The Assessment
During the Assessment portion of the appointment - this is where you, as the practitioner, begin to establish who controls the room.
Massage therapists can sometimes feel like order takers:
“Can you just treat my back?”
“I want a full-body treatment today.”
When this happens, it’s often because the patient doesn’t yet trust your ability to take charge of the process. They don’t feel your confidence — so they try to lead instead.
But your job is to take back the map. To guide, direct, and make decisions based on what the patient needs, not just what they request. And that begins with a strong foundation in clinical reasoning — which starts with an accurate assessment.
Though as massage therapists you cannot diagnose, you can absolutely share a story and your reasoning. This chapter explores how force theory and fascial lines help you transition from assessment to a plan of care that patients believe in.
Using Force To Assess
“...you’re tracing the story of force: where it came from, where it got stuck, and where it’s still being carried.”
A good assessment does more than identify what’s tight — it reveals how force moves through the body. Every restriction, compensation, or imbalance you uncover is the body’s way of adapting to how force has entered, been absorbed, or been resisted over time.
When you understand fascial lines, you begin to see that force doesn’t stop where it lands — it travels. It transfers through chains of tension, following the path of least resistance, and leaves a trace in how your patient stands, moves, and feels.
This is where your clinical reasoning deepens. You’re no longer just observing symptoms — you’re tracing the story of force: where it came from, where it got stuck, and where it’s still being carried.
Understanding how force enters the body is the next step in connecting assessment to injury. Because before you can change movement, you must understand the loads that created the pattern in the first place.
How Force Enters the Body: Unveiling the Pathogenesis of Injury
The body is a marvel of resilience — designed to absorb forces and navigate the physical demands of life. Yet, within this dynamic equilibrium lies the potential for injury. Understanding how force enters the body is pivotal in unraveling the pathogenesis of injury — a complex interplay of biomechanics, physiology, and environmental factors.
Force, often imperceptible and silent, is a constant companion in our daily lives. It manifests in many forms — from the rhythmic pounding of footsteps during a jog to the sudden impact of a collision. Force is the unseen actor that, when applied to the body, initiates a cascade of responses — both protective and potentially damaging.
Take, for instance, the act of lifting a heavy object. The force exerted on the body during this seemingly mundane task engages muscles, ligaments, and bones in a delicate balance. If the load exceeds the body’s capacity or the movement is executed with poor biomechanics, the door to injury swings open.
When the loads are greater than our capacity - injury is the result. Our goal is to increase our capacity to withstand the loads of our everyday movements, so that we can move independently and pain free.
Beyond biomechanics, force also penetrates the cellular level. When subjected to mechanical stress, cells activate signaling pathways that can lead to inflammation, tissue remodeling, or, in extreme cases, degeneration or cell death.
Imagine the repetitive stress on a joint due to improper ergonomics or an athlete’s relentless training regimen. The cells within those tissues bear the brunt — responding with biochemical signals that can either fortify the structure or, if overwhelmed, contribute to its breakdown.
Force can initiate injury through two primary pathways: trauma and microtrauma.
Trauma is immediate and high-force — resulting in fractures, dislocations, or sprains. It’s the collision during a game, the sudden jolt in a car accident — moments where the body faces forces beyond its capacity to protect itself.
Microtrauma, on the other hand, unfolds over time — the subtle accumulation of repetitive forces or sustained stress. Picture the repeated impact on a runner’s knees or the constant strain on a musician’s hands. Microtrauma, often unnoticed early on, gradually weakens tissue and sets the stage for chronic pain or dysfunction.
Force doesn’t act in isolation — it’s shaped by the environment it meets. Surface hardness, footwear, and even climate can change how force enters and dissipates. A runner on pavement faces different stresses than one on a soft trail. Understanding these nuances is essential to both injury prevention and rehabilitation.
Transitioning from Observation to Understanding.
Clinical reasoning is more than identifying what hurts — it’s understanding why it hurts and what pattern it belongs to.
Every muscle, joint, and restriction tells part of a larger story. If you only treat what you see, you’ll miss the deeper network that keeps the pain coming back.
That’s where the fascial lines come in.
Understanding these lines gives you a framework to see beyond local pain and into the global system that drives it. They turn your assessment from a checklist into a map — one that connects symptoms to their source.
The human body is a marvel of interconnectedness, with various systems working in harmony to facilitate movement. Among these, fascial lines play a crucial role — weaving through the body to create a web-like structure that shapes how we move.
First introduced by Thomas Myers in Anatomy Trains, the fascial lines — or myofascial meridians — are continuous bands of fascia that link muscles and structures into functional units. Rather than viewing muscles in isolation, fascial lines emphasize the connectivity of the entire musculoskeletal system.
They act as communication pathways, transmitting tension and force to optimize movement and stability.
“When one line becomes restricted or imbalanced, that tension doesn’t stay local — it ripples through the system.”
Some of the key fascial lines include:
• Superficial Back Line (SBL): connects the plantar fascia to the scalp fascia, influencing posture and extension patterns.
• Deep Front Line (DFL): runs through the inner body from the arches of the feet to the jaw, supporting core stability and balance.
• Lateral Line (LL): stabilizes side-to-side movement and balances front and back body tension.
• Spiral Line (SL): coordinates rotational and cross-body movements.
• Arm Lines: integrate upper-limb motion with the trunk and shoulder girdle.
When one line becomes restricted or imbalanced, that tension doesn’t stay local — it ripples through the system. This is why a tight hamstring can affect shoulder movement, or jaw tension can echo through the pelvis.
Fascial lines remind us that pain is rarely isolated — it’s distributed through a web of tension and support. Your role is to trace that web, find where the body is holding load, and restore the ability to move as a connected whole.
From Assessment to Plan of Care
A good assessment doesn’t end when you identify what’s tight — that’s where it begins.
When your assessment is grounded in solid clinical reasoning and an understanding of fascial connections, you can explain why something feels the way it does and how it fits into the body’s bigger picture.
That clarity builds trust. It turns your findings into a story that patients can understand — one that gives meaning to your recommendations and confidence in your care.
When a patient understands your reasoning, they stop questioning your plan and start believing in it. They can see that every technique, every recommendation, and every follow-up visit has a purpose.
That’s the power of a strong assessment: it doesn’t just guide your hands — it guides the entire conversation about care. And when your reasoning is clear, your plan becomes easier to explain, easier for patients to commit to, and far more effective in achieving results.
When We Meet:
We will review sample cases to deepen our understanding of how force enters the body and its effect on structure and injury.
Case 1:
MOI: Direct trauma to head and neck from walking into car tire that was hoisted in the air, while looking down on his phone. As a result of trauma, Cspine rotation is limited, pain is constant and limiting to his ADLs for the past 2 years. Imaging results show no fracture, only DJD.
How did force enter the body?
What fascial lines are involved?
Case 2:
MOI: 35 year old male with right knee pain after running laps on a track. Office worker, predominately sitting for most of the day. History of low back pain, although the low back is not hurting now. Knee pain is sharp and feels like it will giveway when walking. No swelling or bruising. Imaging shows no tears.
How did force enter the body?
What fascial lines are involved?
