CONGRESS OF FASCIAL MANIPULATION® ASSOCIATION

LUIGI STECCO was born in Cologna Veneta on April 14, 1949 and he is resident in Arzignano, Vicenza. He has been a physiotherapist since 1975. He has been working in private practice since 1989. He is the creator of the methodical named “Manipolazione Fasciale ®”/ “Fascial Manipulation ®”/”Stecco®” . He is the author of several books, translated into many languages.

CLAUDIA CLAIR was born on October 24, 2001, in Padua. She graduated in Medical Biotechnology at the University of Ferrara and later earned a Master’s Degree in Health Biology from the University of Padua. Since 2023, she has been working as a Research Grant recipient at the Department of Neuroscience at the University of Padua. Her research investigates the molecular differences between the superficial and deep fascia and the alterations these tissues undergo in relation to various pathologies. Her academic work also includes the development of a three-dimensional in vitro model of the superficial fascia aimed at simulating pathological conditions through the application of different types of stimuli. In February 2025 and 2026, she presented her research on the characterization of the extracellular matrix of human superficial and deep fascia at the Winter School of Fascial Anatomy. In August 2025, she presented the same project at the Fascial Research Society Congress in New Orleans

LUCIA PETRELLI works at the Institute of Human Anatomy in the Department of Neuroscience at the University of Padua. After obtaining a bachelor’s degree in Biomedical Technology from the University of Siena, she conducted research on arteriosclerosis linked to hypercholesterolemia. At the pharmaceutical companies Fidia S.p.A and Researchlife S.c.p.A, she conducted research on the central and peripheral nervous system and on mast cell activity in the field of inflammatory and immunogenic diseases.  She then moved to the University of Udine, where she conducted morphological studies on collagen and specific membrane proteins in the muscle-tendon junction at. From 2003 she has worked at the University of Padua after participating in morphological studies on the damage in the myocardium and adrenal gland caused by’ hypertension; since 2015 she has also been involved in research studies on fascia using immunohistochemical, histological and ultrastructural techniques that allow the identification of structures (types of collagen) and the localization of nerve fibers and specific cells (fasciocytes, telocytes and mast cells) present in the fascia.

CARMELO PIRRI graduated in Physiotherapy in 2008 (University of Messina), in Medicine and Surgery in 2014 (University of Messina). In 2019 he graduated in Physical and Rehabilitation Medicine (University of Rome Tor Vergata). In 2023 he graduated in Ph.D.: Molecular Medicine (Regenerative Medicine), University of Padova. In 2019 he won a Research Grant, Department of Neurosciences, Institute of Human Anatomy (directed by Prof. Raffaele De Caro), University of Padova. He holds the National Diploma in Musculoskeletal Ultrasound Imaging (SIUMB: SocietàItaliana di Ultrasonologia in Medicina e Biologia). He is active in support teaching at University of Padua, in Cellular Biology and Histology. Since 2018 he collaborates the research team of Prof. Carla Stecco. He has participated in numerous national and international conferences as a presenter. He collaborates in the organization of various anatomical theoretical-practical courses and on anatomical dissection, scientific director Prof. Carla Stecco. He is the author of numerous works on cellular aspects, molecular aspects and Ultrasound Imaging of the Fasciae.

BRASILINA CAROCCIA is a university researcher at the Department of Medicine, University of Padova, a position she has held since 2019. She obtained her M.S. in Medical Biotechnology from the University of Naples Federico II in 2006 and earned her Ph.D. in Arterial Hypertension and Vascular Biology from the University of Padova in 2010. Her doctoral research focused on the isolation and characterization of aldosterone-producing cells as a novel in vitro model to study hormone secretion. From 2011 to 2019, she worked as a postdoctoral fellow at the same department. She has also gained international research experience as a visiting researcher at Boston University (2023) and at the Max Delbrück Center for Molecular Medicine in Berlin under the supervision of Prof. Michael Bader. Throughout her career, she has received several prestigious awards, including the Paul Dudley White International Scholar Award (2024), the STARS@UNIPD Seal of Excellence (2021), the Alberto Ferrari Poster Prize (2014), and the International Award for Publishing Excellence from the Endocrine Society (2013). She is an active member of several scientific societies, including the European Society of Hypertension, the European Council for Cardiovascular Research, the Italian Society of Hypertension, and the Italian Society of Genetics.

JAROSLAW CIECHOMSKI is a physiotherapist (1995) and a certified osteopath (2009). He obtained his PhD in Physical Culture Sciences from the University of Sport, Department of Physiotherapy in Poznań, in 2003. He is a certified instructor of the Fascial Manipulation® method, completing Level I–II in 2012 and Level III in 2019, and the creator of postgraduate training programs in Fascial Manipulation in Pediatrics. His work focuses on the integration of fascial therapy with functional and autonomic regulation in clinical practice and education.

CATERINA FEDE graduated in Biotechnology and Health Biology at the University of Padova and obtained her Ph.D. in 2011. She has been continuously involved in academic research and teaching in Cell Biology, Histology, and Human Anatomy, and currently works at the Department of Neuroscience, Institute of Human Anatomy, University of Padova, with Prof. Carla Stecco. Her research focuses on the cellular and molecular biology of fascia, including extracellular matrix composition, innervation, mechanobiology, and the influence of hormonal and biochemical factors. She is author of numerous peer-reviewed publications and book chapters, and a frequent speaker at international congresses and schools on fascial anatomy. She has received several awards, including the 2019 University Cooperation call (as short-term scholar at Perelman School of Medicine, Pennsylvania), the “Fascia Research Young Scientist Award” (2020) and the Young Investigator Award (Munich, 2025). She participates in international research grants, and in 2024 she was co-chair of the Scientific Program Committee of the Fascia Research Society.

CLARA DE LUCA, MD, graduated from the University of Padua in 2024 and later started a fellowship in the Neuroscience Department of the same University, in collaboration with the Orthopaedics and Traumatology Department. Her field of research focused on the fascia system, more precisely on the involvement of the thoracolumbar fascia in the aetiology of chronic illnesses of the back.

MARIA CRISTINA MENTI was born on March 11, 1995, in Padua (PD), she earned a degree in Exercise and Sport Sciences (L-22) from the University of Padua and, in 2025, a degree in Physiotherapy (LSNT-2) from the same university. In 2024, she enrolled in the Italian School of Fascial Manipulation® (4th edition, 2024–2026). Regarding her professional experience, she has worked for several years as a personal trainer in the field of adapted preventive exercise and functional training. She currently practices as physiotherapist in private clinic, adopting Fascial Manipulation® as her primary therapeutic approach.

PEETU RYTKÖNEN from Oulu, Finland. I am specialized in musculoskeletal physiotherapy (OMT) and I work as a direct access practitioner in both private and occupational healthcare. I have >10 years of experience in clinical practice. In addition to my clinical work at Mehiläinen (Oulu), I am pursuing a PhD at the Faculty of Medicine, University of Oulu. My research focuses on low back pain and the effectiveness of its rehabilitation including fascial manipulation® and movement control exercises.

OPENING: LUIGI STECCO, FOUNDER OF THE METHOD

The fascia is a connective tissue rich in collagen and elastic fibers. According to its anatomical location, fascia is classified as muscular, internal, superficial, or meningeal. If collagen fibers predominate within it, the fascia is considered fibrous; if it contains a greater amount of elastic fibers, it is thinner and more flexible, and is therefore referred to as membranous.

Fibrous fascia, in turn, is termed aponeurotic when it is related to the locomotor system; insertional or parietal when it connects the viscera to the walls of the trunk; dermal when it forms the fibrous support of the epidermis; and dura mater when it provides protection to the central nervous system.

Membranous fascia is called epimysium when it surrounds muscles; visceral or containing fascia when it envelops the internal organs; hypodermic when it forms the loose connective tissue separating the dermis from the muscular fascia; and pia mater when it is intimately associated with the central nervous system.

Thus, the structural organization of fascia is repeated across the four fascial layers of the human body. Their functions also follow similar patterns: aponeurotic fibrous fascia transmits muscular force; internal fibrous fascia anchors the internal organs; dermal fibrous fascia supports the epithelial layer of the epidermis; and the dura mater sustains and protects the delicate nervous tissue from mechanical stress.

The functions of membranous fasciae are closely connected with the nervous system: the epimysial fascia interacts with muscle spindles; the internal visceral fascia interacts with intramural autonomic ganglia; the superficial fascia adapts to external stimuli to facilitate the function of cutaneous receptors; and the pia mater, through its plasticity, interacts with neurons to contribute to memory formation.

REDEFINING THE COLLAGEN COMPOSITION OF HUMAN FASCIAE: EMERGING COLLAGEN TYPES AND STRUCTURAL HETEROGENEITY

Fascia has traditionally been described as a passive connective tissue mainly composed of collagen types I and III. Recent research, however, has revealed its structural and functional complexity, suggesting the possible presence of additional collagen types. This study aimed to quantify the presence and distribution of collagen types I, III, VI, and XII in human superficial and deep fasciae to improve understanding of fascial extracellular matrix composition. Superficial and deep fascia samples were collected from 19 adult patients (ages 20-83 years; thigh and lumbar area). Histology, Azan Mallory staining, hydroxyproline quantification, Western blotting, and immunohistochemistry were performed. The results indicated that deep fascia contained significantly more total collagen than superficial fascia (0.55 ± 0.17 µg/mg vs. 0.36 ± 0.14 µg/mg, p < 0.01). Collagen type VI was the most abundant and widely distributed subtype in both superficial and deep fasciae (mean ratio equal to 0.24 ± 0.13 and 0.27 ± 0.10, respectively), nearly double that of collagen types I (0.12 ± 0.07 and 0.11 ± 0.08), III (0.13 ± 0.09 and 0.17 ± 0.11), and XII (0.13 ± 0.11 and 0.13 ± 0.04). Moreover, statistically significant anatomical differences were observed, despite considerable interindividual variability. Fasciae from the thigh showed higher levels of collagen types I and III (mean ratio of 0.17 and 0.27, respectively, in deep fascia; 0.14 for both types in superficial fascia), whereas fasciae of the lumbar region exhibited greater levels of collagen types VI and XII (ratio equal to 0.33 and 0.15, respectively, in deep fascia; 0.36 and 0.20 in superficial fascia). Overall, these findings highlighted the structural complexity and regional specialization of human fasciae, with potential functional implications for mechanotransduction and tissue adaptation.

THE PROPRIOCEPTIVE ROLES OF THE BICHAT FAT PAD

The Bichat fat pad is adipose tissue surrounded by a thin fascial capsule and located between the masticatory muscles and facial muscles. While it is widely considered to facilitate the gliding of these muscle groups, its potential sensory function remains unclear. Macroscopically, branches of the trigeminal and facial nerves have been observed penetrating the Bichat. However, the presence and distribution of nerves directly innervating the Bichat itself have not been fully investigated. To address this issue, we conducted a histological analysis to verify the presence of nerve fibers, while also assessing its internal collagen structure. Eight Bichat fat pads from four fresh cadavers were collected. Immunohistochemistry of S100- and Tyrosine hydroxylase-immunoreactive nerve fibers in the Bichat was performed. Picro Sirius Red staining was used to evaluate collagen structures. The results confirmed the presence of myelinated fibers and sympathetic nerve fibers within the Bichat, noting distinct regional differences in their distribution. This suggests that this adipose tissue acts as a sensory organ that could detect mechanical stimuli, such as pressure and tension. Such proprioceptive feedback may be crucial for coordinating smooth masticatory movements. Furthermore, Picro Sirius Red staining revealed well-developed fibrous septa and connections with the masseter muscle. These septa likely contribute to protecting these delicate nerve fibers from mechanical stress.

ROLE OF ANGIOTENSIN II ACTIVATES YES-ASSOCIATED PROTEIN (YAP) IN FIBROBLAST PROMOTING DEEP FASCIA REMODELING

The deep fascia, traditionally regarded as a passive structural tissue, is now recognized as a metabolically and biologically active structure where biochemical signals and biomechanical forces interact to influence proprioception, pain, force transmission, and adaptation to mechanical load. In this study, the convergence point between Angiotensin II (Ang II) signaling via its receptor, Angiotensin type 1 receptor (AT1R), and the mechanosensor Yes-associated protein (YAP) was investigated in human fascial fibroblasts. The presence of angiotensin II (Ang II) receptors was confirmed in fibroblasts from the deep fascia, with the AT1 receptor being the most prevalent subtype. Short-term exposure to Ang II (15-30 min) caused YAP dephosphorylation and its translocation to the nucleus, indicating YAP activation. Notably, prolonged Ang II treatment (7 days) significantly increased the expression of fibrosis-related genes, including collagen types I and III (COL1A1, COL3A1), and hyaluronan binding protein 2 (HABP2). This gene expression was decreased by pretreatment with the AT1R antagonist irbesartan or the YAP inhibitor verteporfin. Additionally, Ang II promoted fibroblast proliferation/migration, key features of fibrotic progression, through AT1R-dependent pathways. These findings show that Ang II acts as both a biochemical and biomechanical signal in the deep fascia, activating YAP signaling and promoting fibrotic remodeling. Our results uncover a new Ang II-YAP pathway in fascial fibroblasts, offering potential targets for therapy in fibrosis and related conditions involving the deep fascia.

ROLE OF RECEPTOR SEQUENCE ON HPA AXIS IN GLOBAL STRESS RESPOND

Acupuncture modulates the hypothalamic–pituitary–adrenal (HPA) axis and autonomic balance through peripheral receptor activation and central integration. Stimulation of specific points (e.g., DU-20, PC-6, ST-36) reduces cortisol levels and enhances parasympathetic activity, reflected in increased heart rate variability and modulation of limbic–hypothalamic circuits (Fang et al., 2009; Lee et al., 2013). Mechanistically, afferent input from mechanoreceptors and nociceptors converges in spinal and brainstem centers, influencing the paraventricular nucleus. This aligns with the Fascial Manipulation model, where sequential activation of fascial receptors regulates systemic responses (Stecco, 2014). Both approaches suggest a unified pathway: peripheral stimulation → central processing → HPA and autonomic normalization.

FASCIA AND STEM CELLS

Fascia has long been recognized for its structural, mechanical and sensory roles, and recently a regenerative function has also been suggested. Our recent studies show that deep fascia exhibits regional heterogeneity in extracellular matrix composition, including diverse collagen types (I, III, VI and XII) varying across body regions [1]. Single-cell RNA sequencing and Mass cytometry analysis (CyTOF) show that fascial cells form discrete clusters with variable differentiation, proliferation, and stemness, segregating clearly from tendon cells. Wang et al. demonstrated multiple fibroblast and immune subpopulations in deep fascia contributing to tissue remodeling and regeneration, highlighting its cellular complexity and functional heterogeneity [2]. These data support the existence of tissue- and site-specific fibroblast subpopulations.

In this work immunohistochemistry and immunoblotting for SOX2 (Santa Cruz Biotechnology) were performed on thoracolumbar fascia (TLF) from two female donors (23 and 70 years) and on fascia lata from one male donor (70 y). The distribution, intensity, and cellular localization of staining were evaluated, focusing on fibroblast populations.

A distinct subset of fibroblast-like cells in both TLF samples demonstrated reproducible SOX2 immunoreactivity, whereas fascia lata showed no detectable expression. The selective presence of SOX2+ fibroblasts in TLF may be related to its distinctive extracellular matrix, particularly the abundance of pericellular collagen VI, which can create a niche favorable to progenitor-like cellular states [3]. Whether this SOX2+ population is sex- or site-dependent has yet to be established, warranting further investigation. However, this selective expression of SOX2 indicates the presence of region-specific fibroblast subpopulations with progenitor-like features.

These findings reinforce the concept of fascia as a biologically heterogeneous tissue with site-specific specialization, with potential implications for tissue remodeling, regeneration, and biomechanical adaptation.For the biochemicals analysis, fresh samples were homogenized and analyzed for total collagen and hyaluronan using the Total Collagen Assay and Purple Jelley assay kits. Proteins were extracted and quantified via the BCA Protein Assay kit, followed by Western Blotting for different collagen types (Collagen-I, Collagen-III antibodies). Acute and chronic inflammatory factors, such as TNFalfa and MMP-2, were also quantified using ELISA immunoassay kits.

The superficial fascia leyer is easily visulized by US, and through that we can see an increase of thikness in the lipedema patients respect to the control ones, result also confirmed by hystology, where it corrispond to an encrase of collagen amount. With both techniques it is noticeable that SF is not altered in a homogeneous way, but some areas are more affected, especially the medial distal and in the lateral proximal part of the thigh.

Furthermore, we see higher levels of both acute and chronic inflammatory markers in the superficial fascia, along with a rise in mast cell density. In people with lipedema, the retinacula cutis (the connective tissue that holds the skin) is also thicker and more disorganized. On top of that, the fat lobules are larger and not as well-supported by the retinacula.

This study identifies for the first time the SF as a new key player in the pathogenesis of lipedema, and being easly visualized by US imaging it can become also a diagnostic marker for early diagnosis of lipedema, actually still difficult.

The comprehension of the microscopic alteration related to the development and evolution of the desease can permit a better diagnosisand a targeted tratment of the pathology.

FASCIAL ALTERATIONS IN THE THORACOLUMBAR FASCIA

Lumbar spinal stenosis (LSS) involves the narrowing of the lumbar spinal canal, thereby compromising the space occupied by neural and vascular components. Spinal decompression is the surgical treatment of choice for LSS presenting with disabling pain or with progressive neurological symptoms. However, literature evidence suggests that the surgical management does not always produce the expected outcome, and in 5-23% of cases reoperation is required. Therefore, LSS warrants further investigation to identify additional factors contributing to its aetiopathogenesis. Based on current understanding of the fascial system, we hypothesize that the thoracolumbar fascia (TLF) is involved in the development of low back pain associated with LSS and may serve as a critical element in both diagnostic and therapeutic strategies. This study sought to characterize the molecular properties of the TLF in patients undergoing surgery for LSS, using individuals treated for traumatic vertebral  injuries without other spinal comorbidities as a comparative control group. Methods – Patients scheduled for spinal surgery for the treatment of LSS (cases) or vertebral fractures (controls) at the Orthopaedic Clinic of the University of Padua were invited to participate in the study. 14 patients were enrolled; 5 females and 9 males; 7 patients were assigned to the cases group and 7 patients were assigned to the control group. Samples of TLF were obtained during surgery and later processed in laboratory. Collagen content and composition were investigated via hydroxyproline quantification and western blotting, while the inflammatory rate was analysed through ELISA immunoassays on TNF-alpha and MMP2.  Results – The molecular analysis showed increased levels of collagen content (p=0.0262) and MMP2 (p=0.0379) in the cases group compared to the control group. Conclusion – Our findings demonstrate increased fibrosis and chronic inflammation within the TLF of patients with LSS. Further analysis showed different concentrations of multiple collagen isotypes between cases and controls, but these result did not reach statistical significance. In conclusion, these results highlight the fascial matrix as a critical area for further investigation.

EFFECTIVENESS OF FASCIAL MANIPULATION® ON ACTIVITIES OF DAILY LIVING (ADL) AND MUSCLES’ STRENGTH IN ATRAUMATIC MULTIDIRECTIONAL SHOULDER INSTABILITY (MDI).

Atraumatic multidirectional shoulder instability (MDI) is a symptomatic subluxation or dislocation of the glenohumeral joint occurring in more than one direction. There is a general agreement that the etiology of this condition is due to repetitive microtrauma imposed on a congenitally lax and redundant joint capsule, but according to recent literature, atraumatic MDI seems more a functionally and biomechanical dysfunction rather than a structure dysfunction or a lack of muscle’s strength. Current treatment for MDI consists in conservative or surgical treatment. The gold standard conservative treatment is called Watson protocol and it’s based on rehabilitation with therapeutic exercises to increase strength of shoulder’s and scapula’s muscles. Considering that a fascial alteration can alter the ability of a muscle to fully recruit the muscular fibers, and can create also proprioceptive problems, the aim of this study is to investigate how a fascial focused treatment can improve the shoulder instability. In this pilot study we recruited 15 patients with symptomatic atraumatic MDI and we selected a manual treatment focused into the fascial tissue, such as Fascial Manipulation® method. We performed 3 session, each 10-12 days apart. To evaluate the shoulder’s strength and the effect into the daily activities (ADL), we evaluated each patients with VALD e-dynamo and Western Ontario Instability Shoulder Scale (WOSI). The follow up was set at 3 months. As control group, we used the data of an already published study. Our results, compared with Watson protocol, show similar or a little superior improvements in muscle’s strength and bigger improvements in WOSI score rather than Watson protocol. Furthermore we got improvements in rate of force development (RFD), proving a better neuro-muscular coordination after the fascial manipulation® intervention. Based on our results, our hypothesis is confirmed. In future, we need to combined fascial manipulation® and Watson protocol to see clearly the effectiveness of each intervention.

THE EFFECTIVENESS OF MOVEMENT CONTROL EXERCISES AND FM ON DISABILITY FOR CHRONIC LOW BACK PAIN

Introduction: Movement control exercises (MCE) and fascial manipulation (FM) are widely used in rehabilitation of patients with low back pain (LBP). This is the first large randomized controlled trial (RCT) on effectiveness of MCE and FM. Purpose/Aim: To assess the effectiveness of MCE and FM among chronic LBP patients. Materials and Methods: 240 volunteers were drawn from the participants of multidisciplinary group rehabilitation (MGR) for chronic LBP. Participants responded to questionnaires about pain intensity, pain-related disability and psychosocial factors at baseline and post-intervention at 3 months. Primary outcome measure was Patient Specific Functional Scale (PSFS, 0–30). The change in PSFS was calculated between baseline and 3-month follow-up. Participants were randomized into five groups: 1) control group (G1), 2) MCE and sham-FM (G2), 3) sham-MCE and FM (G3), 4) sham-MCE and sham-FM (G4), and 5) FM and MCE (G5). All participants attended to one-week MGR. Controls (G1) did not receive any additional treatments. Sham-FM included 4 treatments, sham-MCE 4 visits, FM 4-5 treatments and MCE 4-6 visits. MCE and FM were individualized while sham-MCE and sham-FM were performed using a predetermined protocol. ANCOVA was used for testing differences in PSFS between the treatment groups and adjusted for gender, age, treatment adherence, LBP intensity (Visual analogue scale, VAS) and Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) scores. ANCOVA post hoc analysis between all groups were conducted with Bonferroni adjustment for multiple testing. Data was performed as Intention-To Treat method and missing values of PSFS were replaced by baseline data. Results: The final number of participants with full data was 219 (females 149). The mean PSFS at baseline was 10.4 (Standard deviation [SD] 4.3, N=39) for G1, 10.4 (SD 3.8, N=42) for G2, 10.7 (SD 4.5, N=46) for G3, 11.3 (SD 4.6, N=47) for G4 and 8.8 (SD 4.9, N=45) for G5. At 3 months, the mean PSFS improvement was 3.3 (SD 5.5) for G1, 5.4 (SD 5.9) for G2, 4.8 (SD 4.5) for G3, 1.1 (SD 5.5) for G4 and 5.6 (SD 7.4) for G5. The significant difference between groups for PSFS change was found in ANCOVA (p<0.001). In post hoc analysis following significant differences between groups were found: G2 vs. G4 (PSFS difference 4.3, p=0.002), G3 vs. G4 (3.7, p=0.006) and G5 vs. G6 (4.5, p=<0.001).

Conclusion(s): FM® and MCE (G5) or each with sham-treatments (G2 and G3) are more effective compared to sham-treatments (G4) in improving disability in patients with chronic LBP and this difference is clinically significant. None of the groups were significantly more effective compared to MGR (G1).

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Then you can register for free to the FMA Congress, specifying the workshop you would like to attend in the afternoon
– by e-mail to association@fascialmanipulation.com
– by filling in the form below

MASTER CLASS LEVEL 1-2: June 2-4, 2026
Teachers: Cossarini Luca – Iogna Prat Pietro, English language
It is recommended to who has completed Fascial Manipulation Level I°-II°.
It offers a revision and a deepening study of some basic aspect of locomotor system, with particular attention to the treatment of the sportsman

MASTER CLASS LEVEL 3-4: June 2-4, 2026
Teachers: Motton Francesco, English language
It is for who has completed Fascial Manipulation Level I°-II°-III°.
It offers a revision of some internal dysfunction’s concepts. It is a deepening study of therapeutic approach of complex cases, which ask better manual skills.

FASCIAL MANIPULATION CERTIFICATION® EXAM : June 5, 2026
It is for who has completed all the courses of Fascial Manipulation.
It is an exam to gain the title “Certified Fascial Manipulation Specialist”.

FM TEACHERS’ MEETING
Padova June 7-8, 2026
It is reserved for teachers and FM assistants