Effect of Fascial Distortion Model Treatment on Pain Intensity for Musculoskeletal Pain: A Systematic Review and...

Musculoskeletal pain is a common cause of disability and healthcare utilization worldwide. Manual therapies are frequently incorporated into multidisciplinary treatment strategies, and the Fascial Distortion Model (FDM) has been investigated as a treatment for a variety of musculoskeletal conditions. However, the effects of FDM on patient-reported pain have not previously been quantitatively synthesized. However, published evidence syntheses of FDM are limited in scope and have not comprehensively evaluated patient-reported pain outcomes across musculoskeletal conditions. The purpose of this systematic review and meta-analysis was to evaluate the comparative effectiveness of FDM versus alternative interventions on patient-reported pain outcomes and, secondarily, to evaluate pre-post changes in pain following FDM treatment. A systematic literature search of PubMed/MEDLINE, Google Scholar, the Cochrane Library, Semantic Scholar, and ClinicalTrials.gov was conducted from database inception through June 2026. The primary analysis compared post-intervention pain outcomes between FDM and non-FDM interventions in randomized controlled trials, while a secondary pre-post meta-analysis evaluated pain reduction following FDM treatment. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Fourteen studies involving 644 participants met the inclusion criteria. Compared with alternative interventions, FDM demonstrated a statistically significant reduction in pain (MD: -0.92; 95% CI: -1.70 to -0.14); however, the magnitude of benefit did not reach a clinically meaningful threshold. Across all included studies, FDM was associated with clinically meaningful reductions in pain from baseline (MD: -3.42; 95% CI: -4.23 to -2.61), although substantial heterogeneity was observed. Prespecified subgroup analyses demonstrated pooled mean differences of -4.14 (95% CI: -5.86 to -2.42) among studies utilizing diagnosis-specific FDM treatment approaches and -2.94 (95% CI: -3.73 to -2.16) among randomized controlled trials. According to the GRADE assessment, randomized controlled trials provided moderate-certainty evidence supporting an association between FDM and reduced pain. Overall, current evidence suggests that FDM is associated with reductions in musculoskeletal pain but does not appear to provide a clinically meaningful advantage over other conservative treatment approaches. Additional adequately powered randomized controlled trials are needed to better define the comparative effectiveness of FDM across musculoskeletal conditions.