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Comparing Functional Motor Control Exercises With Therapeutic Exercise in Wrestlers With Iliotibial Band Syndrome. J Sport Rehabil 2022; 31:1006-1015. [DOI: 10.1123/jsr.2020-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Context: Iliotibial band syndrome (ITBS) is a common overuse injury in runners with parallels to our findings of overuse in Greco Roman wrestlers. Despite research indicating coordination and movement-based factors about the hip, no studies were found using functional motor control (FMC) in runners or wrestlers with ITBS. Thus, we compared FMC exercises and therapeutic exercises (TEs) on pain, function, muscle strength, and range of motion (ROM) in national-level Greco Roman wrestlers with ITBS. Design: Controlled laboratory study. Methods: Sixty national-level Greco Roman wrestlers diagnosed with ITBS were randomly assigned to 8 weeks of FMC exercises, TE, and a control group (20 individuals for each group). Pain (visual analog scale), function (triple hop test for distance, single-leg vertical jump test, and agility T test), muscle strength (handheld dynamometer), and ROM (goniometer) were measured at baseline and 8 weeks after intervention as posttest. Results: Although both interventions significantly reduced pain (P < .001, η2 = .87), improved function (triple hop test P = .004, η2 = .94; single-leg vertical jump P = .002, η2 = .93; and T test P < .001, η2 = .93) and strength (hip abduction (P < .001, η2 = .52), hip external rotation (P = .02, η2 = .95), knee flexion (P ≤ .001, η2 = .94), and knee extension (P < .001, η2 = .91) compared with the control group, FMC showed more significant improvements in comparison with TE. Significant differences (P = .001) were observed between FMC and TE compared with the control group in ROM outcome. However, TE was more effective than FMC in improving ROM hip abduction (P < .001, η2 = .93), hip adduction (P = .000, η2 = .92), hip internal rotation (P < .001, η2 = .92), and hip external rotation (P < .001, η2 = .93). Conclusion: FMC exercises were superior to TE in terms of pain, function, and muscle strength, whereas TE was more effective for improving ROM. FMC exercise is suggested as an effective intervention for improvement of the outcomes related to ITBS in national-level Greco Roman wrestlers.
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Practitioner utilisation and perceptions of the clinical utility of Danis Bois Method (DBM) Fasciatherapy to pain management: A survey of French physiotherapists. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Souza Bezerra E, Lunardi M, Sakugawa RL, Diefenthaeler F. Acute effects of myofascial release with portable electric massager at different frequencies: A randomized pilot study. J Bodyw Mov Ther 2021; 28:225-230. [PMID: 34776145 DOI: 10.1016/j.jbmt.2021.07.037] [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: 02/05/2021] [Revised: 05/01/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The present study aimed to analyze the acute effects of a myofascial release session (MFR) with a portable electric massager (PEM) at different frequencies (25 Hz and 52 Hz) on the superficial and deep fascial motion. METHODS The limbs of fourteen participants (12 men and 2 women, age = 34 ± 10 years; height = 1.74 ± 0.09 m; weight = 72.77 ± 13.1 kg; right thigh fat thickness = 4.18 ± 3.49 mm; left thigh fat thickness = 4.13 ± 3.35 mm) were randomized to one of the two PEM frequencies (25 Hz vs. 52 Hz). All evaluations were carried out at the same time of day and by the same evaluator (blind). The protocol consisted of 9 min of MFR on the vastus lateralis, alternating between three sites of 5 cm. Before and after the MFR session, the fascial motion was measured in the vastus lateralis (superficial and deep layer) using B-mode ultrasound at two knee positions (0° and 45°). RESULTS The superficial and deep layers presented significant increases in fascia length after myofascial release with the knee extended 0° (p < 0.001) and flexed 45° (p < 0.001). In addition, the fascial motion was not influenced by the frequency applied during the experimental protocol and was independent of layer and knee position. However, the deep layer showed an increase at knee flexed at 45° compared to the superficial layer. On the other hand, there was no difference between layers when the knee was extended (0°). The findings of this study indicate that PEM appears to be effective in changing the fascial motion of the vastus lateralis.
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Affiliation(s)
- Ewertton de Souza Bezerra
- Human Performance Laboratory, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil; Programa de Pós Graduação Stricto Sensu em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil; Programa de Pós Graduação Stricto Sensu em Ciências do Movimento Humano, Faculdade de Educação Física e Fisioterapia, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil
| | - Morgana Lunardi
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Raphael Luiz Sakugawa
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Fernando Diefenthaeler
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Chang PJ, Asher A, Smith SR. A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment. Cancers (Basel) 2021; 13:5191. [PMID: 34680339 PMCID: PMC8534110 DOI: 10.3390/cancers13205191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 01/10/2023] Open
Abstract
Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.
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Affiliation(s)
- Philip J. Chang
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Arash Asher
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Sean R. Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA;
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Analysis of Muscle Activity Following the Application of Myofascial Release Techniques for Low-Back Pain-A Randomized-Controlled Trial. J Clin Med 2021; 10:jcm10184039. [PMID: 34575151 PMCID: PMC8466764 DOI: 10.3390/jcm10184039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/27/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. Lumbosacral dysfunctions and the resulting pain syndromes, such as low-back pain (LBP), are one of the most common musculoskeletal problems being faced by society around the world. So far, a contributory role of thoracolumbar fascia (TLF) dysfunction in some cases of LBP has been suggested. Research also confirms that muscle resting activity level in the TLF area is increased in people with LBP. Myofascial release (MFR) is a therapeutic option offered to patients with chronic low-back pain (CLBP). The therapy aims to improve flexibility and sliding between layers of soft tissue, and thus decrease muscle activity, reduce pain intensity, and improve functional performance. Objective. This study aims to assess changes in resting activity of selected muscles within the TLF in a group of patients with CLBP immediately after a single MFR treatment and one month after the intervention. Methods. A total of 113 patients with CLBP completed the study. Simple randomization was applied to assign subjects to study groups. The experimental group (n = 59) underwent a single session of MFR therapy. No therapeutic intervention was applied to the control group (n = 54). Surface electromyography was used to evaluate positive treatment effects in patients immediately after receiving the therapy (experimental group) and after one month (experimental and control group). Results. A statistically reliable decrease in the activity of erector spinae (ES) and multifidus muscles (MF) was observed after a single session of MFR therapy. Effects of the treatment were present immediately after receiving the therapy and one month after the intervention. Conclusions. A single MFR treatment in patients with CLBP immediately reduces the resting activity levels of ES and MF. Results of measurements carried out one month after the treatment confirm that the therapeutic effects were maintained.
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Brandl A, Egner C, Schleip R. Immediate Effects of Myofascial Release on the Thoracolumbar Fascia and Osteopathic Treatment for Acute Low Back Pain on Spine Shape Parameters: A Randomized, Placebo-Controlled Trial. Life (Basel) 2021; 11:845. [PMID: 34440589 PMCID: PMC8399614 DOI: 10.3390/life11080845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spine shape parameters, such as leg length and kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pathologies. This study examined the immediate effects of a myofascial release (MFR) technique on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in patients with acute low back pain (aLBP). METHODS This study was a single-blind randomized placebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blindedly assigned to three groups to be treated with MFR, OMT, or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, and lordotic angle) were measured before and after the intervention using video raster stereography. RESULTS Within the MFR group, fLLD reduced by 5.2 mm, p < 0.001 and kyphotic angle by 8.2 degrees, p < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, p < 0.001, and kyphotic angle by 8.4°, p = 0.007. CONCLUSION MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.
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Affiliation(s)
- Andreas Brandl
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Christoph Egner
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Robert Schleip
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
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Freiwald J, Magni A, Fanlo-Mazas P, Paulino E, Sequeira de Medeiros L, Moretti B, Schleip R, Solarino G. A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review. Life (Basel) 2021; 11:780. [PMID: 34440524 PMCID: PMC8401625 DOI: 10.3390/life11080780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/29/2022] Open
Abstract
Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient's quality of life, limits their daily living activities, and reduces their work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of superficial heat therapy in the management of non-specific mild-to-moderate LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LBP), and finally review the published evidence regarding the impact of superficial heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is relevant for the management of non-specific mild or moderate low back pain in current clinical practice.
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Affiliation(s)
- Jürgen Freiwald
- Department of Movement and Training Science, Bergische University Wuppertal, 42119 Wuppertal, Germany;
| | - Alberto Magni
- S.I.M.G. Società Italiana di Medicina Generale, 50242 Florence, Italy;
| | - Pablo Fanlo-Mazas
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Ema Paulino
- Farmácia Nuno Álvares, 2800-179 Almada, Portugal;
| | - Luís Sequeira de Medeiros
- Nova Medical School, Nova University Lisbon, 1099-085 Lisbon, Portugal;
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisbon, Portugal
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (B.M.); (G.S.)
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, 80992 Munich, Germany
- Department for Medical Professions, Diploma University of Applied Sciences Bad Sooden-Allendorf, 37242 Bad Sooden-Allendorf, Germany
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (B.M.); (G.S.)
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Lai S, Pan M, Liu J, Li Y. Two Co(II) coordination polymers: crystal structures and treatment activity on myofascial pain syndrome. INORG NANO-MET CHEM 2021. [DOI: 10.1080/24701556.2021.1952258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shangdao Lai
- Department of Anesthesiology, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
- Department of Anesthesiology, Meizhou People's Hospital (Huangtang Hospital), Meizhou, Guangdong, China
| | - Meiyuan Pan
- Medical Laboratory Center, Meizhou People’s Hospital (Huangtang Hospital), Meizhou, Guangdong, China
| | - Jiongfeng Liu
- Department of Anesthesiology, Meizhou People's Hospital (Huangtang Hospital), Meizhou, Guangdong, China
| | - Yalan Li
- Department of Anesthesiology, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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Langevin HM. Fascia Mobility, Proprioception, and Myofascial Pain. Life (Basel) 2021; 11:life11070668. [PMID: 34357040 PMCID: PMC8304470 DOI: 10.3390/life11070668] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 12/19/2022] Open
Abstract
The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.
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Affiliation(s)
- Helene M Langevin
- National Center for Complementary and Integrative Health, National Institutes of Health, 31 Center Drive, Suite 2B11, Bethesda, MD 20892, USA
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Hyaluronan and the Fascial Frontier. Int J Mol Sci 2021; 22:ijms22136845. [PMID: 34202183 PMCID: PMC8269293 DOI: 10.3390/ijms22136845] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 12/11/2022] Open
Abstract
The buzz about hyaluronan (HA) is real. Whether found in face cream to increase water volume loss and viscoelasticity or injected into the knee to restore the properties of synovial fluid, the impact of HA can be recognized in many disciplines from dermatology to orthopedics. HA is the most abundant polysaccharide of the extracellular matrix of connective tissues. HA can impact cell behavior in specific ways by binding cellular HA receptors, which can influence signals that facilitate cell survival, proliferation, adhesion, as well as migration. Characteristics of HA, such as its abundance in a variety of tissues and its responsiveness to chemical, mechanical and hormonal modifications, has made HA an attractive molecule for a wide range of applications. Despite being discovered over 80 years ago, its properties within the world of fascia have only recently received attention. Our fascial system penetrates and envelopes all organs, muscles, bones and nerve fibers, providing the body with a functional structure and an environment that enables all bodily systems to operate in an integrated manner. Recognized interactions between cells and their HA-rich extracellular microenvironment support the importance of studying the relationship between HA and the body’s fascial system. From fasciacytes to chronic pain, this review aims to highlight the connections between HA and fascial health.
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Pepper TM, Brismée JM, Sizer PS, Kapila J, Seeber GH, Huggins CA, Hooper TL. The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness: A Randomized Controlled Trial. Int J Sports Phys Ther 2021; 16:651-661. [PMID: 34123517 PMCID: PMC8169023 DOI: 10.26603/001c.23606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/10/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Iliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces to the iliotibial band (ITB). Stretching interventions are common in ITBS treatment and may predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared. PURPOSE To examine effects of foam rolling and iliotibial complex stretching on ITB stiffness at 0˚ and 10˚ of hip adduction and hip adduction passive range of motion (PROM). STUDY DESIGN Randomized controlled trial. METHODS Data from 11 males (age = 30.5 ± 9.0 years, Body Mass Index (BMI) = 27.8 ± 4.0) and 19 females (age = 23.5 ± 4.9, BMI = 23.2 ± 2.1) were analyzed for this study. Subjects were randomly assigned to one of three groups: control, stretching, and foam rolling. Shear wave ultrasound elastography measurements included ITB Young's modulus at the mid-thigh, the distal femur and the TFL muscle belly. ITB-to-femur depth was measured at mid-thigh level. Hip adduction PROM was measured from digital images taken during the movement. RESULTS No significant interactions or main effects were found for group or time differences in ITB Young's modulus at the three measured locations. The ITB stiffness at the mid-thigh and distal femur increased with 10° adduction, but TFL stiffness did not increase. A main effect for adduction PROM was observed, where PROM increased 0.8˚ post-treatment (p = 0.02). CONCLUSION A single episode of stretching and foam rolling does not affect short-term ITB stiffness. The lack of ITB stiffness changes may be from an inadequate intervention stimulus or indicate that the interventions have no impact on ITB stiffness. LEVELS OF EVIDENCE 1b.
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Affiliation(s)
- Talin M Pepper
- Texas Tech University Health Sciences Center, Lubbock, TX
| | | | | | | | - Gesine H Seeber
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX; University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany; Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christopher A Huggins
- Texas Tech University Health Sciences Center, Lubbock, TX; Lubbock Christian University, Lubbock, TX
| | - Troy L Hooper
- Texas Tech University Health Sciences Center, Lubbock, TX
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Kratz SV, Kratz DJ. Effects of CranioSacral therapy upon symptoms of post-acute concussion and Post-Concussion Syndrome: A pilot study. J Bodyw Mov Ther 2021; 27:667-675. [PMID: 34391304 DOI: 10.1016/j.jbmt.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 03/26/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the utilization of CranioSacral Therapy (CST) in patients with Post-Concussion Syndrome (PCS) and capture patient-reported perceptions of clinical outcomes of lived treatment experiences. DESIGN Two-part, longitudinal study conducted through a chart review of target group, followed by a Patient-reported Treatment Outcome Survey (PTOS). PARTICIPANTS A convenience sample of 212 patients with a historical incidence of head trauma not requiring hospitalization was obtained through medical records department dating back ten years. Inclusion criteria for further chart review (n = 67) was determined by identifying patients with a confirmed concussion directly correlated with presenting symptoms and for which CST was specifically sought as a treatment option. Demographics and patient-determined treatment duration data were analyzed by comparison groups extensively suggested in existing literature: Recovery time since injury as either Post-acute concussion (<6 months) or Post-Concussion Syndrome (PCS) (≥6 months); Athletes (A) or Non-athletes (NA); and traditional gender. Final PTOS group criteria was determined by eliminating confounding issues reporting (n = 47): (A, n = 24 and NA, n = 23). RESULTS Quantitative data was analyzed via Numerical Analysis, and qualitative data was analyzed via Inductive Content Analysis. Symptoms reported in all charts as well as in the PTOS were consistent with identified PCS subtypes. Utilization of CST revealed that most patients determined the treatment effect upon concussion symptoms within 1-3 sessions. Nearly twice as many sessions were attended in the PCS than post-acute groups. Referral sources, studied for a perspective on local concussion after-care discharge planning, ranged from professional to personal recommendation or self-discovery. A majority of patients met goals of reducing post-acute or PCS as reasons cited by self-determined change-in-status or discharge from service. Patients were asked to indicate on the PTOS which pre- and post-treatment symptoms were helped or not helped by this particular intervention. CONCLUSIONS Patient-reported changes of PCS symptoms is critical when evaluating treatment options. CST is an experiential treatment that addresses subjective levels of dysfunction, thus it is the patient deciding the value of an intervention. A sizable portion of patients in all groups reported a positive effect upon their symptoms by CST. Patients indicated personal meaning to CST through their utilization of multiple sessions. A high percentage indicated the likelihood of referring others with PCS for CST. Of the 212 patient charts first studied, the 145 not meeting inclusion criteria suggest some chronic conditions may present as long-term effects of older head injuries. CST is a low-risk, conservative treatment option for PCS sub-types worthy of further clinical study.
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Affiliation(s)
- Susan Vaughan Kratz
- Occupational Therapy Dept, Special Therapies, Inc., 1720 Dolphin Drive, Unit B, Waukesha, WI, 53186, USA.
| | - Daniel J Kratz
- Dept. of Psychology, West Texas A&M University, 2501 4th Avenue, Canyon, TX, 79015, USA.
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Magerl W, Thalacker E, Vogel S, Schleip R, Klein T, Treede RD, Schilder A. Tenderness of the Skin after Chemical Stimulation of Underlying Temporal and Thoracolumbar Fasciae Reveals Somatosensory Crosstalk between Superficial and Deep Tissues. Life (Basel) 2021; 11:life11050370. [PMID: 33919303 PMCID: PMC8143345 DOI: 10.3390/life11050370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/14/2023] Open
Abstract
Musculoskeletal pain is often associated with pain referred to adjacent areas or skin. So far, no study has analyzed the somatosensory changes of the skin after the stimulation of different underlying fasciae. The current study aimed to investigate heterotopic somatosensory crosstalk between deep tissue (muscle or fascia) and superficial tissue (skin) using two established models of deep tissue pain (namely focal high frequency electrical stimulation (HFS) (100 pulses of constant current electrical stimulation at 10× detection threshold) or the injection of hypertonic saline in stimulus locations as verified using ultrasound). In a methodological pilot experiment in the TLF, different injection volumes of hypertonic saline (50–800 µL) revealed that small injection volumes were most suitable, as they elicited sufficient pain but avoided the complication of the numbing pinprick sensitivity encountered after the injection of a very large volume (800 µL), particularly following muscle injections. The testing of fascia at different body sites revealed that 100 µL of hypertonic saline in the temporal fascia and TLF elicited significant pinprick hyperalgesia in the overlying skin (–26.2% and –23.5% adjusted threshold reduction, p < 0.001 and p < 0.05, respectively), but not the trapezius fascia or iliotibial band. Notably, both estimates of hyperalgesia were significantly correlated (r = 0.61, p < 0.005). Comprehensive somatosensory testing (DFNS standard) revealed that no test parameter was changed significantly following electrical HFS. The experiments demonstrated that fascia stimulation at a sufficient stimulus intensity elicited significant across-tissue facilitation to pinprick stimulation (referred hyperalgesia), a hallmark sign of nociceptive central sensitization.
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Affiliation(s)
- Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Emanuela Thalacker
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Simon Vogel
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Health Sciences, Technical University of Munich, 80333 Munich, Germany;
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Thomas Klein
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
- Correspondence: ; Tel.: +49-621-383-71400; Fax: +49-621-383-71401
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Lohr C, Medina-Porqueres I. Immediate effects of myofascial release on neuromechanical characteristics in female and male patients with low back pain and healthy controls as assessed by tensiomyography. A controlled matched-pair study. Clin Biomech (Bristol, Avon) 2021; 84:105351. [PMID: 33848704 DOI: 10.1016/j.clinbiomech.2021.105351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low back pain (LBP) is a major health issue in most industrialised countries. Lumbodorsal fascia has been advocated as a potential source of pain in the lumbopelvic region. Myofascial release constitutes a manual therapeutic approach focussing on the restoration of altered soft tissue function. No previous study has focused on quantifying neuromechanical effects of myofascial release on LBP patients through tensiomyography. The purpose of this study was to quantify immediate neuromechanical alterations of myofascial release on patients with LBP and healthy controls through tensiomyography parameters. METHODS The participants' (n = 30) bilateral lumbar erector spinae muscles were assessed via tensiomyography before and after a 6-min myofascial release treatment of the lumbodorsal fascia to evaluate the muscles' mechanical characteristics. Subjects with LBP (n = 15) were eligible to partake if they reported having had LBP for most days in the past 12 weeks. Muscle displacement (Dm [mm]), velocity of contraction (Vc [mm/s]), and lateral symmetry (Ls [%]) were assessed through tensiomyography testing. FINDINGS Statistical analyses revealed a significant increase for velocity of contraction in the right (p = .021) and left (p = .041) lumbar erector spinae for the subjects with LBP but not for the healthy controls (both p > .14). INTERPRETATION We suggested that myofascial release alters neuromechanical characteristics in subjects with LBP. Tensiomyography may be implemented in clinical settings to monitor intervention effects of the myofascial system, especially the tensiomyography parameter velocity of contraction.
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Affiliation(s)
- Christine Lohr
- Department of Sports and Exercise Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain.
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Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 2021; 9:2077-2089. [PMID: 33850927 PMCID: PMC8017503 DOI: 10.12998/wjcc.v9.i9.2077] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.
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Affiliation(s)
- Qi-Wang Cao
- Department of Algology, The Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410016, Hunan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Lin Wang
- Department of Algology, Affiliate Hospital of the Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - You-Qing Huang
- Department of Algology, The Second Affiliate Hospital of the Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Dong-Lin Jia
- Department of Algology, Peking University Third Hospital, Beijing 100083, China
| | - Hao Jiang
- Department of Algology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510089, Guangdong Province, China
| | - Rong-Guo Liu
- Department of Algology, Fujian Provincial Hospital, Fujian Shengli Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Ying Li
- Department of Algology, Affiliate Hospital of the Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wen Shen
- Department of Algology, Affiliate Hospital of the Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
| | - Ling-Zhi Yu
- Department of Algology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410001, Hunan Province, China
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Kawai T, Takahashi M, Takamoto K, Bito I. Hamstring strains in professional rugby players result in increased fascial stiffness without muscle quality changes as assessed using shear wave elastography. J Bodyw Mov Ther 2021; 27:34-41. [PMID: 34391255 DOI: 10.1016/j.jbmt.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/18/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hamstring strain injury is common among sports injuries. A previous history of this injury is considered a strong predictor of recurrent hamstring strain injury. Fascial tissue reportedly becomes stiffer after hamstring strain injury. However, the association between fascial stiffness and previous hamstring strain injury has not been investigated in clinical studies. We aimed to determine whether a previous history of hamstring strain injury affects fascial tissue and muscle tissues using shear wave elastography. METHOD In eleven male professional rugby players, the stiffness as a shear modulus (kPa) of fascial tissue and muscle was measured on the specific injured area measured by magnetic resonance imaging (MRI) at resting position by using shear wave elastography. The side-to-side differences between the injured and the uninjured side were analyzed. The length and area of the muscle scar tissue were evaluated by MRI in relation to fascial stiffness. RESULTS The shear elastic modulus of fascia was stiffer in the injured vs. the uninjured side; however, no difference was observed in the muscle. No significant relationship was detected between the length and area of the muscle scar tissue (all P > 0.05). DISCUSSION Rugby players with a previous history of hamstring strain injury exhibited passive stiffness of fascial tissues in the injured leg, regardless of the length or area of the muscle scar tissue. However, the passive stiffness of muscles was same between the injured and the uninjured leg. CONCLUSION The results can be beneficial to consider future risk for hamstring strain injuries.
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Affiliation(s)
- Tomonori Kawai
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Ichinomiya Gakuen Cyo, Shimonoseki, Yamaguchi, Japan.
| | - Masayasu Takahashi
- Konan Medical Center, Department of Orthopaedic Surgery, Hyogo, Japan 1-5-16 Kamokogahara Higashinada, Kobe, Hyogo, Japan
| | - Kouichi Takamoto
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Ichinomiya Gakuen Cyo, Shimonoseki, Yamaguchi, Japan.
| | - Itsumu Bito
- Department of Sports and Health Sciences, Faculty of Human Sciences, University of East Asia, Ichinomiya Gakuen Cyo, Shimonoseki, Yamaguchi, Japan
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Naja AS, Madi N, Tfayli Y, Ziade F, Haber G, Kanawati S, Naja Z. Deep Cervical Plexus Block for Neck and Shoulder Pain Due to Myofascial Pain: A Randomized Clinical Trial. Clin J Pain 2021; 37:133-139. [PMID: 33273276 DOI: 10.1097/ajp.0000000000000904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Myofascial pain is one of the most common causes of regional pain with no definitive treatment. This randomized clinical trial was conducted to assess the efficacy of deep cervical plexus block versus placebo injection (sham block) for the treatment of myofascial neck and shoulder pain in terms of analgesic consumption and pain during a follow-up period of 2 weeks after the block. MATERIALS AND METHODS Patients were randomly divided into 2 groups. Group I (block) received deep cervical plexus block and group II (placebo) received normal saline. A total of 66 patients were included in the study, 34 patients in the block group and 32 patients in the placebo group. RESULTS Two weeks after the intervention, the average pain duration was significantly lower in the block group: 1.38±1.39 versus 5.25±1.72 for the block and placebo groups, respectively (P<0.0001). Pain intensity was significantly less in the block group such that 2.9% of patients in the block group had severe pain compared with 53.1% of patients in the placebo group (P<0.0001). Two weeks after receiving the block, the mean opioid consumption calculated as tramadol equivalent was 21.1±44.2 mg compared with 166.1±118.8 mg for the block and placebo groups, respectively. Multivariate analysis showed that patients with a longer history of pain had a higher pain score after 2 weeks. The possibility of recovery is affected by pain duration as patients with a history of chronic pain were least affected by the block. DISCUSSION This technique could be an alternative to pharmacological and other nonpharmacological treatments for myofascial pain.
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Affiliation(s)
- Ahmad S Naja
- Orthopedic Division, American University of Beirut Medical Center
| | - Naji Madi
- Orthopedic Department, Duke University Medical Center, Durham, NC
| | - Yehia Tfayli
- Orthopedic Division, American University of Beirut Medical Center
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University
| | - Georges Haber
- Orthopedic Division, Mount Lebanon Hospital, Hazmiyeh, Lebanon
| | - Saleh Kanawati
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut
| | - Zoher Naja
- Anesthesia and Pain Management Department, Makassed General Hospital, Beirut
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Abstract
Spasticity is one component of the upper motor neuron (UMN) syndrome resulting from a multitude of neurologic conditions, such as stroke, brain injury, spinal cord injury, multiple sclerosis, and cerebral palsy. It is clinically recognized as a phenomenon of velocity-dependent increase in resistance, i.e., hypertonia. Recent advances in the pathophysiology of spasticity improve our understanding of mechanisms underlying this complex phenomenon and its relations to other components of UMN syndrome (weakness and disordered motor control), as well as the resultant clinical problems. This theoretical framework provides a foundation to set up treatment goals and to guide goal-oriented clinical assessment and treatment. Among a spectrum of treatment options, botulinum toxin (BoNT) therapy is the preferred treatment for focal spasticity. The evidence is very robust that BoNT therapy effectively reduces spasticity; however, it does not improve voluntary movement. In this chapter, we highlight a few issues on how to achieve the best clinical outcomes of BoNT therapy, such as dosing, dilution, guidance techniques, adjunctive therapies, early treatment, repeated injections, and central effects, as well as the ways to improve motor function in selected subgroups of patients with spasticity. We also discuss the reasons of poor responses to BoNT therapy and when not to use BoNT therapy.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA.
- TIRR Memorial Hermann Hospital, Houston, TX, USA.
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center Houston (UTHealth), Houston, TX, USA
- TIRR Memorial Hermann Hospital, Houston, TX, USA
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Ajimsha MS, Shenoy PD, Gampawar N. Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review. J Bodyw Mov Ther 2020; 24:423-431. [PMID: 33218543 DOI: 10.1016/j.jbmt.2020.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/19/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. METHODS A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring). RESULTS Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. CONCLUSION Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Pramod D Shenoy
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Neeraj Gampawar
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
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Ganjaei KG, Ray JW, Waite B, Burnham KJ. The Fascial System in Musculoskeletal Function and Myofascial Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00302-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Changes of Ankle Dorsiflexion Using Compression Tissue Flossing: A Systematic Review and Meta-Analysis. J Sport Rehabil 2020; 30:306-314. [PMID: 33075750 DOI: 10.1123/jsr.2020-0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Impaired dorsiflexion range of motion (DFROM) has been established as a predictor of lower-extremity injury. Compression tissue flossing (CTF) may address tissue restrictions associated with impaired DFROM; however, a consensus is yet to support these effects. OBJECTIVES To summarize the available literature regarding CTF on DFROM in physically active individuals. EVIDENCE ACQUISITION PubMed and EBSCOhost (CINAHL, MEDLINE, and SPORTDiscus) were searched from 1965 to July 2019 for related articles using combination terms related to CTF and DRFOM. Articles were included if they measured the immediate effects of CTF on DFROM. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The level of evidence was assessed using the Strength of Recommendation Taxonomy. The magnitude of CTF effects from pre-CTF to post-CTF and compared with a control of range of motion activities only were examined using Hedges g effect sizes and 95% confidence intervals. Randomeffects meta-analysis was performed to synthesize DFROM changes. EVIDENCE SYNTHESIS A total of 6 studies were included in the analysis. The average Physiotherapy Evidence Database score was 60% (range = 30%-80%) with 4 out of 6 studies considered high quality and 2 as low quality. Meta-analysis indicated no DFROM improvements for CTF compared with range of motion activities only (effect size = 0.124; 95% confidence interval, -0.137 to 0.384; P = .352) and moderate improvements from pre-CTF to post-CTF (effect size = 0.455; 95% confidence interval, 0.022 to 0.889; P = .040). CONCLUSIONS There is grade B evidence to suggest CTF may have no effect on DFROM when compared with a control of range of motion activities only and results in moderate improvements from pre-CTF to post-CTF. This suggests that DFROM improvements were most likely due to exercises completed rather than the band application.
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Jędrzejewski G, Kasper-Jędrzejewska M, Dolibog P, Szyguła R, Schleip R, Halski T. The Rolf Method of Structural Integration on Fascial Tissue Stiffness, Elasticity, and Superficial Blood Perfusion in Healthy Individuals: The Prospective, Interventional Study. Front Physiol 2020; 11:1062. [PMID: 33041843 PMCID: PMC7522439 DOI: 10.3389/fphys.2020.01062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/31/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: There are multiple theories surrounding the physiological impact of structural integration (SI) with little evidence or research corroborating any of these. The aim of the study was to assess the effectiveness of 10 sessions of SI on fascial tissue (FT) superficial blood perfusion, stiffness, and elasticity in 13 healthy women. Methods: This was a prospective, interventional study. The primary outcome measures were FTs’ superficial blood perfusion, stiffness, and elasticity of bilateral selected FT points on the body. Data were collected before and after 10 sessions of SI intervention. Statistical analysis was performed using the non-parametric Wilcoxon test (intragroup comparison). Results: The superficial blood perfusion increased significantly in the most selected FT points on the body (p < 0.05). SI interventions produced significant decreases in selected points (brachioradialis, biceps brachii, and trapezius; p < 0.05) of FT stiffness and significant increases in elasticity (brachioradialis, biceps brachii, triceps surae, and trapezius; p < 0.05), especially in the FT of the right (dominant) upper limb. Conclusion: A 10-session of SI demonstrated positive effects on increasing superficial blood perfusion contributed to a decrease in FT stiffness and an increase in elasticity properties in the dominant upper limb. Data collection for this study is currently underway, and the trial is registered at ISRCTN.com with the identifier: ISRCTN46707309.
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Affiliation(s)
| | | | - Paweł Dolibog
- Faculty of Health Sciences, University of Opole, Opole, Poland
| | - Renata Szyguła
- Faculty of Health Sciences, University of Opole, Opole, Poland
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.,Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany
| | - Tomasz Halski
- Faculty of Health Sciences, University of Opole, Opole, Poland
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Creighton A, Stecco A, Whitelaw A, Probst D, Hunt D. Fascial Manipulation method as a treatment for pain, atrophy and skin depigmentation after pes anserine bursa corticosteroid injection: A case report. J Bodyw Mov Ther 2020; 24:280-285. [PMID: 33218523 DOI: 10.1016/j.jbmt.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Andrew Creighton
- Department of Physical Medicine and Rehabilitation, Hospital for Special Surgery, New York City, NY, USA
| | - Antonio Stecco
- Rusk Rehabilitation, New York University School of Medicine, New York City, NY, USA
| | - Amy Whitelaw
- Sports Therapy and Rehabilitation (STAR), Barnes Jewish West County Hospital, St. Louis, MO, USA
| | - Daniel Probst
- Division of Neurorehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Devyani Hunt
- Washington University School of Medicine, Departments of Orthopaedic Surgery and Neurology, Division of Physical Medicine and Rehabilitation, 660 S. Euclid Ave., Campus Box 8233, St. Louis, MO, USA.
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Raja G P, Fernandes S, Cruz AM, Prabhu A. The plausible role of Deep Cervical Fascia and its continuum in chronic craniofacial and Cervicobrachial Pain: A case report. Heliyon 2020; 6:e04560. [PMID: 32760842 PMCID: PMC7393392 DOI: 10.1016/j.heliyon.2020.e04560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/23/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration. Objective We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation). Methods This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed. Results Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI). Conclusion This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.
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Affiliation(s)
- Prabu Raja G
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shifra Fernandes
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Antony Marie Cruz
- School of Communication, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anupama Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Fan C, Guidolin D, Ragazzo S, Fede C, Pirri C, Gaudreault N, Porzionato A, Macchi V, De Caro R, Stecco C. Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae. ACTA ACUST UNITED AC 2020; 56:medicina56060260. [PMID: 32471194 PMCID: PMC7353893 DOI: 10.3390/medicina56060260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.
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Affiliation(s)
- Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Serena Ragazzo
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, School of Rehabilitation, University of Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada;
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy; (C.F.); (D.G.); (S.R.); (C.F.); (C.P.); (A.P.); (V.M.); (R.D.C.)
- Correspondence: ; Tel.: +39-049-8272315; Fax: +39-049-8272328
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Kaneda H, Takahira N, Tsuda K, Tozaki K, Sakai K, Kudo S, Takahashi Y, Sasaki S, Fukushima K, Kenmoku T. The effects of tissue flossing and static stretching on gastrocnemius exertion and flexibility. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-192235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hiroaki Kaneda
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Naonobu Takahira
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
- Physical Therapy Course, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Kouji Tsuda
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Kiyoshi Tozaki
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Kenta Sakai
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Sho Kudo
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Yoshiki Takahashi
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Shuichi Sasaki
- Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Tomonori Kenmoku
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Kanagawa, Japan
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Sensitivity of the Fasciae to the Endocannabinoid System: Production of Hyaluronan-Rich Vesicles and Potential Peripheral Effects of Cannabinoids in Fascial Tissue. Int J Mol Sci 2020; 21:ijms21082936. [PMID: 32331297 PMCID: PMC7216169 DOI: 10.3390/ijms21082936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
The demonstrated expression of endocannabinoid receptors in myofascial tissue suggested the role of fascia as a source and modulator of pain. Fibroblasts can modulate the production of the various components of the extracellular matrix, according to type of stimuli: physical, mechanical, hormonal, and pharmacological. In this work, fascial fibroblasts were isolated from small samples of human fascia lata of the thigh, collected from three volunteer patients (two men, one woman) during orthopedic surgery. This text demonstrates for the first time that the agonist of cannabinoid receptor 2, HU-308, can lead to in vitro production of hyaluronan-rich vesicles only 3–4 h after treatment, being rapidly released into the extracellular environment. We demonstrated that these vesicles are rich in hyaluronan after Alcian blue and Toluidine blue stainings, immunocytochemistry, and transmission electron microscopy. In addition, incubation with the antagonist AM630 blocked vesicles production by cells, confirming that release of hyaluronan is a cannabinoid-mediated effect. These results may show how fascial cells respond to the endocannabinoid system by regulating and remodeling the formation of the extracellular matrix. This is a first step in our understanding of how therapeutic applications of cannabinoids to treat pain may also have a peripheral effect, altering the biosynthesis of the extracellular matrix in fasciae and, consequently, remodeling the tissue and its properties.
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Pérez-Llanes R, Meroño-Gallut J, Donoso-Úbeda E, López-Pina J, Cuesta-Barriuso R. Safety and effectiveness of fascial therapy in the treatment of adult patients with hemophilic elbow arthropathy: a pilot study. Physiother Theory Pract 2020; 38:276-285. [PMID: 32223585 DOI: 10.1080/09593985.2020.1744207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Hemophilic arthropathy is characterized by loss of function and chronic pain. Fascial therapy mobilizes the connective tissue and is thus involved in the condition of the injured fascial complex and the surrounding tissues.Objective: To evaluate the safety of a physiotherapy program using fascial therapy in patients with hemophilic elbow arthropathy.Methods: Fourteen adult patients with hemophilia were randomly assigned to a control group and an intervention group. The intervention consisted of three 45-min sessions of fascial therapy over a 3-week period. Assessment was carried out at baseline, after treatment, and at follow-up. The study variables were bleeding frequency using a self-registration of bleeding; joint pain using the visual analog scale; range of motion with a universal goniometer; and joint status assessed with Hemophilia Joint Health Score.Results: None of the patients developed joint bleeding during the experimental period. Joint pain in the experimental group decreased by 1.43 out of 2.43 (95% CI 0.52 to 2.33) and 2.14 out of 2.57 (95% CI 0.18 to 4.10) in right and left elbow, respectively, more than the control group by 3 weeks. Flexion increased by 3.57 degrees out of 129.14 (95% CI 5.48 to 1.65) in right elbow and joint condition improved by 1.14 points out of 6.0 (95% CI 0.01 to 2.26) more than the control group by 3 weeks.Conclusion: Fascial therapy does not appear to produce elbow hemarthrosis in patients with hemophilia. This treatment can improve joint pain, range of motion, and elbow status in patients with hemophilia.
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Affiliation(s)
- Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - José López-Pina
- Department of Basic Phycology and Methodology, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, European University of Madrid, Madrid, Spain.,Real Fundación Victoria Eugenia, Instituto De Salud Carlos III, Madrid, Spain.,Fishemo CEE, Spanish Federation Oh Hemophilia, Madrid, Spain
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Acupotomy Alleviates Energy Crisis at Rat Myofascial Trigger Points. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5129562. [PMID: 32190087 PMCID: PMC7064863 DOI: 10.1155/2020/5129562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/18/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the effects of acupotomy on energy crises in rat trigger points (TrPs) by measuring mechanical pain thresholds (MPTs) and levels of acetylcholinesterase (AChE), free sarcoplasmic calcium (Ca2+), adenosine 5'-triphosphate (ATP), adenosine 5'-monophosphate (AMP), substance P (SP), and calcitonin gene-related peptide (CGRP) in rat muscle TrP tissue. Male Sprague Dawley rats (n = 32) were randomly divided into four groups: control, TrP, acupotomy, and lidocaine injection. Enzyme-linked immunosorbent assays were used to measure AChE, and free sarcoplasmic Ca2+ concentrations were determined by fluorescent staining with Fura-2 AM; high-performance liquid chromatography was used to measure ATP and AMP, and SP and CGRP were evaluated by immunohistochemistry. Compared with the control group, free sarcoplasmic Ca2+, AMP, SP, and CGRP were higher in the model group, while MPT, AChE, and ATP were lower. Treatment with acupotomy or lidocaine injection reduced free sarcoplasmic Ca2+, SP, and CGRP and increased MPTs and AChE levels compared with the model group. However, only acupotomy also led to decreased AMP and increased ATP levels relative to the model group. We conclude that acupotomy can alleviate energy crises at TrPs.
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80
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Cao L, Gao Y, Wu K, Li Y, Chen C, Yuan S. Sympathetic hyperinnervation in myofascial trigger points. Med Hypotheses 2020; 139:109633. [PMID: 32087493 DOI: 10.1016/j.mehy.2020.109633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the local distribution and activity of sympathetic nerves in myofascial trigger points (MTrPs) and explore the pathological mechanism of myofascial pain syndrome (MPS) using a rat model of disease. METHODS MPS was modeled in the model group (MG) by a combination of blunt trauma and eccentric exercise in Sprague-Dawley rats (n = 8). Eight rats were randomly assigned to the control group (CG). Histopathology was applied to detect the local conditions of the MTrPs. Tyrosine hydroxylase (TH), nerve growth factor (NGF), and norepinephrine (NE) were detected in the MTrPs to evaluate sympathetic remodeling. RESULTS Muscle fiber rupture, atrophy and shape irregularity were universally observed in the MTrPs. TH expression was significantly increased in the MG, as detected by immunofluorescence, and NGF and TH expression was also higher in MTrPs in the MG than in MTrPs in the CG, as determined by immunohistochemistry. Furthermore, the expression of NE was significantly increased in MTrPs, as determined by ELISA. CONCLUSION There was sympathetic hyperinnervation in MTrPs, which could partially explain the symptoms of MTrPs and is an interesting and useful new perspective regarding the diagnosis and treatment of MPS. PERSPECTIVE The sympathetic nerves in MTrPs are remodeled, leading to sympathetic hyperinnervation. Sympathetic hyperinnervation can partially explain the symptoms of MPS. The pathological mechanism of sympathetic hyperinnervation may be a new perspective for the diagnosis and treatment of MPS.
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Affiliation(s)
- Lei Cao
- Department of Anesthesiology, Hainan Province Hospital of Traditional Chinese Medicine, Haikou, Hainan, China
| | - Yanping Gao
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Kai Wu
- Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yikai Li
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Chao Chen
- Department of Orthopaedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shiguo Yuan
- Academy of Orthopedics, Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
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81
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Kameda M, Tanimae H, Kihara A, Matsumoto F. Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review. J Phys Ther Sci 2020; 32:173-191. [PMID: 32158082 PMCID: PMC7032979 DOI: 10.1589/jpts.32.173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022] Open
Abstract
[Purpose] Gluteus medius syndrome is one of the major causes of back pain or leg pain
and is similar to greater trochanteric pain syndrome, which also presents with back pain
or leg pain. Greater trochanteric pain syndrome is associated with lumbar degenerative
disease and hip osteoarthritis. The objective of this review was to demonstrate gluteus
medius syndrome as a disease entity by reviewing relevant articles to elucidate the
condition. [Methods] Gluteus medius syndrome was defined as myofascial pain syndrome
arising from the gluteus medius. We performed a search of the literature using the
following keywords: “back pain”, “leg pain”, “greater trochanteric pain syndrome”,
“degenerative lumbar disease”, “hip osteoarthritis”, and “gluteus medius”. We reviewed
articles related to gluteus medius syndrome and described the findings in terms of
diagnosis and treatment based on the underlying pathology. [Results] A total of 135
articles were included in this review. Gluteus medius syndrome is similar as a disease
entity to greater trochanteric pain syndrome, which presents with symptoms of low back
pain and leg pain. Gluteus medius syndrome is also related to lumbar degenerative disease,
hip osteoarthritis, knee osteoarthritis, and failed back surgery syndrome. [Conclusion]
Accurate diagnosis of gluteus medius syndrome and appropriate treatment could possibly
improve lumbar degenerative disease and osteoarthritis of the hip and knee, as well as
hip-spine syndrome and failed back surgery syndrome.
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Affiliation(s)
- Masahiro Kameda
- Senshunkai Hospital: 2-14-26 Kaiden, Nagaokakyo, Kyoto 617-0826, Japan
| | | | - Akinori Kihara
- Kuretake Gakuen Clinical Research Institute of Oriental Medicine, Japan
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T 1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation ® in Subjects with Elbow Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030708. [PMID: 31979044 PMCID: PMC7037807 DOI: 10.3390/ijerph17030708] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 12/16/2022]
Abstract
Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.
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83
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Phan V, Shah J, Tandon H, Srbely J, DeStefano S, Kumbhare D, Sikdar S, Clouse A, Gandhi A, Gerber L. Myofascial Pain Syndrome: A Narrative Review Identifying Inconsistencies in Nomenclature. PM R 2020; 12:916-925. [DOI: 10.1002/pmrj.12290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Vy Phan
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - Jay Shah
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - Hannah Tandon
- Rehabilitation Medicine DepartmentClinical Center, National Institutes of Health Bethesda MD
| | - John Srbely
- Department of Human Health and Nutritional SciencesUniversity of Guelph Guelph Canada
| | - Secili DeStefano
- Department of Health Administration and PolicyCollege of Health and Human Services, George Mason University Fairfax VA
| | - Dinesh Kumbhare
- Department of Medicine, Division of Physical Medicine and RehabilitationUniversity of Toronto Toronto Canada
| | - Siddhartha Sikdar
- Department of Bioengineering, Center for Adaptive Systems of Brain‐Body InteractionsGeorge Mason University Fairfax VA
| | - Allison Clouse
- Department of Human Health and Nutritional SciencesUniversity of Guelph Guelph Canada
| | - Amar Gandhi
- Department of Health Administration and PolicyCollege of Health and Human Services, George Mason University Fairfax VA
| | - Lynn Gerber
- Department of Health Administration and Policy, Center for the Study of Chronic Illness and Disability, College of Health and Human Services, Center for Adaptive Systems of Brain‐Body InteractionsGeorge Mason University Fairfax VA
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84
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Vining RD, Shannon ZK, Minkalis AL, Twist EJ. Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations. J Manipulative Physiol Ther 2019; 42:651-664. [PMID: 31870637 DOI: 10.1016/j.jmpt.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this systematic review is to evaluate and summarize current evidence for diagnosis of common conditions causing low back pain and to propose standardized terminology use. METHODS A systematic review of the scientific literature was conducted from inception through December 2018. Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane, and Index to Chiropractic Literature. Methodological quality was assessed with the Scottish Intercollegiate Guidelines Network checklists. RESULTS Of the 3995 articles screened, 36 (8 systematic reviews and 28 individual studies) met final eligibility criteria. Diagnostic criteria for identifying likely discogenic, sacroiliac joint, and zygapophyseal (facet) joint pain are supported by clinical studies using injection-confirmed tissue provocation or anesthetic procedures. Diagnostic criteria for myofascial pain, sensitization (central and peripheral), and radicular pain are supported by expert consensus-level evidence. Criteria for radiculopathy and neurogenic claudication are supported by studies using combined expert-level consensus and imaging findings. CONCLUSION The absence of high-quality, objective, gold-standard diagnostic methods limits the accuracy of current evidence-based criteria and results in few high-quality studies with a low risk of bias in patient selection and reference standard diagnosis. These limitations suggest practitioners should use evidence-based criteria to inform working diagnoses rather than definitive diagnoses for low back pain. To avoid the unnecessary complexity and confusion created by multiple overlapping and nonspecific terms, adopting International Association for the Study of Pain terminology and definitions is recommended.
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Affiliation(s)
- Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa.
| | - Zacariah K Shannon
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Amy L Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Elissa J Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
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Buscemi A, Petralia MC, Ramaci T, Rapisarda A, Provazza C, Di Corrado D, Perciavalle V, Perciavalle V, Coco M. Ergojump evaluation of the explosive strength in volleyball athletes pre- and post-fascial treatment. Exp Ther Med 2019; 18:1470-1476. [PMID: 31384337 PMCID: PMC6639914 DOI: 10.3892/etm.2019.7628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/28/2018] [Indexed: 01/03/2023] Open
Abstract
It has previously been demonstrated that physiological mechanisms are involved in muscle pain and fatigue, as the nociceptive afferents of the fascial system are able to modulate the afferent response of the central nervous system. The purpose of the present study was to evaluate a sample of volleyball players, and investigate whether osteopathic treatment of the lower limb muscle groups improved the explosive force of the limbs, whilst reducing spasms and tension, releasing tissue strain and correcting posture. A randomized control study was performed to evaluate 57 athletes who underwent fascial manipulative treatment to assess if such treatment affected the muscle strength of the lower limbs. The treatment group demonstrated a statistically significant improvement in the squatting jump test (P<0.0001) and in the counter movement jump test (P<0.0001). Furthermore, the control group did not exhibit any improvement in the squatting jump test (P<0.56) or in the counter movement jump test (P<0.32). The results suggested that correction of the fascial system required a minimum time of 30 days in order to obtain an improvement of fascial mechanics and sports performance. Therefore, use of a fascial protocol during athletic training will help improve the balance of the bands and, as a direct consequence, improve the efficiency of the musculoskeletal system, thereby reducing the risk of injury. It would therefore be advisable to perform osteopathic treatment techniques every two months during an athletic season to maintain the balance of the fascial system and obtain the most efficient results.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Center Studies of Osteopathy, I-95129 Catania, Italy
| | | | - Tiziana Ramaci
- Sciences of Man and of The Society, University Kore of Enna, I-94100 Enna, Italy
| | | | - Carmelo Provazza
- Department of Research, Center Studies of Osteopathy, I-95129 Catania, Italy
| | - Donatella Di Corrado
- Sciences of Man and of The Society, University Kore of Enna, I-94100 Enna, Italy
| | - Vincenzo Perciavalle
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
| | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, I-95123 Catania, Italy
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Astorga Verdugo S, Gonzalez Silva S, Rojas Cabezas G, Martinez Araya A. [Effectiveness of thoracolumbar myofascial release on increasing sternocleidomastoid resistance and reducing forward head posture angle]. Rehabilitacion (Madr) 2019; 53:162-168. [PMID: 31370943 DOI: 10.1016/j.rh.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of thoracolumbar myofascial release to increase the resistance of the sternocleidomastoid (SCM) muscle bilaterally and to decrease the angle of forward head posture in young women enrolled at the Autónoma University of Chile. MATERIAL AND METHODS This longitudinal study was based on the immediate measurement (5minutes) of muscular resistance (seconds) through the fatigue test by means of surface electromyography in the bilateral sternocleidomastoid and analysis of the angle of forward head posture after the application of thoracolumbar myofascial release (TMFR). The 35 women evaluated met the inclusion criteria of female sex, age between 22 and 27 years, sedentary lifestyle, senior students of the Autónoma University of Chile, forward angle head posture between 43.8 and 51 degrees, body mass index indicating normal weight or overweight, and without spinal abnormalities. All participants provided written informed consent. RESULTS After the application of TMFR, there were statistically significant and immediate changes in the muscular resistance of the sternocleidomastoid with an average increase of 27.4seconds (P<.05) and an average decrease in the forward head posture angle of 2.8 degrees (P<.05). CONCLUSION TMFR produces an immediate effect in increasing the muscular resistance of the bilateral sternocleidomastoid and reducing the forward head posture angle in young women with forward head posture.
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Affiliation(s)
- S Astorga Verdugo
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
| | - S Gonzalez Silva
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - G Rojas Cabezas
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - A Martinez Araya
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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87
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Ajimsha M, Shenoy PD. Improving the quality of myofascial release research – A critical appraisal of systematic reviews. J Bodyw Mov Ther 2019; 23:561-567. [DOI: 10.1016/j.jbmt.2019.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 03/23/2019] [Indexed: 01/08/2023]
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88
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Schleip R, Klingler W. Active contractile properties of fascia. Clin Anat 2019; 32:891-895. [PMID: 31012158 DOI: 10.1002/ca.23391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/19/2019] [Accepted: 04/21/2019] [Indexed: 12/16/2022]
Abstract
The ubiquitous network of fascial tissues in the human body is usually regarded as a passive contributor to musculoskeletal dynamics. This review aims to highlight the current understanding of fascial stiffness regulation. Notably the ability for active cellular contraction which may augment the stiffness of fascial tissues and thereby contribute to musculoskeletal dynamics. A related narrative literature search via PubMed and Google Scholar reveals a multitude of studies indicating that the intrafascial presence of myofibroblasts may enable these tissues to alter their stiffness. This contractile tissue behavior occurs not only in several pathological fibrotic contractures but has also been documented in normal fasciae. When viewed at time frames of seconds and minutes the force of such tissue contractions is not sufficient for exerting a significant effect on mechanical joint stability. However, when viewed in a time-window of several minutes and longer, such cellular contractions can impact motoneuronal coordination. In addition, over a time frame of days to months, this cellular activity can induce long-term and severe tissue contractures. These findings tend to question the common clear distinction between active tissues and passive tissues in musculoskeletal dynamics. Clin. Anat. 32:891-895, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany.,Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany.,Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Werner Klingler
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany.,Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Stecco A, Pirri C, Stecco C. Fascial entrapment neuropathy. Clin Anat 2019; 32:883-890. [PMID: 31004463 DOI: 10.1002/ca.23388] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and "internal stretch lesion." The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883-890, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Antonio Stecco
- RUSK Rehabilitation, New York University School of Medicine, New York, New York
| | - Carmelo Pirri
- Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Carla Stecco
- Molecular Medicine Department, University of Padua, Padua, Italy
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90
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Schleip R, Gabbiani G, Wilke J, Naylor I, Hinz B, Zorn A, Jäger H, Breul R, Schreiner S, Klingler W. Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation. Front Physiol 2019; 10:336. [PMID: 31001134 PMCID: PMC6455047 DOI: 10.3389/fphys.2019.00336] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Fascial tissues form a ubiquitous network throughout the whole body, which is usually regarded as a passive contributor to biomechanical behavior. We aimed to answer the question, whether fascia may possess the capacity for cellular contraction which, in turn, could play an active role in musculoskeletal mechanics. Human and rat fascial specimens from different body sites were investigated for the presence of myofibroblasts using immunohistochemical staining for α-smooth muscle actin (n = 31 donors, n = 20 animals). In addition, mechanographic force registrations were performed on isolated rat fascial tissues (n = 8 to n = 18), which had been exposed to pharmacological stimulants. The density of myofibroblasts was increased in the human lumbar fascia in comparison to fasciae from the two other regions examined in this study: fascia lata and plantar fascia [H(2) = 14.0, p < 0.01]. Mechanographic force measurements revealed contractions in response to stimulation by fetal bovine serum, the thromboxane A2 analog U46619, TGF-β1, and mepyramine, while challenge by botulinum toxin type C3–used as a Rho kinase inhibitor– provoked relaxation (p < 0.05). In contrast, fascial tissues were insensitive to angiotensin II and caffeine (p < 0.05). A positive correlation between myofibroblast density and contractile response was found (rs = 0.83, p < 0.001). The hypothetical application of the registered forces to human lumbar tissues predicts a potential impact below the threshold for mechanical spinal stability but strong enough to possibly alter motoneuronal coordination in the lumbar region. It is concluded that tension of myofascial tissue is actively regulated by myofibroblasts with the potential to impact active musculoskeletal dynamics.
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Affiliation(s)
- Robert Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Günzburg, Germany.,Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany.,Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Giulio Gabbiani
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jan Wilke
- Department of Sports Medicine, Institute of Sport Science, Goethe University Frankfurt, Frankfurt, Germany
| | - Ian Naylor
- School of Pharmacy, University of Bradford, Bradford, United Kingdom
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Matrix Dynamics Group, University of Toronto, Toronto, ON, Canada
| | - Adjo Zorn
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Heike Jäger
- Division of Neurophysiology, Ulm University, Ulm, Germany
| | - Rainer Breul
- Anatomische Anstalt, Ludwig-Maximilians-Universität, München, Germany
| | | | - Werner Klingler
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany.,Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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91
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The effectiveness of Biomechanical Taping Technique on visual analogue scale, static maximum handgrip strength, and Patient Rated Tennis Elbow Evaluation of patients with lateral epicondylalgia: A cross-over study. J Bodyw Mov Ther 2019; 23:405-416. [DOI: 10.1016/j.jbmt.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/11/2018] [Accepted: 05/26/2018] [Indexed: 12/11/2022]
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92
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Kameda M, Tanimae H. Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases. J Phys Ther Sci 2019; 31:141-148. [PMID: 30858653 PMCID: PMC6382483 DOI: 10.1589/jpts.31.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Ineffective and prolonged treatment of low back pain is a major social problem
resulting in a huge economic burden. The effectiveness of back pain and/or leg pain
treatment using active soft tissue release alone or in combination with a trigger point
block was examined. [Participants and Methods] Among 115 patients who underwent medical
examination at Senshunkai Hospital during the study period, information on treatment
outcomes using active soft tissue release alone or in combination with a trigger point
block, location of myofascial trigger points, and duration of treatment were extracted for
patients with low back pain, leg pain, or low back pain with leg pain. [Results]
Myofascial pain syndrome was diagnosed in 73.4% (36/49) in the low back pain group, 50%
(16/32) in the leg pain group, and 85.3% (29/34) in the low back pain with leg pain group.
Symptom improvement was noted in all three groups with active soft tissue release alone
(90.9%, 20/22; 90.0%, 9/10; and 100%, 14/14, respectively) and active soft tissue release
+ a trigger point block (90.9%, 10/11; 100%, 1/1; and 92.9%, 13/14, respectively). The
gluteus medius was the major myofascial trigger point in all groups. [Conclusion] Manual
therapy with active soft tissue release and a trigger point block constitutes an effective
treatment combination for low back pain and leg pain, but prolonged treatment is required
in chronic cases.
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Affiliation(s)
- Masahiro Kameda
- Senshunkai Hospital: 2-14-26 Kaiden, Nagaokakyo, Kyoto 617-0826, Japan
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93
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Hughes EJ, McDermott K, Funk MF. Evaluation of hyaluronan content in areas of densification compared to adjacent areas of fascia. J Bodyw Mov Ther 2019; 23:324-328. [PMID: 31103115 DOI: 10.1016/j.jbmt.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
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94
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Harper B, Steinbeck L, Aron A. Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study. J Bodyw Mov Ther 2018; 23:115-121. [PMID: 30691738 DOI: 10.1016/j.jbmt.2018.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/28/2018] [Accepted: 08/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Connective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation® (FM®) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge. OBJECTIVES To assess the effects of FM® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP). DESIGN Six-months controlled clinical trial. METHOD 102 participants with LBP received SPT or FM®. Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress. RESULTS The FM® group had a significantly lower ODI (p < 0.009) and NPS scores (p < 0.0001) and significantly higher GROC scores (p < 0.003) once their means were adjusted for initial scores. When comparing the SPT to FM®, the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM® group (p = 0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM® group (p = 0.0001). The FM® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3 ± 2.2 to -1.5 ± 2.4, p=0.0001). CONCLUSIONS FM® appears to improve NPRS, GROC, and ODI more than SPT. FM® may provide an effective treatment technique for LBP.
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Affiliation(s)
- Brent Harper
- Radford University, Doctor of Physical Therapy Program, College of Health and Human Services, USA.
| | - Larry Steinbeck
- Radford University, Doctor of Physical Therapy Program, College of Health and Human Services, USA
| | - Adrian Aron
- Radford University, Doctor of Physical Therapy Program, College of Health and Human Services, USA
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95
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e Silva DCCM, de Andrade Alexandre DJ, Silva JG. Immediate effect of myofascial release on range of motion, pain and biceps and rectus femoris muscle activity after total knee replacement. J Bodyw Mov Ther 2018; 22:930-936. [DOI: 10.1016/j.jbmt.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/06/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
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96
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Abstract
Urogenital problems are dramatically increasing; especially chronic pelvic pain syndrome (CPPS) poses a major challenge for physicians and therapists. Few forms of therapy have been able to promise relief because the cause of CPPS remains unclear. Functional complaints are increasingly discussed as triggers. Osteopathic treatment has been reported to help many patients in recent years. In this article, the approach and osteopathic point of view of functional complaints are presented. In addition, possible causes for the development of CPPS and important anatomical structures that are directly involved in it are explained. Further interdisciplinary research of functional relationships would be desirable in the future.
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97
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Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature. Surg Radiol Anat 2018; 40:1329-1341. [DOI: 10.1007/s00276-018-2086-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/01/2018] [Indexed: 01/14/2023]
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98
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Fede C, Angelini A, Stern R, Macchi V, Porzionato A, Ruggieri P, De Caro R, Stecco C. Quantification of hyaluronan in human fasciae: variations with function and anatomical site. J Anat 2018; 233:552-556. [PMID: 30040133 DOI: 10.1111/joa.12866] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Recently, alterations in fascial gliding-like movement have been invoked as critical in the etiology of myofascial pain. Various methods have been attempted for the relief of this major and debilitating clinical problem. Paramount have been attempts to restore correct gliding between fascial layers and the movement over bone, joint, and muscular structures. One of the key elements that underlies such fascial movement is hyaluronan. However, until now, the precise content of hyaluronan within fasciae has been unknown. This study quantifies for the first time the hyaluronan content of human fascial samples obtained from a variety of anatomic sites. Here, we demonstrate that the average amount varies according to anatomic site, and according to the different kinds of sliding properties of the particular fascia. For example, the fascia lata has 35 μg of hyaluronan per gram of tissue, similar to that of the rectus sheath (29 μg g-1 ). However, the types of fascia adherent to muscle contain far less hyaluronan: 6 μg g-1 in the fascia overlying the trapezius and deltoid muscles. In the fascia that surrounds joints, the hyaluronan increases to 90 μg g-1 , such as in the retinacula of the ankle, where greater degrees of movement occur. Surprisingly, no significant differences were detected at any site as a function of age or sex (P-value > 0.05, t-test) with the sole exception of the plantar fascia. This work can provide a better understanding of the role of hyaluronan in fascia. It will facilitate a better comprehension of the modulation of the hyaluronan-rich layer that occurs in relation to the various conditions that affect fascia, and the diverse factors that underlie the attendant pathologies.
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Affiliation(s)
- C Fede
- Department of Neuroscience, University of Padua, Padua, Italy
| | - A Angelini
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic Clinic, University of Padua, Padua, Italy
| | - R Stern
- Division of Basic Biomedical Sciences, Touro College of Osteopathic Medicine, New York, NY, USA
| | - V Macchi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - A Porzionato
- Department of Neuroscience, University of Padua, Padua, Italy
| | - P Ruggieri
- Department of Surgery, Oncology and Gastroenterology DiSCOG, Orthopedic Clinic, University of Padua, Padua, Italy
| | - R De Caro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - C Stecco
- Department of Neuroscience, University of Padua, Padua, Italy
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99
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Morley JJ, Traum E. The effects of dorso-lumbar motion restriction on EMG activity of selected muscles during running. J Bodyw Mov Ther 2018; 22:166-177. [PMID: 29332742 DOI: 10.1016/j.jbmt.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/19/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
Abstract
The effects of restricting dorso-lumbar spine mobility on electromyographic activity of the erector spinae, quadriceps femoris, hamstrings and gastrocnemius muscles in runners was investigated. Thermoplastic casting material was fashioned into a rigid orthosis and used to restrict spinal motion during running. Volunteers ran on a treadmill at 2.78 m/sec, under normal conditions and with spinal motion restricted. Surface electromyographic data was collected during both sets of trials. Normal electromyographic data was also compared with previous authors to determine similarity with their electromyographic data. RESULTS Casted running resulted in an increase in erector spinae (p < 0.01) and quadriceps femoris (p = 0.02) electromyography activity. Total stride time and swing time of gait were decreased during casted running (p < 0.01), indicating a shift towards shorter and thus more frequent steps to run the same distance. The normal electromyographic data collected was in agreement with previously reported work. CONCLUSIONS Neurological control over muscle and the fascia surrounding it is responsible for joint movement and load transfer. Experimentally restricting spinal motion during running demonstrated an increase in erector spinae and rectus femoris electromyographic activity. This lends support to the hypothesis that decreased spinal mobility may be a contributing factor to overuse muscle injuries in runners.
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Affiliation(s)
- Joseph J Morley
- Former Chairman, Clinic Internship Department, Los Angeles College of Chiropractic, USA.
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100
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Abouelhuda AM, Kim HS, Kim SY, Kim YK. Association between headache and temporomandibular disorder. J Korean Assoc Oral Maxillofac Surg 2017; 43:363-367. [PMID: 29333365 PMCID: PMC5756792 DOI: 10.5125/jkaoms.2017.43.6.363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/06/2017] [Indexed: 01/03/2023] Open
Abstract
Headaches are one of the most common conditions associated with temporomandibular disorder (TMD). In the present paper, we evaluated the relationship between headache and TMD, determined whether headache influences the symptoms of TMD, and reported two cases of TMD accompanied by headache. Our practical experience and a review of the literature suggested that headache increases the frequency and intensity of pain parameters, thus complicating dysfunctional diseases in both diagnostic and treatment phases. Therefore, early and multidisciplinary treatment of TMD is necessary to avoid the overlap of painful events that could result in pain chronicity.
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Affiliation(s)
- Amira Mokhtar Abouelhuda
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Seok Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Yun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Kyun Kim
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
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