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Weber P, Klingler W, Schleip R, Weber N, Joisten C. Functional and Structural Long-Term Effects of Repetitive Instrument-Assisted Manual Therapy (IAMT) of the Lumbar Back on the Dorsal Myofascial Chain Among Female Soccer Players: A Randomized, Placebo-Controlled Pilot Trial. Cureus 2024; 16:e69337. [PMID: 39398775 PMCID: PMC11471137 DOI: 10.7759/cureus.69337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 10/15/2024] Open
Abstract
INTRODUCTION Instrument-assisted manual therapy (IAMT) is suitable for optimizing movement prerequisites, such as range of motion, flexibility, microcirculation, and pain inhibition along myofascial chains, potentially leading to a reduction in hamstring injuries. To date, however, IAMT's modes of action remain largely unclear. This study aimed to examine the functional and structural effects of repetitive IAMT after 2.5 and five weeks. METHODS Sixteen healthy female soccer players (age: 21.4 (±5.1) years) were randomly grouped into an intervention group and a placebo control group. The intervention group received nine IAMT sessions twice weekly at the right lumbar region. The placebo group received a single pressureless "therapy" at baseline. In addition to structural ultrasound analyses (absolute motion and shear motion), functional mobility tests (passive straight leg raise (PSLR) test and lumbar and thoracic double inclinometry) were performed 4.0 (±2.0) days after the fourth IAMT and 3.4 (±1.1) days after the ninth IAMT in both groups. RESULTS Hamstring flexibility in the PSLR test improved significantly after the ninth IAMT compared with the placebo group (p < 0.05, effect size: 0.913). No systematic differences were seen at the structural level. CONCLUSION Repetitive IAMT can improve hamstring flexibility. Further studies in larger groups and diverse collectives are necessary to additionally test the postulated preventive effect also on hamstring injuries. Whether ultrasound is the right method for detecting structural changes in this context needs to be verified in the future.
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Affiliation(s)
- Patrick Weber
- Department of Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, DEU
- Department of Physiotherapy, Medical Cooperative Society, PANOVIA, Hürth, DEU
| | - Werner Klingler
- Department of Anaesthesiology, SRH Hospital Sigmaringen, Sigmaringen, DEU
- Department of Experimental Anaesthesiology, Ulm University, Ulm, DEU
- Department of Clinical Sciences, Queensland University of Technology, Brisbane, AUS
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, DEU
- Department of Medical Professions, Diploma University of Applied Sciences, Bad Sooden-Allendorf, DEU
| | - Nadine Weber
- Department of Medicine, Medical Cooperative Society, PANOVIA, Hürth, DEU
| | - Christine Joisten
- Department of Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, DEU
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Hsu CY, Hsu T, Lin YN, Cheng YH. Additional Effect of Interfascial Hydrodissection With Dextrose on Shoulder and Neck Function in Patients With Myofascial Pain Syndrome: A Randomized Control Trial. Am J Phys Med Rehabil 2024; 103:827-834. [PMID: 38320240 DOI: 10.1097/phm.0000000000002442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate whether the application of an interfascial injection with dextrose water could result in reduced pain and improved shoulder function and range of motion. DESIGN This is a double-blind randomized controlled trial. Thirty-five patients with chronic shoulder pain were randomly assigned to receive either an interfascial injection of 10 mL of 10% dextrose water guided by ultrasound or a sham injection of 0.5 mL of 10% dextrose water into the subcutaneous layer. All patients received education on a home program of self-massage and self-stretching. Shoulder pain, shoulder range of motion, and neck and shoulder function were measured before injection and at 4 and 12 wks after injection. RESULTS Both groups showed significant improvements in visual analog scale scores at 12-wk follow-up. The interfascial injection group exhibited a significant pain reduction compared with the sham group at the 12-wks follow-up. No between-group differences were observed in shoulder range of motion, pain threshold, and neck and shoulder function. CONCLUSIONS Interfascial injection is effective in decreasing pain in patients with myofascial pain syndrome.
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Affiliation(s)
- Chih Yang Hsu
- From the Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan (CYH, TH, Y-NL, Y-HC); and Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan (Y-NL)
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Hojo E, Sui Y, Shan X, Zheng K, Rossman P, Manduca A, Powell GM, An KN, Zhao KD, Bauer BA, Ehman RL, Yin Z. MR elastography-based slip interface imaging (SII) for functional assessment of myofascial interfaces: A feasibility study. Magn Reson Med 2024; 92:676-687. [PMID: 38523575 PMCID: PMC11142878 DOI: 10.1002/mrm.30087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Abnormal adherence at functional myofascial interfaces is hypothesized as an important phenomenon in myofascial pain syndrome. This study aimed to investigate the feasibility of MR elastography (MRE)-based slip interface imaging (SII) to visualize and assess myofascial mobility in healthy volunteers. METHODS SII was used to assess local shear strain at functional myofascial interfaces in the flexor digitorum profundus (FDP) and thighs. In the FDP, MRE was performed at 90 Hz vibration to each index, middle, ring, and little finger. Two thigh MRE scans were performed at 40 Hz with knees flexed and extended. The normalized octahedral shear strain (NOSS) maps were calculated to visualize myofascial slip interfaces. The entropy of the probability distribution of the gradient NOSS was computed for the two knee positions at the intermuscular interface between vastus lateralis and vastus intermedius, around rectus femoris, and between vastus intermedius and vastus medialis. RESULTS NOSS map depicted distinct functional slip interfaces in the FDP for each finger. Compared to knee flexion, clearer slip interfaces and larger gradient NOSS entropy at the vastus lateralis-vastus intermedius interface were observed during knee extension, where the quadriceps are not passively stretched. This suggests the optimal position for using SII to visualize myofascial slip interface in skeletal muscles is when muscles are not subjected to any additional force. CONCLUSION The study demonstrated that MRE-based SII can visualize and assess myofascial interface mobility in extremities. The results provide a foundation for investigating the hypothesis that myofascial pain syndrome is characterized by changes in the mobility of myofascial interfaces.
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Affiliation(s)
- Emi Hojo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Yi Sui
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Xiang Shan
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Keni Zheng
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Phillip Rossman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Garret M. Powell
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kai-Nan An
- Orthopedics Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kristin D. Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Brent A. Bauer
- General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard L. Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Dones VC, Serra MAB, Tangcuangco LPD, Orpilla VB. Superficial fascia displacement in cervical flexion: differentiating myofascial pain syndrome, a cross-sectional study. J Osteopath Med 2024; 124:353-363. [PMID: 38444081 DOI: 10.1515/jom-2023-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Abstract
CONTEXT Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial flexibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM). OBJECTIVES This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of superficial fascial displacement during active cervical flexion with the clinical diagnosis of MPS. METHODS A cross-sectional study selectively included MPS and non-MPS participants from different workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a sonographer recorded superficial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized. RESULTS In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found significant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically significant (p>0.05). Also, the type of work, the direction of fascial displacement, and the difference in superficial fascial displacement during cervical flexion did not show a significant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a specificity of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS. CONCLUSIONS We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as significant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.
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Affiliation(s)
- Valentin C Dones
- Center for Health Research and Movement Science, 37572 University of Santo Tomas , Manila, Philippines
| | - Mark Angel B Serra
- Center for Health Research and Movement Science, 37572 University of Santo Tomas , Manila, Philippines
| | | | - Vergel B Orpilla
- College of Rehabilitation Sciences, 37572 University of Santo Tomas , Manila, Philippines
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Lin Y, Dai R, Vogelaar G, Rinkevich Y. Organ dependency on fascia connective tissue. Am J Physiol Cell Physiol 2024; 327:C357-C361. [PMID: 38912738 DOI: 10.1152/ajpcell.00350.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
Fascia is a specialized connective tissue system that encapsulates and interconnects between tissues and organs throughout the body. The fascia system regulates pain sensation, organ inflammation, trauma, and fibrotic diseases. This mini-review summarizes recent findings from animal models, which reveal the inter-dependency between tissues/organs and the fascia system. Special mechanisms are explored of fascia response to skin inflammatory processes and fibrotic microenvironments in trauma models. We highlight the functionally diverse communities of its fascia-born fibroblasts and the significance of their stage-specific differentiation and communication to disease progression. Understanding the molecular mechanisms and cellular processes within the fascia microenvironment may serve as a basis for future clinical translation.
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Affiliation(s)
- Yue Lin
- Institute of Regenerative Biology and Medicine (IRBM), Helmholtz Zentrum München, Munich, Germany
| | - Ruoxuan Dai
- Institute of Regenerative Biology and Medicine (IRBM), Helmholtz Zentrum München, Munich, Germany
| | - George Vogelaar
- Institute of Regenerative Biology and Medicine (IRBM), Helmholtz Zentrum München, Munich, Germany
| | - Yuval Rinkevich
- Institute of Regenerative Biology and Medicine (IRBM), Helmholtz Zentrum München, Munich, Germany
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Luo J, West N, Lauder GR. myoActivation®, a Structured Assessment and Therapeutic Process for Adolescents With Myofascial Dysfunction and Chronic Low Back Pain: A Case Series. Cureus 2024; 16:e68029. [PMID: 39347347 PMCID: PMC11431991 DOI: 10.7759/cureus.68029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Myofascial dysfunction is a significant, but often unrecognized, contributor to chronic low back pain (CLBP). myoActivation is an innovative method that utilizes a structured assessment and therapeutic process to recognize and manage myofascial dysfunction and pain. Since 2017, the British Columbia Children's Hospital Complex Pain Service has used myoActivation as a tool in the interdisciplinary care of adolescents with chronic pain. This case series explores the journey to discharge of patients in whom myoActivation was incorporated as part of their CLBP management. Methods We retrospectively reviewed clinical records of adolescents reporting CLBP who underwent myoActivation between August 2022 and January 2023 and had subsequently been discharged. Information obtained for analysis included preclinical information (medical/injury/pain history, previous investigations, diagnoses, therapies, and quality of life indicators); clinic recommendations, assessment findings, management strategies, and specifics of the myoActivation process; and reported changes at discharge (quality-of-life measures and medication use). Results Eight cases were reviewed: all female, with a median age (range) of 16.5 (15.7-19.5) years. Before admission, patients had experienced chronic pain for a median duration of 4.3 (1-8) years, had self-reported average pain intensity of 7.5 (4-9) on the 0-10 numeric pain scale, with poor quality-of-life impacts including sleep disturbance (8/8, 100%), school absence (8/8, 100%), and low mood (6/8, 75%). Patients attended three (2-5) myoActivation sessions over two (1-10) weeks. The overall duration of their interdisciplinary care was 12 (7-25) months. At discharge, there were improvements in pain (7/8, 88%), physical functioning (5/8, 63%), sleep (6/8, 75%), school attendance (5/8, 63%), and mood (4/6, 67%) and reduced prescription and over-the-counter medication use in most cases. Conclusion This case series suggests that myoActivation may be a useful clinical tool in the assessment and management of adolescents with myofascial dysfunction and CLBP. Prospective longitudinal research is required to establish evidence that confirms the clinical efficacy of myoActivation within interdisciplinary care.
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Affiliation(s)
- Jessica Luo
- Department of Pediatric Anesthesia, British Columbia Children's Hospital Research Institute, Vancouver, CAN
- Faculty of Science, University of British Columbia, Vancouver, CAN
| | - Nicholas West
- Department of Pediatric Anesthesia, British Columbia Children's Hospital Research Institute, Vancouver, CAN
| | - Gillian R Lauder
- Department of Anesthesiology, Pharmacology, and Therapeutics, British Columbia Children's Hospital Research Institute, Vancouver, CAN
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Fukino K, Tsutsumi M, Honda E, Nimura A, Iwanaga J, Akita K. Contribution of the complex comprising the masticatory fascia, disc, and capsule to temporomandibular joint stabilization: An anatomical study. Ann Anat 2024; 254:152268. [PMID: 38657780 DOI: 10.1016/j.aanat.2024.152268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Anterior displacement of the temporomandibular joint (TMJ) disc is the most typical pathological condition of TMJ disorders. Structures attached to the articular disc may support the disc in various directions and contribute to stabilizing the TMJ. However, the relationship between the articular disc, capsule, and masticatory muscles remains unclear. Therefore, this study aimed to clarify the relationship between the masticatory muscles, related masticatory fascia, articular disc, and capsule. METHODS We examined 10 halves from adult Japanese cadavers, with five halves macroscopically analyzed and the remaining five histologically analyzed. The TMJ was dissected from the lateral aspect for gross anatomical analysis. For histological analysis, the relationship between the temporal and masseteric fasciae and the articular capsule was observed in the coronal section. Additionally, we evaluated relationships among the disc, capsule, temporal fascia, and masseteric fascia in 10 living and healthy volunteers using magnetic resonance imaging. RESULTS The articular disc was attached to the capsule without a clear border. The capsule continued into the masseteric and temporal fasciae. Consequently, the articular disc, capsule, masseteric, and temporal fasciae were considered a single complex. CONCLUSIONS The single complex of the temporalis, masseter, capsule, masticatory fascia, and disc may antagonize the force in the posterolateral direction through the fascia.
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Affiliation(s)
- Keiko Fukino
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiichi Honda
- Department of Oral and Maxillofacial Radiology, University of Tokushima, Graduate School, 3-18-15 Kuramoto, Tokushima 770-8504, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Dal Farra F, Bergna A, Lunghi C, Bruini I, Galli M, Vismara L, Tramontano M. Reported biological effects following Osteopathic Manipulative Treatment: A comprehensive mapping review. Complement Ther Med 2024; 82:103043. [PMID: 38685285 DOI: 10.1016/j.ctim.2024.103043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND PURPOSE Osteopathic Manipulative Treatment (OMT) is a therapeutic whole-body approach mainly focused on correcting somatic dysfunctions. The aim of this scoping review is to systematically map the literature regarding the documented biological effects observed following OMT. METHODS The 2020 JBIRM version and the PRISMA-ScR were followed for the conceptualization and reporting of this review. The protocol was registered on the "Open Science Framework Registry" (https://doi.org/10.17605/OSF.IO/MFAUP). We searched for original articles published on Medline, Embase, and Scopus, from inception to the present. RESULTS Overall, 10,419 records were identified. After duplicate removal, screening for title and abstract, and specific exclusions with reasons, a total of 146 studies were included. Wide differences were detected among studies in their geographical localization, study design, temporal distribution, participants' condition, OMT protocols, and documented biological effects. Such variety in frequency distribution was properly described through descriptive statistics. CONCLUSIONS Biological modifications that appear to be induced by OMT have been detected in several body systems, but mostly in neurophysiological correlates and musculoskeletal changes. Results suggest a growing interest over the years on this topic, especially in the last two decades. More efforts in research are recommended to highlight whether such changes specifically depend on OMT, and to demonstrate its specific contribution to clinical practice.
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Affiliation(s)
- Fulvio Dal Farra
- Department Information Engineering, University of Brescia, Via Branze 38, 25123 Brescia, Italy
| | - Andrea Bergna
- Research Department, SOMA Istituto Osteopatia Milano, 20126 Milan, Italy; AISO - Associazione Italiana Scuole di Osteopatia, 65125 Pescara, Italy.
| | | | - Irene Bruini
- Research Department, SOMA Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Matteo Galli
- Research Department, SOMA Istituto Osteopatia Milano, 20126 Milan, Italy
| | - Luca Vismara
- Division of Neurology and Neurorehabilitation - IRCCS Istituto Auxologico Italiano, 28824 Piancavallo, Verbania, Italy
| | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Scaturro D, Migliorino D, Lauricella L, Quartararo F, Calabrese N, Tomasello S, Vecchio M, Letizia Mauro G. Extracorporeal ShockWave Treatment vs. mesotherapy in the treatment of myofascial syndromes: a clinical trial. Front Med (Lausanne) 2024; 11:1388922. [PMID: 38841584 PMCID: PMC11152160 DOI: 10.3389/fmed.2024.1388922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/23/2024] [Indexed: 06/07/2024] Open
Abstract
Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.
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Affiliation(s)
- Dalila Scaturro
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
| | - Domenico Migliorino
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Lorenza Lauricella
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
| | - Francesco Quartararo
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Noemi Calabrese
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Sofia Tomasello
- Department of Neuroscience, Biomedicine and Movement of the University of Verona, Verona, Italy
| | - Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Giulia Letizia Mauro
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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Dones V, Dalusong MT, Chiong-Maya A, Vergel O. The difference in the upper trapezius deep fascia slides between individuals with and without myofascial pain syndrome: A case-control study. J Bodyw Mov Ther 2024; 38:375-383. [PMID: 38763582 DOI: 10.1016/j.jbmt.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 08/28/2023] [Accepted: 12/05/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION MPS is a chronic disorder caused by myofascial trigger points, leading to pain and limited neck movements due to impacted fascia. Studies have reported reduced fascia slides in chronic low back pain, but limited fascia slides in MPS patients are still unreported. AIM We determined differences in upper trapezius' deep fascia slides between MPS and non-MPS participants. METHODS Between January-August 2019, participants from diverse work sectors were recruited in Manila. An expert physiotherapist diagnosed MPS, while non-MPS participants performed full painless cervical movements. Participants underwent upper trapezius deep fascia scans on both shoulders while performing six cervical movements. An HS1 Konica Minolta ultrasound recorded the data. Two blinded physiotherapists used Tracker 5.0 © 2018 to analyze videos and quantify deep fascia slides by measuring the distance between two x-axis points. The Multivariate analysis of variance (MANOVA) assessed deep fascia slide differences in six active cervical movements. Pillai's Trace, with a range of 0-1 and a p-value of <0.05, was set. Effect sizes in individuals with and without MPS were calculated using Hedges' g and Cohen's d. RESULTS Of the 327 participants (136 non-MPS, 191 MPS), 101 MPS participants had shoulder pain for <1 year and 103 experienced unilateral pain. The study examined 3800 ultrasound videos but found no significant difference in deep fascia slides across cervical movements between MPS and non-MPS groups (Pillai's Trace = 0.004, p = 0.94). Minor differences in deep fascia displacement were observed, with small effect sizes (g = 0.02-0.08). CONCLUSION A limited deep fascia slide does not characterize MPS participants from non-MPS participants.
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Affiliation(s)
- Valentin Dones
- Center for Health Research and Movement Science, University of Santo Tomas, Philippines; College of Rehabilitation Sciences, University of Santo Tomas, Philippines.
| | | | - Arlene Chiong-Maya
- College of Rehabilitation Sciences, University of Santo Tomas, Philippines.
| | - Orpilla Vergel
- College of Rehabilitation Sciences, University of Santo Tomas, Philippines.
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Yi KH, Kim DC, Lee S, Lee HJ, Lee JH. Intramuscular Neural Distribution of the Gluteus Maximus Muscle: Diagnostic Electromyography and Injective Treatments. Diagnostics (Basel) 2024; 14:140. [PMID: 38248017 PMCID: PMC10813873 DOI: 10.3390/diagnostics14020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION The purpose of this study was to investigate neural patterns within the gluteus maximus (Gmax) muscle to identify optimal EMG placement and injection sites for botulinum toxin and other injectable agents. METHODS This study used 10 fixed and 1 non-fixed adult Korean cadavers. Intramuscular arborization patterns were confirmed in the cranial, middle, and caudal segments of 20 Gmax muscles using Sihler staining. Ultrasound images were obtained from one cadaver, and blue dye was injected using ultrasound guidance to confirm the results. RESULTS The intramuscular innervation pattern of the Gmax was mostly in the middle part of this muscle. The nerve endings of the Gmax are mainly located in the 40-70% range in the cranial segment, the 30-60% range in the middle segment, and the 40-70% range in the caudal segment. DISCUSSION Addressing the spasticity of the gluteus maximus requires precise, site-specific botulinum toxin injections. The use of EMG and other injection therapies should be guided by the findings of this study. We propose that these specific sites, which correspond to areas with the densest nerve branches, are the safest and most efficient locations for both botulinum toxin injections and EMG procedures.
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Affiliation(s)
- Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea;
- Maylin Clinic (Apgujeong), Seoul 06005, Republic of Korea
| | - Dong Chan Kim
- Department of Rehabilitation Medicine, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea;
| | - Siyun Lee
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA;
| | - Hyung-Jin Lee
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea
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Suarez-Ramos C, Gonzalez-Suarez C, Gomez IN, Gonzalez MK, Co PH, Llamas JA. Effectiveness of ultrasound guided interfascial hydrodissection with the use of saline anesthetic solution for myofascial pain syndrome of the upper trapezius: a single blind randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1281813. [PMID: 38149112 PMCID: PMC10750391 DOI: 10.3389/fresc.2023.1281813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/31/2023] [Indexed: 12/28/2023]
Abstract
Background Myofascial pain syndrome (MPS) is described as pain that arise from myofascial trigger points (MTrPs) which is a hyperirritable spot within a taut band of skeletal muscle. A newer needling technique called the interfascial hydrodissection (IH), wherein anesthetic saline solution (ASS) is injected between the fascia of the muscles using ultrasound as guide. It is theorized that this technique blocks the nerve branches and improve gliding in between the muscle and fascia. Objective To determine the short and long-term effects of interfascial hydrodissection using 2% Lidocaine and saline solution compared to dry needling with MPS of the upper trapezius on pain and quality of life using. Methods This study is a single-blind randomized controlled trial where ultrasound guided IH with ASS was compared to dry needling (DN) of the MTrPs. Both groups were taught self-stretch exercises (SSE) to be done everyday after the procedure. Outcome measures were pain using the visual analogue scale (VAS) and quality of life assessment with EQ-5D-5l questionnaire. All participants were assessed by a blinded assessor before the intervention, immediately after, 10 and 30 min, one week, two weeks, four weeks, three months, and six months after the procedure. Data Analysis: Two-way mixed ANOVA and follow-up independent T-test were conducted for the outcome measures across several time points between the 2 groups. Results A total of 46 participants with two dropouts were all included during the final analysis. Both groups demonstrated significant differences in VAS scores between baseline and the different time points, the IH + SSE group demonstrated the more significant effect size at as compared to the DN + SSE group. For EQ-5D-5l, no statistical differences were seen in all dimensions but there was a larger effect size for usual activities, pain/discomfort and anxiety/depression. Conclusion Interfascial hydrodissection is a technique that can manage both short and long term symptoms of MPS. This could be utilized as an alternative management for those with chronic MPS of the upper trapezius. Philippine Health Research Registry ID PHRR221003-005034.
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Affiliation(s)
- Charidy Suarez-Ramos
- Physical Medicine and Rehabilitation, Our Lady of Lourdes Hospital, Manila, Philippines
| | - Consuelo Gonzalez-Suarez
- Physical Medicine and Rehabilitation, Our Lady of Lourdes Hospital, Manila, Philippines
- Research Center for Health Science, University of Santo Tomas, Manila, Philippines
| | - Ivan Neil Gomez
- Department of Occupational Therapy, College of Rehabilitation Science, University of Santo Tomas, Manila, Philippines
- Center of Health Research and Movement Sciences, University of Santo Tomas, Manila, Philippines
| | - Maria Katherine Gonzalez
- Physical Therapy and Rehabilitation Medicine Department, Gat Andres Bonifacio Medical Center, Manila, Philippines
| | - Philippe Hubert Co
- Health Hub Physical Therapy, Rehabilitation Medicine and Orthopedics Clinic Inc., Manila, Philippines
| | - Jose Alfonso Llamas
- Physical Therapy and Rehabilitation Medicine Department, Region I Medical Center, Dagupan City, Pangasinan, Philippines
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Creighton D, Fausone D, Swanson B, Young W, Nolff S, Ruble A, Hassan N, Soley E. Myofascial and discogenic origins of lumbar pain: A critical review. J Man Manip Ther 2023; 31:435-448. [PMID: 37503571 PMCID: PMC10642329 DOI: 10.1080/10669817.2023.2237739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
The purpose of this three-part narrative review is to examine the anatomy of, and the research which supports, either the lumbar myofascia or intervertebral disc (IVD) as principal sources of our patient's low back pain. A comprehensive understanding of anatomical lumbar pain generators in combination with the current treatment-based classification system will further improve and enhance clinical decision-making skills. Section I reviews the anatomy of the spinal myofascia, myofascial sources of lumbar pain, and imaging of myofascial tissues. Part II reviews the anatomy of the IVD, examines the IVD as a potential lumbar pain generator, and includes detailed discussion on Nerve Growth Factor, Inflammatory Cytokines, Vertebral End Plates and Modic change, Annular tears, and Discogenic instability. Part III looks at the history of myofascial pain, lab-based research and myofascial pain, and various levels of discogenic pain provocation research including animal, laboratory and human subjects. Our review concludes with author recommendations on developing a comprehensive understanding of altered stress concentrations affecting the posterior annulus fibrosis, neo-innervation of the IVD, inflammatory cytokines, discogenic instability, and how this knowledge can complement use of the Treatment-Based Classification System.
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Unalmis Y, Muniroglu S. Examination of the effect of fascial therapy on some physical fitness parameters in taekwondo athletes. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:299-307. [PMID: 38314051 PMCID: PMC10831376 DOI: 10.1016/j.smhs.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/09/2023] [Accepted: 09/21/2023] [Indexed: 02/06/2024] Open
Abstract
One of the objectives of this study is to determine the effect of the eight-week fascial therapy program on flexibility, vertical jump, standing long jump, speed and anaerobic strength parameters in taekwondo athletes. Another aim of the research is to create a therapy protocol that can be used in athletes related to performance development through the relaxation of the fascial system, which is considered an indicator of physical fitness and has numerous functions in the body. This study included 32 taekwondo players who were licensed, actively attending taekwondo training. In the study, two groups were formed as fascial therapy group (FTG) (n = 16) and control group (CG) (n = 16). After the groups were randomized, fascial relaxation techniques were applied to the fascial therapy group for eight weeks, up to twice a week, and for 30 min. According to the findings obtained as a result of the research, FTG ([-0.36 ± 0.17] seconds [s]) for the 20 m (m) Sprint (T2-T1) had a lower mean time than CG (0.00 ± 0.07) s, FTG (0.06 ± 1.95) for the Flamingo Balance Test (T2-T1) had a lower mean fall than CG (1.25 ± 1.13), FTG ([3.56 ± 2.37] centimeters [cm]) for the Sit & Reach Test (T2-T1) had a lower mean fall than CG ([-0.19 ± 1.28] cm), FTG ([5.75 ± 2.54] cm) had a higher jump distance than CG ([1.88 ± 8.11] cm) according to the results of Vertical Jump Test (T2-T1) and finally FTG ([9.13 ± 5.56] cm) had a longer distance than CG ([-0.31 ± 1.85] cm) according to the results of Standing Long Jump Test (T2-T1). The result of our study has shown that fascial techniques can be used safely by experienced physiotherapists and can be included in the training program. It is recommended that coaches of sports disciplines work with experienced physiotherapists on this subject and include fascial methods in their training programs.
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Affiliation(s)
- Yagmur Unalmis
- Ankara University, Faculty of Sport Sciences, Dögol Caddesi 06100 Beşevler, Ankara, Turkey
| | - Surhat Muniroglu
- Ankara University, Faculty of Sport Sciences, Dögol Caddesi 06100 Beşevler, Ankara, Turkey
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Iglesias-Peón M, Mesa-Jiménez J, Fernández-DE-Las-Peñas C, García Iglesias N, Iglesias Peón CM, Rodrigues-DE-Souza DP, Alburquerque-Sendín F. Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders. J Appl Oral Sci 2023; 31:e20230045. [PMID: 37909525 PMCID: PMC10609633 DOI: 10.1590/1678-7757-2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/24/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test. METHODS A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. RESULTS The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. CONCLUSION The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.
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Affiliation(s)
- Marcos Iglesias-Peón
- Osteopatía y Fisioterapia Guadalajara, Guadalajara, España
- Universidad de Córdoba, Programa de Doctorado en Biomedicina, Córdoba, España
| | - Juan Mesa-Jiménez
- Universidad CEU San Pablo, Departamento de Fisioterapia, Madrid, España
| | - César Fernández-DE-Las-Peñas
- Universidad Rey Juan Carlos, Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Alcorcón, Madrid, España
| | | | | | | | - Francisco Alburquerque-Sendín
- Universidad de Córdoba, Facultad de Medicina y Enfermería, Departamento de Enfermería, Farmacología y Fisioterapia, Córdoba, España
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
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Bhatnagar T, Azim FT, Behrouzian M, Davies K, Wickenheiser D, Jahren G, West N, Leveille L, Lauder GR. Assessing changes in range of motion in adolescent patients undergoing myoActivation® for chronic pain related to myofascial dysfunction: a feasibility study. FRONTIERS IN PAIN RESEARCH 2023; 4:1225088. [PMID: 37954067 PMCID: PMC10634437 DOI: 10.3389/fpain.2023.1225088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction myoActivation® assessment utilizes systemized movement tests to assess for pain and limitations in motion secondary to myofascial dysfunction. myoActivation needling therapy resolves the myofascial components of pain and is associated with immediately observed changes in pain, flexibility, and range of motion. The principal aim of this feasibility study was to objectively characterize the kinematic metrics of upper and lower body motion before and after myoActivation movement tests and therapy. Methods Five consecutive eligible adolescent participants considered appropriate for myoActivation were consented to receive their myoActivation intervention in a motion laboratory. Clinical motion analysis was used to measure the changes in maximum range of motion (maxROM) and maximum angular speed to maximum ROM (speedROM) of movement tests predicted to change. Metrics were analyzed to assess changes over specified time intervals - i) baseline to after initial myoActivation session, and ii) baseline to after complete myoActivation course. Each participant served as their own control. Results We demonstrated objective evidence of improved maxROM and/or speedROM in 63% of the movement tests predicted to change after just one session of myoActivation and in 77% of movement tests predicted to change over the complete course of treatment. The myoActivation clinician observed positive change in 11/19 of movement tests across all patients, that were predicted to change after the initial myoActivation session; 81% of these positive changes were confirmed by the kinematic data. Discussion Clinical motion analysis provides objective support to clinicians evaluating, treating, and teaching myofascial release. A larger, prospective clinical trial is warranted to explore the impact of myoActivation on movement. Refinement of observation techniques and outcome measures established in this feasibility study will strengthen future clinical motion analysis of the myoActivation process.
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Affiliation(s)
- Tim Bhatnagar
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farah T. Azim
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Mona Behrouzian
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Karen Davies
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Diane Wickenheiser
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
| | - Gail Jahren
- Department of Nursing, BC Children’s Hospital, Vancouver, BC, Canada
| | - Nicholas West
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
| | - Lise Leveille
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian R. Lauder
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Sikdar S, Srbely J, Shah J, Assefa Y, Stecco A, DeStefano S, Imamura M, Gerber LH. A model for personalized diagnostics for non-specific low back pain: the role of the myofascial unit. FRONTIERS IN PAIN RESEARCH 2023; 4:1237802. [PMID: 37901614 PMCID: PMC10606250 DOI: 10.3389/fpain.2023.1237802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Low back pain (LBP) is the leading cause of disability worldwide. Most LBP is non-specific or idiopathic, which is defined as symptoms of unknown origin without a clear specific cause or pathology. Current guidelines for clinical evaluation are based on ruling out underlying serious medical conditions, but not on addressing underlying potential contributors to pain. Although efforts have been made to identify subgroups within this population based on response to treatment, a comprehensive framework to guide assessment is still lacking. In this paper, we propose a model for a personalized mechanism-based assessment based on the available evidence that seeks to identify the underlying pathologies that may initiate and perpetuate central sensitization associated with chronic non-specific low back pain (nsLBP). We propose that central sensitization can have downstream effects on the "myofascial unit", defined as an integrated anatomical and functional structure that includes muscle fibers, fascia (including endomysium, perimysium and epimysium) and its associated innervations (free nerve endings, muscle spindles), lymphatics, and blood vessels. The tissue-level abnormalities can be perpetuated through a vicious cycle of neurogenic inflammation, impaired fascial gliding, and interstitial inflammatory stasis that manifest as the clinical findings for nsLBP. We postulate that our proposed model offers biological plausibility for the complex spectrum of clinical findings, including tissue-level abnormalities, biomechanical dysfunction and postural asymmetry, ecological and psychosocial factors, associated with nsLBP. The model suggests a multi-domain evaluation that is personalized, feasible and helps rule out specific causes for back pain guiding clinically relevant management. It may also provide a roadmap for future research to elucidate mechanisms underlying this ubiquitous and complex problem.
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Affiliation(s)
- Siddhartha Sikdar
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - John Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, CA, United States
| | - Jay Shah
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Yonathan Assefa
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York City, NY, United States
| | | | - Marta Imamura
- Faculty of Medicine, University of São Paolo, São Paulo, Brazil
| | - Lynn H. Gerber
- Center for Adaptive Systems of Brain Body Interactions, George Mason University, Fairfax, VA, United States
- Department of Medicine, INOVA Health System, Fairfax, VA, United States
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Conte da Silva A, Aily JB, Mattiello SM. Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial. J Bodyw Mov Ther 2023; 36:335-342. [PMID: 37949581 DOI: 10.1016/j.jbmt.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). METHODS Sixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. RESULTS There were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to -0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. CONCLUSION The IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. TRIAL REGISTRATION RBR-44v8y7.
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Affiliation(s)
| | - Jéssica Bianca Aily
- Physiotherapy Department, Federal University of São Carlos, São Carlos, SP, Brazil.
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Brandl A, Wilke J, Egner C, Schmidt T, Schleip R. Effects of Maximal Eccentric Trunk Extensor Exercise on Lumbar Extramuscular Connective Tissue: A Matched-Pairs Ultrasound Study. J Sports Sci Med 2023; 22:447-454. [PMID: 37711713 PMCID: PMC10499134 DOI: 10.52082/jssm.2023.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
Recently, it has been shown that the extramuscular connective tissue (ECT) is likely involved in delayed onset muscle soreness (DOMS). Therefore, the aim of the present study was to investigate the effects of maximal trunk extension eccentric exercise (EE) on ECT thickness, self-reported DOMS, ECT stiffness, skin temperature, and possible correlations between these outcomes. Healthy adults (n = 16, 29.34 ± 9.87 years) performed fatiguing EE of the trunk. A group of highly active individuals (TR, n = 8, > 14 h of sport per week) was compared with a group of less active individuals (UTR, n = 8, < 2 h of sport per week). Ultrasound measurements of ECT thickness, stiffness with MyotonPro and IndentoPro, skin temperature with infrared thermography, and pain on palpation (100 mm visual analog scale, VAS) as a surrogate for DOMS were recorded before (t0), immediately (t1), 24 h (t24), and 48 h (t48) after EE. ECT thickness increased after EE from t0 to t24 (5.96 mm to 7.10 mm, p = 0.007) and from t0 to t48 (5.96 mm to 7.21 mm, p < 0.001). VAS also increased from t0 to t24 (15.6 mm to 23.8 mm, p < 0.001) and from t0 to t48 (15.6 mm to 22.8 mm, p < 0.001). Skin temperature increased from t1 to t24 (31.6° Celsius to 32.7° Celsius, p = 0.032) and t1 to t48 (31.6° Celsius to 32.9° Celsius, p = 0.003), while stiffness remained unchanged (p > 0.05). Correlation analysis revealed no linear relationship between the outcomes within the 48-hour measurement period. The results may confirm previous findings of possible ECT involvement in the genesis of DOMS in the extremities also for the paraspinal ECT of trunk extensors. Subsequent work should focus on possible interventions targeting the ECT to prevent or reduce DOMS after strenuous muscle EE.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Vienna School of Osteopathy, Vienna, Austria
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
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Du Y, Cai X, Xu B, Wu Y, Chen M, Wang J, Yuan B, Zhang W, Zhu J, Yang C. Global Status and Future Trends of Fascia and Pain Research in 2013-2022: Bibliometric Analysis Based on CiteSpace and VOSviewer. J Pain Res 2023; 16:2633-2653. [PMID: 37538250 PMCID: PMC10394092 DOI: 10.2147/jpr.s412161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Fascial pathological pain is the main type of chronic pain in older adults today, and studying the relationship between fascia and pain can help in the clinical search for effective treatments. However, in the face of the vast amount of research findings, there is no systematic assessment of the relationship between fascia and pain in a bibliometric analysis. Therefore, the purpose of this study is to analyze studies on fascia and pain using CiteSpace and VOSviewer to identify research hotspots and future directions. Materials and Methods A total of 744 papers related to fascia and pain from 2013 to 2022 were collected from the core collection database of Web of Science, and the authors, countries, institutions, keyword co-occurrence, keyword clustering, and keyword emergence were analyzed by CiteSpace and VOSviewer to construct a knowledge map. Results Literature publication has shown an overall upward trend over the past decade, but there have been some fluctuations. Carmelo Pirri, Caterina Fede, and Raffaele De Caro are the top three authors with the most articles. The United States, China, and Spain are major contributors to fascial and pain research. The University of Padua, Universidad Complutense and Harvard Medical School are leading institutions in this field. However, it is noteworthy that the collaboration between authors, countries and institutions is not active. Keyword analysis showed that hot spots and trends in research on fascia and pain focused on hot diseases, major interventions, and mechanism exploration. Conclusion This analysis identifies the most influential authors, institutions, and countries in the field of fascial and pain research and provides a reference for assessing their academic impact. The analysis of keywords and co-cited literature is useful for analyzing research hotspots and their evolution, as well as for predicting future trends.
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Affiliation(s)
- Yikuan Du
- Central Laboratory, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, 523059, People’s Republic of China
| | - Xiaolin Cai
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bijun Xu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Yuqing Wu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Mianhai Chen
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinjin Wang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bing Yuan
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Weichui Zhang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinfeng Zhu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Chun Yang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
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Medeiros F, Martins W, Behm D, Ribeiro D, Marinho E, Santos W, Viana RB. Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis. J Bodyw Mov Ther 2023; 35:273-283. [PMID: 37330781 DOI: 10.1016/j.jbmt.2023.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/21/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the effects of foam roller or stick massage performed after exercise-induced muscle damage protocols on indirect markers of muscle damage compared to a non-intervention control group in healthy individuals. METHODS PubMed, Biblioteca Virtual em Saúde, Scopus, Google Scholar, and Cochrane Library database were searched in August 2, 2020, with last update on February 21, 2021. Were included clinical trials involving healthy adult individuals who received foam roller/stick massage versus a non-intervention group and evaluated indirect markers of muscle damage. Risk of bias was assessed by the Cochrane Risk of Bias tools. Standardized mean differences with 95% confidence intervals were used to measure the foam roller/stick massage effect on muscle soreness. RESULTS The five included studies investigated 151 participants (136 men). Overall, the studies presented a moderate/high risk of bias. A between-groups meta-analysis showed no significant difference between massage and non-intervention control groups on muscle soreness immediately after (0.26 [95%CI: 0.14; 0.65], p = 0.20), 24 h (-0.64 [95%CI: 1.34; 0.07], p = 0.08), 48 h (-0.35 [95%CI: 0.85; 0.15], p = 0.17), 72 h (-0.40 [95%CI: 0.92; 0.12], p = 0.13), and 96 h (0.05 [95%CI: 0.40; 0.50], p = 0.82) after an exercise-induced muscle damage protocol. Moreover, the qualitative synthesis showed that foam roller or stick massage had no significant effect on range of motion, muscle swelling, and maximal voluntary isometric contraction recovery. CONCLUSION In conclusion, the current literature appears to not support the advantage of foam roller or stick massage to improve recovery of muscle damage indirect markers (muscle soreness, range of motion, muscle swelling, and maximal voluntary isometric contraction) compared to a non-intervention control group in healthy individuals. Furthermore, due to the heterogeneity of the methodological designs among the included studies, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on foam roller or stick massage to draw any definite conclusions. REVIEW PROTOCOL NUMBER The study was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) on August 2, 2020, with last update on February 21, 2021. Protocol number: CRD2017058559.
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Affiliation(s)
- Flávia Medeiros
- College of Physical Education, University of Brasilia, Brazil.
| | | | - David Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, Canada.
| | - Deise Ribeiro
- College of Physical Education, University of Brasilia, Brazil.
| | | | - Wanderson Santos
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.
| | - Ricardo Borges Viana
- Institute of Physical Education and Sport, Federal University of Ceará, Fortaleza, Brazil.
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23
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Dones VC, Chavez FTB, Serra MAB, Rimando M, San Jose MCZ. Concurrent validity of palpation and musculoskeletal ultrasound in evaluating the fascia of individuals with and without myofascial pain syndrome. J Bodyw Mov Ther 2023; 35:238-243. [PMID: 37330776 DOI: 10.1016/j.jbmt.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Palpation evaluates the fascia, a three-dimensional web of connective tissues. We propose altered fascia system displacement in patients with myofascial pain syndrome. This study determined the concurrent validity of palpation and musculoskeletal ultrasound (MSUS) videos played on Windows Media Player 10 (WMP) when evaluating the direction of the fascia system's displacement at the end of the cervical active range of motion (AROM). METHODS This cross-sectional study used palpation as index test and MSUS videos on WMP as reference test. First, three physical therapists palpated right and left shoulders for each cervical AROM. Second, during cervical AROM, PT-Sonographer recorded the fascia system displacement. Third, using the WMP, the physical therapists evaluated the direction of skin, superficial and deep fascia displacements at the end of cervical AROM. MedCalc Version 19.5.3 determined the "exact" Clopper-Pearson Interval (CPI). RESULTS We found strong accuracy between palpation and MSUS videos on WMP when determining the direction of skin displacement during cervical flexion and extension (CPI= 78.56 to 96.89). There was moderate agreement between palpation and MSUS videos on WMP when determining the direction of the skin, superficial fascia, and deep fascia displacements during cervical lateral flexion and rotation (CPI= 42.25 to 64.13). CONCLUSION Skin palpation during cervical flexion and extension may be useful in evaluating patients with myofascial pain syndrome (MPS). It is unclear what fascia system was evaluated when shoulders were palpated at the end of cervical lateral flexion and rotation. Palpation as diagnostic tool for MPS was not investigated.
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Affiliation(s)
- Valentin C Dones
- Center for Health Research and Movement Science, University of Santo Tomas, Philippines; College of Rehabilitation Sciences, University of Santo Tomas, Philippines.
| | - Fe Therese B Chavez
- Center for Health Research and Movement Science, University of Santo Tomas, Philippines; College of Rehabilitation Sciences, University of Santo Tomas, Philippines
| | - Mark Angel B Serra
- College of Rehabilitation Sciences, University of Santo Tomas, Philippines
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24
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Bellotti S, Busato M, Cattaneo C, Branchini M. Effectiveness of the Fascial Manipulation Approach Associated with a Physiotherapy Program in Recurrent Shoulder Disease. Life (Basel) 2023; 13:1396. [PMID: 37374178 DOI: 10.3390/life13061396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results.
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Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel) 2023; 10:bioengineering10040474. [PMID: 37106661 PMCID: PMC10135675 DOI: 10.3390/bioengineering10040474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Damage to the fascia can cause significant performance deficits in high-performance sports and recreational exercise and may contribute to the development of musculoskeletal disorders and persistent potential pain. The fascia is widely distributed from head to toe, encompassing muscles, bones, blood vessels, nerves, and internal organs and comprising various layers of different depths, indicating the complexity of its pathogenesis. It is a connective tissue composed of irregularly arranged collagen fibers, distinctly different from the regularly arranged collagen fibers found in tendons, ligaments, or periosteum, and mechanical changes in the fascia (stiffness or tension) can produce changes in its connective tissue that can cause pain. While these mechanical changes induce inflammation associated with mechanical loading, they are also affected by biochemical influences such as aging, sex hormones, and obesity. Therefore, this paper will review the current state of knowledge on the molecular level response to the mechanical properties of the fascia and its response to other physiological challenges, including mechanical changes, innervation, injury, and aging; imaging techniques available to study the fascial system; and therapeutic interventions targeting fascial tissue in sports medicine. This article aims to summarize contemporary views.
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Affiliation(s)
- Yuya Kodama
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Toshinori Ohmori
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Akihiro Kanamaru
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Tomoyoshi Sakaguchi
- Department of Central Rehabilitation, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
| | - Masami Nakagawa
- Department of Central Rehabilitation, Okayama Rosai Hospital, 1-10-25 Midorimachi, Minamiku, Okayama 702-8055, Japan
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26
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Zagury JG, Ananthan S, Quek SYP, Subramanian G. Myofascial Temporomandibular Disorders at a Turning Point: Pragmatic or Evidence-Based Management? Dent Clin North Am 2023; 67:335-348. [PMID: 36965935 DOI: 10.1016/j.cden.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Unvalidated theories have been proposed for the etiopathogenesis of masticatory myofascial temporomandibular disorders (mTMD). Modalities such as cone-beam computed tomography/computed tomography and MRI contributes little to the diagnosis of mTMD. Diagnosing mTMD is based on the recognition of "familiar pain" presentation in the masticatory myofascial tissue. This assessment tool contributes little our understanding of the underlying disease process. Thus, management of mTMD is empirical and arbitrary. Exploring emerging technologies to identify biomarkers and objectively assess myofascial tissue physiology in disease and health may be key in moving the diagnosis of mTMD from the pragmatic paradigm to an evidence-based paradigm.
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Affiliation(s)
- Julyana Gomes Zagury
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ, USA
| | - Sowmya Ananthan
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ, USA
| | - Samuel Y P Quek
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ, USA.
| | - Gayathri Subramanian
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ, USA
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27
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Origo D, Dal Farra F, Bruni MF, Catalano A, Marzagalli L, Bruini I. Are fascial strains involved in chronic pelvic pain syndrome? An exploratory matched case-control study. Int Urol Nephrol 2023; 55:511-518. [PMID: 36522568 DOI: 10.1007/s11255-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic pelvic pain (CPP) and chronic pelvic pain syndrome (CPPS) do not have a definite cause, even if their impact on quality of life was demonstrated. Furthermore, there is evidence of myofascial dysfunctions in a large number of CPP/CPPS, so that the role of fascia can be hypothesized. METHODS The aim of this exploratory matched case-control study was to assess whether fascial strains (FS) represent a factor associated with CPP/CPPS. The study followed the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) statement. We collected data from 189 subjects (cases: 58; controls: 131) who attended the clinic. The participants were managed through a 2:1 enrollment ratio. A standardized booklet requested for clinical information, previous FS and the following questionnaires: "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI), "Hospital Anxiety and Depression Scale" (HADS), "Fear Avoidance Belief Questionnaire" (FABQ). Each subject underwent a palpatory assessment to detect abnormal palpatory findings in the pelvic area. RESULTS The analyses showed that episiotomy, genito-urinary infections and surgery had a significantly increased odds ratio (OR) of 4.13, 3.1 and 3.08, respectively. FS as a whole had a significantly raised OR: 2.22 (1.14 to 4.33). The analysis was adjusted for physical activity and for type of job and OR decreased to 1.94 (0.82 to 4.61), losing its significance (p = 0.129). A strong correlation between symptoms' impact and CPP/CPPS was detected (rpbs = 0.710; p < 0.001) and a moderate one (0.3 < rpbs < 0.7; p < 0.001) was found considering anxiety, depression and abnormal palpatory findings. CONCLUSION This exploratory study suggests that FS could represent an etiological factor for developing CPP/CPPS. However, further research on fascial dysfunctions and relative implications in CPP/CPPS is needed for confirmation.
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Affiliation(s)
- Daniele Origo
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Fulvio Dal Farra
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy. .,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Maria Federica Bruni
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Andrea Catalano
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Lorenzo Marzagalli
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
| | - Irene Bruini
- Research Department, SOMA Osteopathic Institute Milan, Viale Sarca 336 F, 20126, Milan, Italy
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Andriollo DB, Frigo LF, Cielo CA. Effect of Pompage on Vocal and Respiratory Measurements from Female Teachers: A Randomized Clinical Trial. Folia Phoniatr Logop 2023; 75:295-305. [PMID: 36812904 DOI: 10.1159/000529832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Teachers stand out among occupational groups due to their contribution to modern societies, and their voice is the main form of interaction. OBJECTIVE The aim of the study was to verify the changes in vocal and respiratory measurements from teachers with vocal and musculoskeletal complaints and with normal larynx after applying a musculoskeletal manipulation protocol of myofascial release using pompage. METHODS Controlled and randomized clinical trial with 56 participants: 28 teachers in the study group and 28 teachers in the control group. Anamnesis, videolaryngoscopy, hearing screening, sound pressure and maximum phonation time measurements, and manovacuometry were performed. The musculoskeletal manipulation protocol of myofascial release using pompage consisted of a total of 24 sessions, 40 min for each session, three times a week, for 8 weeks. RESULTS There was a significant improvement in the maximum respiratory pressure in the study group after the intervention. The sound pressure level and the maximum phonation time did not change significantly. DISCUSSION AND CONCLUSION Musculoskeletal manipulation protocol of myofascial release using pompage had a direct effect on the respiratory measurements from female teachers, significantly increasing the maximum respiratory pressure but without affecting sound pressure level and the /a/ maximum phonation time.
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Affiliation(s)
- Débora Bonesso Andriollo
- Programa de Pós-graduação em Fonoaudiologia, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Brazil
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Ricci V, Mezian K, Chang KV, Tarantino D, Güvener O, Gervasoni F, Naňka O, Özçakar L. Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3838. [PMID: 36900848 PMCID: PMC10001397 DOI: 10.3390/ijerph20053838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Cervical myofascial pain is a very common clinical condition in the daily practice of musculoskeletal physicians. Physical examination is currently the cornerstone for evaluating the cervical muscles and identifying the eventual presence of myofascial trigger points. Herein, the role of ultrasound assessment in precisely localizing them is progressively mounting in the pertinent literature. Moreover, using ultrasound, not only the muscle tissue but also the fascial and neural elements can be accurately located/evaluated. Indeed, several potential pain generators, in addition to paraspinal muscles, can be involved in the clinical scenario of cervical myofascial pain syndrome. In this article, the authors extensively reviewed the sonographic approach for cervical myofascial pain in order to better diagnose or guide different procedures that can be performed in the clinical practice of musculoskeletal physicians.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University, 12800 Prague, Czech Republic
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei Hu Branch, Taipei 10845, Taiwan
| | - Domiziano Tarantino
- Department of Public Health, Rehabilitation Unit, University Federico II of Naples, 80131 Naples, Italy
| | - Orhan Güvener
- Department of Physical and Rehabilitation Medicine, Mersin University Medical School, 33000 Mersin, Turkey
| | - Fabrizio Gervasoni
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey
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Hopen SR. Intrafasciomembranal Fluid Pressure: A Novel Approach to the Etiology of Myalgias, Part II. Cureus 2023; 15:e35163. [PMID: 36949992 PMCID: PMC10028401 DOI: 10.7759/cureus.35163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
The fascia forms a hierarchy of spaces (small and large compartments) that contain and enclose muscle fibers, fiber bundles, skeletal muscles, and compartments of several skeletal muscles. Solid fascia serves as a membrane that enables an increased volume and fluid pressure within such a fasciomembrane, an intrafasciomembrial fluid pressure (IFMFP). Increased IFMFP provides a theoretical model and a common explanation for the etiology of the myalgias: trigger point (TrP), chronic exertional compartment syndrome (CECS), overtraining syndrome (OTS), and delayed onset muscle soreness (DOMS). Many myalgias and their symptoms are poorly understood, and this review aims to provide an extension to this theoretical model and novel approach. This review suggests that the swelling from elevated IFMFP also likely leads to a longitudinal shortening of the same affected tissue. This model of swelling and shortening provides additional explanations for the changes in the lines of force through the body that can lead to changes in the body's posture and, thus, to compensatory movements. This new approximation also provides a biomechanical explanation for the thickening of the fascia and referred pain, and also suggests that IFMFP is a factor in weather-related pain.
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Ożóg P, Weber-Rajek M, Radzimińska A, Goch A. Analysis of Postural Stability Following the Application of Myofascial Release Techniques for Low Back Pain-A Randomized-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2198. [PMID: 36767565 PMCID: PMC9915703 DOI: 10.3390/ijerph20032198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Low back pain (LBP) is one of the most frequently observed disorders of the musculoskeletal system in the modern population. It is suggested that myofascial disorders in the highly innervated thoracolumbar fascia (TLF), reported in patients with LBP, may be an underlying cause of the ailment. Research also confirms that patients with LBP demonstrate poorer postural stability compared with individuals without the condition. Myofascial release techniques (MFR) are additional therapeutic options that complement existing therapies and help provide a more holistic treatment for chronic LBP (CLBP). OBJECTIVE Evaluation of changes in postural stability following one MFR intervention applied to CLBP subjects immediately after manual therapy and after a month. It was hypothesized that postural stability is going to aggravate immediately after the MFR intervention and improve one month after treatment compared with the baseline results before the treatment. METHODS 113 patients with CLBP participated in a randomized-controlled trial. The experimental group (n = 59) received one MFR intervention, whereas the control group (n = 54) did not receive any therapeutic intervention. Posturography was performed to determine experimental group's immediate response to the therapy and to evaluate the experimental and control groups' responses to the therapy one month after the intervention. RESULTS Only 2 out of 12 comparisons of stabilometric parameters demonstrated reliable effects that are in line with our research hypotheses. Even though both comparisons were observed for therapy outcomes within the experimental group, no reliable differences between the groups were found. CONCLUSIONS A single MFR treatment in the TLF did not affect postural stability in CLBP patients in the experimental group. Further studies are needed to extend the findings by performing a series of holistic MFR treatments applied to a larger area of the body surface that would induce more general tissue changes and thus having a greater impact on postural stability.
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Russo L, Montagnani E, Pietrantuono D, D’Angona F, Fratini T, Di Giminiani R, Palermi S, Ceccarini F, Migliaccio GM, Lupu E, Padulo J. Self-Myofascial Release of the Foot Plantar Surface: The Effects of a Single Exercise Session on the Posterior Muscular Chain Flexibility after One Hour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:974. [PMID: 36673731 PMCID: PMC9858880 DOI: 10.3390/ijerph20020974] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 05/31/2023]
Abstract
This study evaluated the effects of a single exercise session of Self-Myofascial Release (SMR) on the posterior muscular chain flexibility after one hour from the intervention. Thirty-six participants performed SMR using a rigid ball under the surface of both feet. Participants were tested with the Sit and Reach (S&R) test at four different times: before (T0), immediately after (T1), 30 (T2), and 60 (T3) minutes after the SMR intervention. The sample (n = 36) was categorized into three groups: (1) flexible, (2) average, and (3) stiff, based on the flexibility level at T0 (S&R values of >10 cm, >0 but <10 cm and <0 cm, respectively). For the whole sample, we detected significant improvements in the S&R test between the T1, T2, and T3 compared to T0. The stiff group showed a significant (p < 0.05) improvement between T1−T2 and T1−T3. Results were similar between the average group and the whole sample. The flexible group did not show any significant difference (p > 0.05) over time. In conclusion, this investigation demonstrated that an SMR session of both feet was able to increase posterior muscular chain flexibility up to one hour after intervention. Considering that a standard training session generally lasts one hour, our study can help professionals take advantage of SMR effects for the entire training period. Furthermore, our results also demonstrate that physical exercise practitioners should also assess individuals’ flexibility before training, as the SMR procedure used in this work does not seem necessary in flexible individuals.
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Affiliation(s)
- Luca Russo
- Department of Human Sciences, Università Telematica degli Studi IUL, 50122 Florence, Italy
| | - Eleonora Montagnani
- Department of Sports and Health Sciences, University of Brighton, Brighton BN2 4AT, UK
| | - Davide Pietrantuono
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Fabiola D’Angona
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Tommaso Fratini
- Department of Human Sciences, Università Telematica degli Studi IUL, 50122 Florence, Italy
| | - Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80132 Naples, Italy
| | - Francesco Ceccarini
- Department of Psychology, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates
| | | | - Elena Lupu
- Department of Motor Activities, Petroleum Gas University Ploiesti, 100600 Ploiesti, Romania
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
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From Histoanatomy to Sonography in Myofascial Pain Syndrome: A EURO-MUSCULUS/USPRM Approach. Am J Phys Med Rehabil 2023; 102:92-97. [PMID: 35067549 DOI: 10.1097/phm.0000000000001975] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Myofascial pain is a common clinical condition, whereby accurate physical examination is usually considered as the cornerstone to identify/diagnose the "trigger point complex," that is, the characteristic finding of this syndrome. Considering the emerging role of ultrasound examination as the natural extension of physical assessment for musculoskeletal disorders, we briefly revise the histological/anatomical features of trigger points and propose a standardized, multistep sonographic approach to myofascial pain. We also imply that the integrated clinical-ultrasound evaluation could be considered as a potential tool to discriminate different phases/subsets of this challenging pathology.
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Comparison of dry needling and kinesio taping® in management of latent trapezius myofascial trigger points. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-01025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Weber P, Klingler W, Schleip R, Weber N, Joisten C. The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial. J Clin Med 2022; 11:jcm11237110. [PMID: 36498690 PMCID: PMC9736370 DOI: 10.3390/jcm11237110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/26/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Instrument-assisted manual therapy (IAMT) is indicated to improve flexibility, reduce pain, and induce hyperaemia locally and along myofascial chains. The underlying effects are largely unclear. This randomised, placebo-controlled pilot study aimed to gain first insights into these effects, primarily on the structural level, through ultrasonography. Methods: 67 healthy female soccer players aged 20.9 (±3.9) years were examined after right lumbar intervention (IAMT: intervention group (IG), heat application: comparison group (CG), pressure-less placebo: placebo group (PG)). Ultrasonography (absolute movement and shear motion), flexibility tests (passive straight leg raise test (PSLR), lumbar and thoracic double inclinometry), and superficial skin temperature were recorded before (t0), immediately (t1) and 45 min after the intervention (t2). Results: IAMT decreased the absolute mobility of the superficial lamina and its shear motion to the superficial fascia compared with the PG (t1; p < 0.05). PSLR improved in the IG compared with the CG (t2) and PG (t1, t2; p < 0.05). The temperature increased in the IG and CG compared with the PG (t1, t2) and in the CG compared with the IG (t1; p < 0.05). Conclusion: IAMT of the lumbar back briefly reduces absolute mobility of the superficial lamina and its shear motion to the superficial fascia, improves flexibility, and increases the temperature.
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Affiliation(s)
- Patrick Weber
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
- Correspondence:
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, 72488 Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, 89081 Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany
- Department for Medical Professions, Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Nadine Weber
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
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Kimura H, Suda M, Kobayashi T, Suzuki S, Fukui S, Obata H. Effectiveness of ultrasound-guided fascia hydrorelease on the coracohumeral ligament in patients with global limitation of the shoulder range of motion: a pilot study. Sci Rep 2022; 12:19782. [PMID: 36396688 PMCID: PMC9671893 DOI: 10.1038/s41598-022-23362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
We conducted a prospective single-arm interventional study of the treatment efficacy of ultrasound-guided fascia hydrorelease (US-FHR) on the coracohumeral ligament (CHL) of patients with global limitation of shoulder range of motion (ROM) without local inflammation. The primary outcome was the change in passive ROM (pROM) of external rotation (ER) after first US-FHR. Secondary outcomes included the change in pROM of other directions from baseline, the pain visual analogue scale (pVAS) at the timepoints after each procedure (first, second US-FHR and rehabilitation) as well as the change in the Shoulder Pain and Disability Index (SPADI) from the first to the second visit. Eleven patients underwent US-FHR. The pROM of ER after the 1st US-FHR changed by a median of 7.1° (p < 0.01). There was a statistically significant improvement in the pROM of flexion, extension, abduction, external rotation, and internal rotation from baseline to each timepoints. The pVAS at rest showed no significant improvement, although the pVAS at maximal ER showed a trend towards improvement. The SPADI score decreased by a median of 13.4 (p < 0.01). No adverse events were observed. US-FHR on the CHL with or without rehabilitation might be an effective, less invasive treatment for patients with global limitation of shoulder ROM.
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Affiliation(s)
| | - Masei Suda
- Department of Rheumatology, Suwa Central Hospital, Chino-shi, Nagano, Japan.
- Immuno-Rheumatology Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Aomori, Japan
| | | | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Center for Clinical Epidemiology, St. Luke's International University, Chuo-ku, Tokyo, Japan
| | - Hideaki Obata
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi, Saitama, Japan
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Liu M, Liu Y, Li X, Pei M, Han M, Qi F. Dexmedetomidine inhibits abnormal muscle hypertrophy of myofascial trigger points via TNF-α/ NF-κB signaling pathway in rats. Front Pharmacol 2022; 13:1031804. [PMID: 36408215 PMCID: PMC9669483 DOI: 10.3389/fphar.2022.1031804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Myofascial pain syndrome (MPS) is a chronic pain disorder with inflammation-related primarily characterized by the presence of myofascial trigger points (MTrPs). Myocyte enhancer factor 2C (MEF2C) is involved in the occurrence of a variety of skeletal muscle diseases. However, it is not yet clear if MEF2C is involved in MTrPs. The purpose of this study was to investigate whether MEF2C was involved in the inflammatory pathogenesis of MTrPs. In the present study, we used RNA sequencing (RNA-seq) to compare the differential expression of myocyte enhancer factor 2C (MEF2C) in healthy participants and MTrPs participants. The widely used rat MTrPs model was established to research the upstream and downstream regulatory mechanism of MEF2C and found that MEF2C was significantly increased in patients with MTrPs. Dexmedetomidine (Dex) was injected intramuscularly in the MTrPs animal to assess its effects on MEF2C. The expression of MEF2C protein and mRNA in skeletal muscle of rats in the MTrPs group were up-regulated. In addition, the expression of TNF- α, p-P65, MLCK, and Myocilin (MyoC) was up-regulated and the mechanical pain threshold was decreased. Peripheral TNF- α injection significantly decreased the mechanical pain threshold and increased the expression of p-P65, MLCK, MEF2C, and MyoC in healthy rats. Maslinic acid increased the mechanical pain threshold and inhibited the expression of p-P65, MLCK, MEF2C, and MyoC. In addition, peripheral injection of DEX in MTrPs rats also inhibited the expression of TNF- α, p-P65, MLCK, MEF2C, and MyoC. These results suggest that MEF2C is involved in the inflammatory pathogenesis of MTrPs and DEX serves as a potential therapeutic strategy for the treatment of MPS.
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Affiliation(s)
- Mingjian Liu
- Department of Anesthesiology and Pain Clinic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Basic Medical Sciences, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yu Liu
- Department of Anesthesiology and Pain Clinic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Basic Medical Sciences, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Xuan Li
- Department of Anesthesiology and Pain Clinic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Basic Medical Sciences, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Miao Pei
- Laboratory of Basic Medical Sciences, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Department of Anesthesiology Clinic, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China
| | - Mei Han
- Department of the Quality Management, The Second Hospital of Shandong University, Jinan, China
- *Correspondence: Mei Han, ; Feng Qi,
| | - Feng Qi
- Department of Anesthesiology and Pain Clinic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Mei Han, ; Feng Qi,
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Brandl A, Egner C, Reer R, Schmidt T, Schleip R. Associations between Deformation of the Thoracolumbar Fascia and Activation of the Erector Spinae and Multifidus Muscle in Patients with Acute Low Back Pain and Healthy Controls: A Matched Pair Case-Control Study. Life (Basel) 2022; 12:life12111735. [PMID: 36362889 PMCID: PMC9697365 DOI: 10.3390/life12111735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae and multifidus muscle (ESM) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality (GC) were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). GC showed a direct effect of TLF deformation on ESM activation only in the aLBP group (p < 0.03). Conclusions: The results suggest that in aLBP, ESM activity is significantly affected by TLF, whereas this relationship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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Brandl A, Bartsch K, James H, Miller ME, Schleip R. Influence of Rolfing Structural Integration on Active Range of Motion: A Retrospective Cohort Study. J Clin Med 2022; 11:5878. [PMID: 36233746 PMCID: PMC9570915 DOI: 10.3390/jcm11195878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Recent work has investigated significant force transmission between the components of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause−effect pathology, comprehensive neuromusculoskeletal therapy such as the Rolf Method of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retrospectively screened from the medical records of an SI practice over a 23-year period. A total of 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flexion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001) but were not affected by age. Conclusions: An SI intervention could produce multiple changes in the components of myofascial chains that could help maintain upright posture in humans and reduce inadequate compensatory patterns. SI may also affect differently the outcome of some AROM parameters in women and men.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Katja Bartsch
- Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Helen James
- Department of Physical Therapy, California State University, Fresno, CA 93740, USA
| | - Marilyn E. Miller
- Department of Physical Therapy, University of St. Augustine for Health Sciences at San Diego, San Diego, CA 92069, USA
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
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Brandl A, Egner C, Schleip R. Practical Measurement of Changes in Leg Length Discrepancy After a Myofascial Release on the Thoracolumbar Fascia in Patients With Acute Low Back Pain: A Pilot Study. Cureus 2022; 14:e29084. [PMID: 36258943 PMCID: PMC9558767 DOI: 10.7759/cureus.29084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background Recent work has examined an association between leg length discrepancy (LLD) and low back pain (LBP). Myofascial release (MFR) techniques are thought to be frequently applied in the treatment of chronic and acute LBP. The purpose of this study was to evaluate a practical measure of LLD and the feasibility of an MFR technique in a randomised controlled trial (RCT). Methods In 12 subjects (seven women and five men) with acute LBP and LLD greater than 3 mm, an MFR technique was performed on the thoracolumbar fascia. At the baseline, after the intervention, and at follow-up, LLD was measured using a cross-line laser and finger-to-floor distance, and the pain was measured with a visual analogue scale (VAS). Patients completed a questionnaire after follow-up to assess the acceptability of the study procedure. The therapist evaluated the methods in terms of their feasibility. Results LLD measurement and MFR treatment required little time and few resources. Participants agreed to the study procedure with moderate to high acceptance. The LLD decreased by 5 mm after treatment and by 4 mm at follow-up. The VAS showed a reduction in pain of 17.50 mm at follow-up but not immediately after treatment. Conclusion The measurement of LLD is applicable in daily osteopathic practice, but it cannot be assumed to be a valid method for an RCT. Validated methods such as video raster stereography are, therefore, recommended. Comprehensive RCTs to study the effects of MFR intervention on leg length are feasible.
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Differential Sensitization of Muscle versus Fascia in Individuals with Low Back Pain. Bioengineering (Basel) 2022; 9:bioengineering9090440. [PMID: 36134986 PMCID: PMC9495767 DOI: 10.3390/bioengineering9090440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Muscles and the deep fascia surrounding them have been suggested to play an important role in various musculoskeletal pain conditions including low back pain. Both have been shown to host rich nociceptive innervation and to undergo changes in individuals with chronic pain. However, evidence for the respective contribution of muscle and fascia sensitization in humans with myofascial pain syndrome is lacking. Here, we studied the sensitization of muscle and fascia in individuals with myofascial low back pain. Twenty individuals with acute (5) and chronic (15) myofascial low back pain of the quadratus lumborum muscle and a matched control group of twenty healthy individuals were recruited and clinically evaluated. All participants underwent ultrasound-guided needling of their subcutaneous tissue, deep fascia and quadratus lumborum muscle. Reported pain intensity and episodes of muscle twitching were recorded and analyzed. Among pain patients, both muscles and deep fascia demonstrated pain hypersensitivity, but muscles were significantly more sensitized than the deep fascia. No difference between acute- or chronic-pain patients was observed. Results of this study suggest that while both deep fascia and muscle show pain sensitization in both early and chronic stages of low back pain, muscles are more sensitized than fascia.
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Pérez-Bellmunt A, Simon M, López-de-Celis C, Ortiz-Miguel S, González-Rueda V, Fernandez-de-Las-Peñas C. Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial. J Manipulative Physiol Ther 2022; 45:490-496. [PMID: 33431281 DOI: 10.1016/j.jmpt.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate changes in neuromuscular function, pain perception, and basic physical properties in latent myofascial trigger points (TrPs) after a single treatment session of ischemic compression in the gastrocnemius muscle. METHODS A randomized within-participant clinical trial with a blinded assessor was conducted. Twenty-nine asymptomatic volunteers with latent gastrocnemius-muscle TrPs were bilaterally explored. Each extremity was randomly assigned to the control group (no treatment) or the experimental group (90 seconds of ischemic compression over each TrP). Neuromuscular function of the gastrocnemius muscle was assessed using a MyotonPro. Muscle flexibility was analyzed using the lunge test and the passive ankle range of motion. The strength was determined with a handheld dynamometer (MicroFET2). Pain perception was analyzed with a 0-to-10 numerical pain rating scale and determination of pressure pain thresholds over each latent TrP. RESULTS The results revealed a reduction of 15.8% in pain perception and an increment of pressure tolerance of 9.9% without pain in the treatment group. Changes in muscle flexibility (active and passive) and most parameters for neuromuscular response (rigidity, elasticity, and relaxation) were also observed, but they were not significantly different between groups. The clinical effect sizes were moderate for pain perception (d = 0.69), pressure pain threshold (d = 0.78), muscle tone (d = 0.51), and elasticity (d = 0.54) in favor of the treated extremity. Small clinical effect sizes were observed for muscle physical outcomes. CONCLUSION The present study shows that the use of a single session of ischemic compression for latent gastrocnemius-muscle TrPs improved some sensory outcomes. The effects on ankle range of motion and neuromuscular responses were inconclusive.
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Affiliation(s)
| | - Mathias Simon
- Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
| | | | | | | | - César Fernandez-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Fascial Manipulation Method Is Effective in the Treatment of Myofascial Pain, but the Treatment Protocol Matters: A Randomised Control Trial—Preliminary Report. J Clin Med 2022; 11:jcm11154546. [PMID: 35956161 PMCID: PMC9369771 DOI: 10.3390/jcm11154546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/23/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background: There are many therapeutic methods targeting fascia. However, the only method whose basic assumption is to eliminate the densification of fascia is Fascial Manipulation. Objective: To evaluate the effectiveness of various Fascial Manipulation (FM) protocols in reducing myofascial pain. Design: Randomized control trial. Subjects: A total of 54 individuals, aged 18–29 years, with musculoskeletal pain for at least 1 week. Methods: The patients were divided into four groups subjected to different treatment protocols: group 1—underwent the standard FM treatment protocol (STP), group 2—modified protocol (MTP), group 3—modified protocol 2 (MTP2), and the control group (CG)—did not undergo any therapy. Each protocol involved three treatments at intervals of 7–10 days and a follow-up examination after 30 days. The outcome was pain level measured using the VAS. Results: In the STP, all the measurements showed a significant decrease in pain level—the mean difference was 2.077 after the first treatment, 3.462 after the third treatment and 3.385 in the follow-up. In the MTP, a significant mean difference was noted after the third treatment, 3, and in the follow up, 2.4. In the MTP2, it was noted after the third session, 2, and in the follow up, 2.25. Only the CG group did not display significant changes. Conclusions: FM-based therapy results in pain relief. However, there are differences in the dynamics and durability of the results depending on the chosen protocol.
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Iglesias-Peón M, Mesa-Jiménez J, Fernández-de-las-Peñas C, Rojas-García J, Rodrigues-de-Souza DP, Alburquerque-Sendín F. Validity of the Isometric Contraction Test of the Masticatory Muscles for Diagnosis of Muscular Temporomandibular Disorders. Diagnostics (Basel) 2022; 12:diagnostics12081861. [PMID: 36010212 PMCID: PMC9406470 DOI: 10.3390/diagnostics12081861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
In recent years, the Diagnostic Criteria for Temporomandibular Pain Disorders (DC/TMD) has been questioned, mainly because of the dependence on the muscular pressure needed to be applied during the clinical examination. Therefore, it is necessary to establish improvements in diagnostic strategies for DC/TMD of axis I. The aim of this study was to determine the validity of the Isometric Contraction Test of the masticatory muscles (ICTest) to diagnose DC/TMD of axis I. Forty (n = 40) patients with muscular TMD (myalgia in any of its subtypes), as well as forty age and sex matched controls, participated. They were diagnosed according to DC/TMD of axis I and performed the ICTest in a single session. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and positive (LR+) and negative likelihood ratios (LR−) of the ICTest compared with the DC/TMD of axis I were calculated. The ICTest showed a specificity of 95% for the diagnosis of myalgia, and between 94.9% and 96.8% for all subtypes in relation to the DC/TMD of axis I. For sensitivity, lower values were obtained, that is, 90.0% for myalgia, and losing sensitivity depending on the type of myalgia. The LR+ was over 10 for all diagnoses, with the exception of myofascial pain with referral, which was lower. When addressing the LR−, the myofascial diagnosis was the only one below 0.2. According to the results, the ICTest could be considered a valid procedure to diagnose subjects with muscular TMD in a clinical setting.
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Affiliation(s)
- Marcos Iglesias-Peón
- Osteopatía y Fisioterapia Guadalajara, 19005 Guadalajara, Spain; (M.I.-P.); (J.R.-G.)
- Doctoral Program in Biomedicine, University of Córdoba, 14004 Córdoba, Spain
| | - Juan Mesa-Jiménez
- Department of Physical Therapy, Universidad San Pablo CEU, Boadilla del Monte, 28668 Madrid, Spain;
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Jorge Rojas-García
- Osteopatía y Fisioterapia Guadalajara, 19005 Guadalajara, Spain; (M.I.-P.); (J.R.-G.)
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain;
- Correspondence: ; Tel.: +34-957-218-241
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain;
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
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45
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Malik KM, Nelson AM, Chiang TH, Imani F, Khademi SH. The Specifics of Non-specific Low Back Pain: Re-evaluating the Current Paradigm to Improve Patient Outcomes. Anesth Pain Med 2022; 12:e131499. [PMID: 36937089 PMCID: PMC10016128 DOI: 10.5812/aapm-131499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/09/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Low back pain (LBP) is the leading cause of pain and debility worldwide and the most frequent reason for work-related disability. Global expenditures related to LBP are staggering and amount to billions of dollars each year in the United States alone. Yet, despite the considerable healthcare resources consumed, the care provided to patients with LBP has regularly been cited as both ineffective and exorbitant. Among the myriad reasons for this suboptimal care, the current approach to evaluation and management of patients with LBP is a likely contributor and is hitherto un-investigated. Following the current methodology, over 90% of patients with LBP are provided with no specific diagnosis, are managed inconsistently, and receive no express preventative care. We believed that this approach added costs and promoted chronic unresolved pain and disability. This narrative review highlights problems with the current methodology, proposes a novel concept for categorizing patients with LBP, and recommends strategies for improvement. Stratifying patients according to the etiology, in lieu of the prospects for morbidity, the strategy proposed in this article may help ascertain the cause of patient's LBP early, consolidate treatments, permit timely preventative measures, and, as a result, may improve patient outcomes.
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Affiliation(s)
- Khalid M Malik
- Division of Pain Medicine, Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, USA
- Corresponding Author: Division of Pain Medicine, Department of Anesthesiology, College of Medicine, University of Illinois, Chicago, USA.
| | - Ariana M. Nelson
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, California, USA
| | - Ting-Hsuan Chiang
- Department of Anesthesiology & Perioperative Care, University of California Irvine, Orange, California, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Khademi
- Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding Author: Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Liao C, Wang Q, An J, Chen J, Li X, Long Q, Xiao L, Guan X, Liu J. CD44 Glycosylation as a Therapeutic Target in Oncology. Front Oncol 2022; 12:883831. [PMID: 35936713 PMCID: PMC9351704 DOI: 10.3389/fonc.2022.883831] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022] Open
Abstract
The interaction of non-kinase transmembrane glycoprotein CD44 with ligands including hyaluronic acid (HA) is closely related to the occurrence and development of tumors. Changes in CD44 glycosylation can regulate its binding to HA, Siglec-15, fibronectin, TM4SF5, PRG4, FGF2, collagen and podoplanin and activate or inhibit c-Src/STAT3/Twist1/Bmi1, PI3K/AKT/mTOR, ERK/NF-κB/NANOG and other signaling pathways, thereby having a profound impact on the tumor microenvironment and tumor cell fate. However, the glycosylation of CD44 is complex and largely unknown, and the current understanding of how CD44 glycosylation affects tumors is limited. These issues must be addressed before targeted CD44 glycosylation can be applied to treat human cancers.
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Affiliation(s)
- Chengcheng Liao
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Qian Wang
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- Microbial Resources and Drug Development Key Laboratory of Guizhou Tertiary Institution, Life Sciences Institute, Zunyi Medical University, Zunyi, China
| | - Jiaxing An
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Chen
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaolan Li
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- Microbial Resources and Drug Development Key Laboratory of Guizhou Tertiary Institution, Life Sciences Institute, Zunyi Medical University, Zunyi, China
| | - Qian Long
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
| | - Linlin Xiao
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Linlin Xiao, ; Xiaoyan Guan, ; Jianguo Liu,
| | - Xiaoyan Guan
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Linlin Xiao, ; Xiaoyan Guan, ; Jianguo Liu,
| | - Jianguo Liu
- Department of Orthodontics II, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
- Oral Disease Research Key Laboratory of Guizhou Tertiary Institution, School of Stomatology, Zunyi Medical University, Zunyi, China
- *Correspondence: Linlin Xiao, ; Xiaoyan Guan, ; Jianguo Liu,
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Pirri C, Fede C, Petrelli L, De Rose E, Biz C, Guidolin D, De Caro R, Stecco C. Immediate Effects of Extracorporeal Shock Wave Therapy in Fascial Fibroblasts: An In Vitro Study. Biomedicines 2022; 10:biomedicines10071732. [PMID: 35885037 PMCID: PMC9312511 DOI: 10.3390/biomedicines10071732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/06/2022] [Accepted: 07/16/2022] [Indexed: 12/04/2022] Open
Abstract
Extracorporeal shock waves (ESWs) are used in the treatment of soft tissue injuries, but their role in the treatment of myofascial pain has not yet been demonstrated. The aim of this study was to investigate changes in cell biology of fibroblasts derived from deep/muscular fascia following treatment with ESWs. Primary fascial fibroblasts were collected from small samples of human fascia lata of the thigh of three volunteer patients (two men, one woman) during orthopedic surgery, and put in culture. These cells were exposed to 100 impulses of 0.05 mJ/mm2 with a frequency of 2.5 Hz, using 3D-printed support. This study demonstrated for the first time that ESWs can lead to in vitro production of hyaluronan-rich vesicles immediately after the treatment. At 1, 4, and 24 h after treatment, Alcian blue and Toluidine blue staining; immunocytochemistry to detect hyaluronic acid binding protein (HABP), collagen I, and collagen III; and transmission electron microscopy demonstrated that these vesicles are rich in hyaluronan and collagen I and III. The diameter of these vesicles was assessed, highlighting a small size at 1 h after ESW treatment, whereas at 4 and 24 h, they had an increase in the size. Particularly evident was the release of hyaluronan-rich vesicles, collagen-I, and collagen-III starting at 1 h, with an increase at 4 h and maintenance by 24 h. These in vitro data indicate that fascial cells respond to ESW treatment by regulating and remodeling the formation of extracellular matrix.
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Affiliation(s)
- Carmelo Pirri
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
| | - Caterina Fede
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
| | - Lucia Petrelli
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
| | - Enrico De Rose
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
| | - Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, 35128 Padua, Italy;
| | - Diego Guidolin
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
| | - Raffaele De Caro
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
| | - Carla Stecco
- Institute of Humana Anatomy, Department of Neurosciences, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (E.D.R.); (D.G.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
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49
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Chiou-Tan FY. Musculoskeletal mimics of cervical radiculopathy. Muscle Nerve 2022; 66:6-14. [PMID: 35466429 DOI: 10.1002/mus.27553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/10/2022]
Abstract
Musculoskeletal mimics of cervical radiculopathy will be explored in this AANEM monograph. A review of the literature and textbooks was conducted. Musculoskeletal cervical radiculopathy mimics include: (1) head/neck pain, such as neck tension, cervicogenic headache, and temporomandibular disorder; (2) referred pain from shoulder pathology, such as rotator cuff tears/impingement; (3) elbow region abnormalities, including medial/lateral epicondylitis; (4) wrist/hand conditions, such as DeQuervain's tenosynovitis and intersection syndrome; (5) muscle connective tissue disorders, including myofascial trigger points; (6) conditions that have decreased range of motion, including frozen shoulder and rounded shoulders with tight pectoral/scalene muscles; (7) conditions with joint hyperlaxity and instability, as seen in post-stroke shoulder subluxation; (8) vascular conditions, such as thoracic outlet syndrome; and (9) autonomic controlled soft tissue changes associated with complex regional pain syndrome. Formulating a differential diagnosis and recognizing mimics of cervical radiculopathy can decrease the time between symptom onset and diagnosis/treatment plan.
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Affiliation(s)
- Faye Y Chiou-Tan
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.,Harris Health System, Electrodiagnostic Laboratory, Smith Clinic/Ben Taub Hospital, Houston, Texas, USA
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50
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Roch M, Morin M, Gaudreault N. Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPRO. Physiother Can 2022. [DOI: 10.3138/ptc-2020-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This article investigates the immediate effects of a dry needling (DN) puncture on the viscoelastic properties (tone, stiffness, elasticity) of a trigger point (TP) in the infraspinatus muscle in non-traumatic chronic shoulder pain. Method: Forty-eight individuals with non-traumatic chronic shoulder pain were recruited. The presence of a TP in the infraspinatus muscle was confirmed by a standardized palpatory exam. The viscoelastic properties were measured with a MyotonPRO device at baseline (T1), immediately after DN (T2), and 30 minutes later (T3). A DN puncture was applied to the TP to obtain a local twitch response while performing the technique. Results: Analyses of variance showed significant decreases in tone ( p < 0.001) and stiffness ( p = 0.003) across time after the DN technique. Post hoc tests revealed a significant reduction in tone and stiffness from T1 to T2 ( p ≤ 0.004) and no significant changes from T2 to T3 ( p ≥ 0.10). At T3, only stiffness remained significantly lower compared to T1 ( p = 0.013). Conclusions: This study brings new insights on the immediate mechanical effect of DN on tone and stiffness of TPs. Whether these effects are associated with symptom improvement and long-term effects still needs to be verified.
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Affiliation(s)
- Mélanie Roch
- Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de Réadaptation, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Morin
- Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de Réadaptation, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nathaly Gaudreault
- Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de Réadaptation, Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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