Back Pain & Soft Tissue: Why Muscles, Fascia, and Breathing Matter
- Ben Tolson
- 28 minutes ago
- 5 min read
Back pain isn’t only about “bones out of place.” The soft tissues - muscles, fascia, tendons, and even your breathing pattern - often drive the pain you feel. In this post, I’ll explain how soft tissues contribute to back pain, what I look for in an assessment, and the gentle, evidence-informed techniques I use (massage, neuromuscular work, acupuncture, muscle energy, and breathing retraining) to help you move and feel better.
Muscle vs joint: it’s not either/or
There’s a long-running debate: fix restricted joints first or treat soft tissues first? The most practical answer is both, based on what’s primary for you.
Janda (1988): We don’t always know which starts the problem - muscle or joint - but they massively influence each other. Even the benefits of manipulation may partly come from its effects on soft tissues.
Steiner (1994): A common cascade into disc/facet pain can start in muscle:
a twist/rapid stretch triggers a myotatic reflex in erector spinae,
muscles spasm to guard,
vertebrae approximate → disc bulging or facet compression,
capsular nerves get irritated → guarding escalates,
the pain–spasm–pain loop sustains itself.
Treatment implication: reverse the chain: reduce spasm, gently restore motion, create space so a bulging disc can recede and facets can glide again. Before invasive procedures, conservative soft-tissue work + articular separation is worth trying; soft-tissue-led strategies like muscle energy techniques have shown good lumbar results (Brodin, 1982).
Lewit (1985): Some restriction patterns remain even under anesthesia with muscle relaxants - meaning true joint blocks exist that aren’t just muscular. Also, some joints (e.g., sacroiliac, tibiofibular, acromioclavicular) have mobility features not fully governed by muscle tone. Clinically, we must distinguish muscle-tightness limits from articular “joint-play” limits - often both are present.
Liebenson (1996): Short, overactive muscles increase joint stress; inhibited, weak muscles undermine joint stability, leading to compensations, fixations, or even hypermobility. Treating one normalises the other.
Bottom line: If your muscles are tight and overactive, they can jam joints; if your joints are restricted or unstable, muscles will guard. A balanced plan addresses the right thing in the right order.
Quick takeaways
Soft tissues can start or sustain back pain. They react to stress, posture, overuse, injury, and even emotional load.
Pain often comes from “trigger points.” These are small, irritable spots in tight bands of muscle that can refer pain elsewhere.
Your body adapts to stress in stages. First tension, then reduced circulation, then stiffness/fibrosis if it lingers.
Breathing and mood change muscle tone. Upper-chest breathing and anxiety can increase fascial tension and pain.
Gentle manual therapy + movement + habit changes usually works better than any single “quick fix.”
How soft tissues create (and keep) back pain
When tissues are stressed - by long sitting, heavy or repetitive work, falls, sports overuse, or emotional strain - they react:
Protective tension (muscles guard the area).
Circulation dips, waste products build up → soreness.
Nerves sensitise (you feel more, sooner).
Fibres stiffen and shorten (think Velcro-like cross-links).
Movement patterns change (other muscles compensate, posture shifts).
Left alone, this can become a cycle: tight postural muscles get shorter; their opposites get inhibited and weaker; joints feel “stuck”; and trigger points add referred pain (for example, a glute trigger referring pain down the leg).
Trigger points: tiny sources, big pain
Trigger points are small, tender spots in taut bands of muscle. Pressing them can reproduce your familiar pain in a different area (that’s the clue). They’re common in the low back, glutes, hip flexors, QL, and hamstrings. Treating them helps, but lasting relief also needs muscle length restoration, better breathing, and smarter daily mechanics.
Why breathing changes your back
Upper-chest, fast breathing (common with stress) blows off too much CO₂, which can increase smooth-muscle and fascial tone. That extra tone makes tissues feel “ropier” and tender. Re-training a calm, diaphragmatic breath can reduce background tension - often a turning point for stubborn back pain.
What I assess in your first visit
When you book an appointment with me, I will assess several different areas:
Posture & movement: how you bend, extend, rotate, and breathe.
Tender/trigger points: in paraspinals, glutes, hip flexors, QL, hamstrings, adductors.
Muscle balance: which muscles are short/tight vs. long/inhibited (e.g., tight erector spinae with inhibited abdominals).
Skin/fascia glide: areas of “stickiness” can reflect deeper irritation.
Viscero-somatic clues: paraspinal zones that sometimes mirror organ stress (useful context, not diagnosis).
How I treat back pain: gentle, layered methods Neuromuscular Technique (NMT)
Slow, precise pressure along muscle attachments and taut bands to find and release local dysfunction.
Trigger point therapy (manual or acupuncture/dry needling)
Brief, tolerable pressure (or a fine needle) to “switch off” the trigger point, followed by gentle stretch to restore resting length. Learn more about Acupuncture at Ben Tolson Massage Therapy.
Muscle Energy Technique (MET)
You gently push against my resistance for ~7–10 seconds; when you relax, the muscle lets go a little more, allowing a painless stretch. Excellent for tight hip flexors, hamstrings, QL, and deep spinal rotators.
Strain–Counterstrain (positional release)
I position you where a tender point feels least painful and hold ~90 seconds; this calms the local reflex and helps the tissue reset - great for acute flares.
Fascial Manipulation
Fascial Manipulation involves light, sustained skin and fascial glides can reflexively ease the underlying tissues and improve glide.
What a typical Treatment Plan looks like
Session 1–2: Calm things down
Reduce trigger point activity, down-regulate sensitivity, improve breathing pattern.
Session 3–5: Restore motion & balance
MET and gentle joint mobilisation; progressive stretching of short/postural muscles; wake up inhibited glutes/abs.
Session 6+ (as needed): Build resilience
Strength & endurance for hips/core; refine lifting, sitting, and walking strategies; taper to self-care.
(Everyone’s different; acute strains may settle in a couple of sessions, while long-standing cases need a few more.)
Your self-care checklist
2–3 “movement snacks” daily Cat–camel ×10, hip flexor stretch 30–45s/side, hamstring glide ×10, thoracic rotations ×10/side.
Diaphragm reset (2–5 minutes)
Lie on your back, one hand on belly, inhale through the nose feeling the lower ribs widen; long, easy exhale through the nose or pursed lips.
Heat or gentle cold
10–15 minutes to modulate pain as needed.
Sit smart
Hips slightly higher than knees, feet grounded, change posture every 30–45 minutes.
Walk
Short, frequent walks circulate nutrients and calm the nervous system.
Sleep routine
Side-lying with a pillow between knees or supine with a small pillow under knees.
When to seek medical evaluation first
Unexplained weight loss, fever, history of cancer
Recent significant trauma
Progressive neurological changes (numbness, weakness), saddle anesthesia, bowel/bladder changes
Constant night pain unrelieved by rest
If any of these apply, start with your GP - then we can integrate soft-tissue care as appropriate.
FAQ
“Do you adjust the spine?”
I focus on soft-tissue and gentle mobilisation. Often, once the soft tissues normalise, joints move freely without forceful adjustments.
“Is needling required?”
No. Acupuncture/dry needling can help, but manual options (pressure, MET, positional release) can achieve similar outcomes.
“How many sessions?”
Acute strains: often 2–4. Persistent patterns: 4–8 with home care. We’ll reassess progress regularly.
If you love a little science
Soft tissues respond to stress with tension → reduced circulation → stiffness if prolonged.
Trigger points are common pain drivers; treating them plus restoring muscle length works best.
Breathing and psychosocial stress can increase fascial tone - addressing them often unlocks stubborn pain.
Gentle is effective: light, well-timed inputs (manual pressure, positioning, MET) can outperform aggressive approaches for sensitive backs.
Local Treatment in Cotham & Clifton, Bristol
Ben works from Cotham Chiropractic Clinic and Comfort Health in Clifton, both easily accessible from central Bristol. Whether you’re dealing with a recent flare-up or recurring back problems, his expertise and ability to provide effective results is second-to-none.
Take the First Step Towards Back Pain Relief
If back pain is stopping you from living life to the full, don’t ignore it or wait until it worsens. Book a free consultation with Ben Tolson Massage Therapy in Cotham and Clifton, Bristol, and take the first step towards identifying the cause, treating the symptoms, and moving freely again.
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