Fascia as a Functional System in Health and Disease: From Fundamental Biology to Assessment and Targeted Interventions.

Fascia is increasingly recognized as a dynamic functional system. It can actively sense, transmit, and regulate mechanical, sensory, and metabolic signals. Why does fascia play such a critical role in chronic pain and movement disorders? Researchers are now rethinking the pathophysiological mechanisms underlying this role. Previous systematic reviews have typically focused primarily on specific mechanisms or interventions. In contrast, this study takes a holistic view of fascial function. It integrates multiple physiological functions of the fascia: mechanical integration, sensory modulation, cellular and matrix remodeling, as well as metabolic and immune regulation. From the perspective of functional imbalance, we further explore the pathological mechanisms associated with the fascia. Building on this, we then focus on how to assess fascial function from multiple dimensions and on specific targeted interventions. For assessment, we have systematically compiled a set of multi-stage quantitative techniques. These include clinical palpation, ultrasound, and elastography, tissue mechanics testing, microdialysis, omics approaches, electrophysiological testing, and digital modeling. For interventions, we have listed a range of modulating approaches, such as manual therapy, exercise rehabilitation, dry needling and acupuncture, fascial injections, targeted drugs, and biotechnological materials derived from tissue engineering. This review summarizes a clinical decision-making framework guided by the assessment of fascial functional status. It emphasizes a systematic approach and links quantitative diagnosis with precise interventions. Additionally, it provides a literature synthesis for understanding fascial mechanisms and related disorders and offers a reference foundation for the field's transition from empirical treatment to measurable, reproducible, and individualized practice.