and C-reactive protein to determine infection), and imaging studies (like X-rays or CT scans to assess the condition of the affected area).

What tests are needed for fasciitis patients?

1. Physical examination: To check for tenderness, lumps, and whether pain worsens or improves with changes in posture.
2. Laboratory tests: To rule out infections or immune-related causes of fasciitis.
   1. Complete blood count (CBC): To detect abnormalities in blood cell counts and identify infections, aiding in diagnosis.
   2. C-reactive protein (CRP): To assess inflammation presence and severity.
3. Imaging studies: To evaluate local lesions and assess muscle, fascia, and other tissue conditions.
   1. X-ray or CT scan: To determine the location and structural changes of fascial lesions and examine surrounding tissues.
   2. Magnetic resonance imaging (MRI): To accurately assess fascial and muscle changes, determine disease severity, and guide treatment planning ^[5,7,8].

Why is an MRI necessary for fasciitis?

Fascia is a type of soft tissue ^[3]. MRI provides superior soft tissue contrast, making it the best imaging method for detecting soft tissue abnormalities like fasciitis.

On MRI, fasciitis appears as linear or patchy low signals in the superficial fascia (subcutaneous fat layer) on T1-weighted images, with clear boundaries. On T2-weighted images, it shows high signals, and fat-suppressed images reveal significant high-signal shadows ^[9].

How to differentiate lumbar fasciitis from lumbar disc herniation?

1. Clinical symptoms: Lumbar disc herniation compressing nerves often causes radiating limb pain, recurrent symptoms, limited mobility, worsened by bending or coughing, and relieved by rest. Lumbar fasciitis mainly causes localized back pain, which also improves with rest.
2. Physical examination: Lumbar disc herniation may show tenderness between or beside the spinous processes, a positive straight leg raise test (pain radiating along the sciatic nerve when the leg is raised below 70° ^[10]), and sensory (e.g., leg numbness) or motor deficits (e.g., pain or inability to move the leg). Lumbar fasciitis typically has a negative straight leg raise test.
3. Imaging: CT or MRI can distinguish them. Lumbar disc herniation shows disc degeneration and nucleus pulposus protrusion, while lumbar fasciitis reveals fascial lesions without spinal degeneration ^[11].

How to differentiate cervical fasciitis from cervical disc herniation?

1. Clinical symptoms: Cervical disc herniation compressing nerves often causes radiating arm pain, electric shock-like sensations, or numbness, worsened by neck pressure or arm traction. Cervical fasciitis mainly causes localized neck and upper back pain, relieved by rest.
2. Physical examination: Cervical disc herniation may show tenderness between or beside the cervical spinous processes, with sensory (e.g., arm numbness) or motor deficits (e.g., limited arm movement). Cervical fasciitis lacks these signs.
3. Imaging: CT or MRI can differentiate them. Cervical disc herniation shows disc degeneration and nucleus pulposus protrusion, while cervical fasciitis reveals fascial lesions without cervical degeneration ^[11].

TREATMENT

Which department should I see for fasciitis?

Patients with fasciitis can generally visit the orthopedics department.

What are the treatment methods for fasciitis?

The primary treatment for fasciitis is medication, aimed at relieving pain, improving function, and shortening the disease cycle. There is currently no complete cure.

Other specific treatment methods include: stretching exercises, oral or topical pain relievers, nerve block therapy, shockwave therapy, exercise therapy, surgical treatment, etc. ^[1,3,12]. The choice of treatment should be determined by a doctor after evaluating the condition.

What are the treatment principles for fasciitis during the acute phase?

1. PRICE principle: Suitable for those without medical experience. It stands for Protect, Rest, Ice, Compression, and Elevation. These measures primarily aim to reduce swelling and inflammation while promoting tissue healing ^[3].
   1. Protect: First, protect the affected area, such as using braces to immobilize it and prevent further injury.
   2. Rest: Immediately stop activities involving the injured area and avoid strenuous exercise (e.g., running). Rest is essential, and bed rest may be needed if pain is severe.
   3. Ice: Within the first 48 hours, apply an ice pack wrapped in a clean towel every 2–3 hours for 15–20 minutes each time. Ice helps reduce swelling and pain.
   4. Compression: Use an elastic bandage to wrap the affected area, spiraling from the distal to the proximal end to prevent excessive swelling.
   5. Elevation: Keep the injured area elevated above heart level to minimize swelling ^[4].
2. POLICE principle: Suitable for professionals. It stands for Protect, Optimal Loading, Ice, Compression, and Elevation. Optimal loading is supported by newer research but requires professional expertise, distinguishing it from the general PRICE principle ^[3].

Can painkillers be used for fasciitis?

Yes.

Nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin, acetaminophen, indomethacin, and ibuprofen) are commonly used for their effective pain relief ^[3]. While some worry about gastrointestinal side effects, selective COX-2 inhibitors (e.g., celecoxib and nimesulide) have minimal gastrointestinal reactions.

For patients with a history of gastritis, topical pain-relief ointments like Voltaren can be used to avoid gastrointestinal issues.

Does fasciitis always require surgery?

It depends.

Neck, back, and lumbar fasciitis involve widespread lesions and are generally not suitable for surgery. Plantar fasciitis, which is more localized, may require surgery if conservative treatments (rest, ice, stretching, etc.) fail after 6–12 months.

Common surgical methods include soft tissue release or plantar fasciotomy, which involve partial removal or loosening of the affected fascia to relieve pressure and symptoms. Although risks like pain and bleeding exist, patients should follow their doctor's guidance ^[1,2,5].

What should be noted after plantar fasciitis surgery?

Post-surgery, patients should focus on reducing swelling and keep the affected limb elevated before discharge. Gradual rehabilitation exercises under professional guidance are necessary to prevent re-adhesion and contraction of the fascia ^[3].

How effective is extracorporeal shockwave therapy for fasciitis?

Extracorporeal shockwave therapy directly targets the painful area, loosening muscle and soft tissue adhesions to relieve pain and improve function ^[3].

Most clinical reports support its efficacy ^[13]. It is simple, reliable, minimally invasive, and has few side effects. Some patients may experience incomplete pain relief but still benefit overall, possibly requiring supplementary treatments.

How effective is exercise therapy for fasciitis?

Exercise therapy involves specific movements to restore function and sensation. For example, plantar fasciitis patients can perform stretching exercises for the plantar fascia and calf muscles under professional guidance ^[12]. Proper stretching helps relieve muscle pain and promotes the absorption of inflammatory substances.

This method effectively reduces pain and improves spinal function and joint mobility ^[1].

Can fasciitis be completely cured?

No.

Fasciitis is a degenerative condition. Treatment can only alleviate inflammation and pain but not eliminate it entirely. Recurrence is likely due to overexertion, poor posture, or damp weather. Thus, it is a chronic condition managed by symptom relief and reducing flare-ups ^[1,2].

DIET & LIFESTYLE

How long does fasciitis usually require rest?

The duration of rest mainly depends on whether the acute inflammation subsides. It can range from as short as one week to as long as several months ^[7,13]. The primary way to determine whether the inflammation of fasciitis is under control is through the patient's subjective feelings—reduced pain, no pain during activity, and no localized tenderness.

What are the relief methods for nuchal and dorsal fasciitis?

Some scholars suggest that exercise therapy (such as shoulder-back expansion exercises) can help alleviate nuchal and dorsal fasciitis ^[2]. The specific methods are as follows:

1. Choose a quiet place with fresh air. Stand upright with hands and feet straight, chest out and abdomen in. Tense the neck muscles and lean backward as much as possible, maintaining the muscle tension for one minute.
2. Make fists, bend elbows, and move both arms in the same direction to perform chest expansion exercises. Exert force backward during expansion and relax when returning to the front.
3. Lift the shoulders freely with force, trying to touch the back of the head with the shoulders for about 30 seconds, then relax the shoulders.
4. Repeat the process in a regular manner. After 10–15 minutes, you should feel relaxation in the neck and shoulder area.

What should fasciitis patients pay attention to in daily life?

1. Maintain a regular lifestyle, get adequate rest, avoid staying up late, and refrain from heavy physical labor or strenuous exercise.
2. Patients with lumbar and dorsal fasciitis should rest on a moderately firm bed during the acute phase and limit lower back movement.
3. Persist in functional exercises (such as plantar fascia and gastrocnemius stretching), balance activity with rest, and progress gradually while avoiding forced movements.
4. Pay attention to posture during work and daily activities. Avoid prolonged standing or sitting. It is recommended to take short breaks every 45 minutes—stand up, walk around, or do some stretching exercises.
5. Keep warm and avoid prolonged exposure to damp or cold environments.
6. Schedule regular follow-ups and physical examinations. The frequency of check-ups varies by individual, so follow the doctor's advice.

What should fasciitis patients pay attention to in their diet?

There are generally no special dietary requirements for fasciitis. A balanced and nutritious diet is sufficient.

1. Supplement with high-quality protein, preferably white meats like chicken, duck, and fish. Consume one egg and a glass of milk daily.
2. Eat fresh fruits and vegetables to replenish essential vitamins.
3. Use less salt when cooking (recommended daily intake is <5g, roughly the amount of a beer bottle cap), reduce oil (limit cooking oil to 20–25g per day, avoiding fried foods), and minimize high-sodium condiments (such as soy sauce, monosodium glutamate, and ketchup). Avoid pickled vegetables and meats.

PREVENTION

Can Fasciitis Be Prevented? How to Prevent Fasciitis?

Yes, it can be prevented.

1. Maintain a healthy lifestyle, develop good habits, adopt proper working postures, and exercise moderately.
2. Avoid injury-prone movements, take protective measures, and eliminate such triggers in the future.
3. Correct poor posture, maintain proper alignment, and avoid staying in one position for too long (over 45 minutes). Balance work and rest ^[3].
4. Incorporate muscle stretching exercises in training. Skipping warm-ups before exercise may lead to overstretching of muscles.