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Ryskalin L, Fulceri F, Morucci G, Busoni F, Soldani P, Gesi M. Ultrasonographic measurements of gastro-soleus fascia thickness in midportion Achilles tendinopathy: A case-control study. Ann Anat 2024; 256:152321. [PMID: 39186962 DOI: 10.1016/j.aanat.2024.152321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/25/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The Achilles tendon is one of the thickest, largest, and strongest tendons in the human body. Biomechanically, the AT represents the conjoint tendon of the triceps surae muscle, placed in series with the plantar fascia (PF) to ensure force transmission from the triceps surae toward the toes during walking, running, and jumping. Commonly encountered in the diagnostic evaluation of heel pain, Achilles tendinopathy (AT) refers to a combination of pathological changes affecting the tendon itself often resulting from excessive repetitive stress and overuse. Nevertheless, increasing evidence demonstrates that structural alterations due to overuse or abnormal patterns of skeletal muscle activity are not necessarily restricted to the muscles or tendons but can also affect the fascial tissue. At the same time, there has been recent discussion regarding the role of the fascial tissue as a potential contributor to the pathophysiological mechanisms of the development of several musculoskeletal disorders including tendinopathies. To the best of our knowledge, ultrasound (US) imaging studies on the fascial structures related to the triceps surae complex, as well as their possible correlation with Achillodynia have never been presented in the current literature. METHODS In the present study, a comparative US imaging evaluation of textural features of the suro-Achilleo-plantar complex was performed in 14 healthy controls and 14 symptomatic subjects complaining of midportion AT. The thickness of the Achilles tendon, paratenon, intermuscular fascia, and PF has been assessed with US. In addition, both groups underwent the Victorian Institute of Sport Assessment-Achilles (VISA-A), a disease-specific questionnaire that measures the severity of symptoms of AT. Correlations between quantitative ultrasound measures and VISA-A scores were determined through Pearson or Spearman's rho correlations. RESULTS Our ultrasonographic findings revealed statistically significant differences (p<0.05) in Achilles tendon and paratenon thicknesses between AT patients and controls. No significant differences were observed between groups in PF at the calcaneal insertion as all mean measures were within the expected range of a normal PF on US imaging. In contrast, in tendinopathic subjects, the deep intermuscular fascia between medial gastrocnemius (MG) and soleus (SOL) muscles is significantly (p<0.01) and considerably thickened compared to those of healthy subjects. Moderate correlations exist between tendon and paratenon thicknesses (r= 0.54, p= 0.04) and between MG-SOL fascia and tendon thicknesses (r= 0.58, p= 0.03). Regarding symptom severity and US morphological findings, the Spearman ρ test showed no correlation. CONCLUSIONS Our data demonstrate that, in symptomatic subjects, US alterations are not restricted to paratenon and intratendinous areas, but also affect upstream structures along the myofascial chain, resulting in thickening of the fascia interposed between MG and SOL muscles. Moreover, positive correlations were found between MG-SOL fascia thickening and abnormalities in AT, paratenon, and symptom severity. Thus, US alterations in the fascial system should be interpreted within the clinical context of patients with AT as they may in turn represent important predictors of subsequent clinical outcomes and could help healthcare professionals and clinicians to refine non-operative treatment strategies and rehabilitation protocols for this disease.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | - Federica Fulceri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy.
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | | | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
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2
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Wang H, Liu Y, Xu S, Wang T, Chen X, Jia H, Dong Q, Zhang H, Wang S, Ma H, Hou Z. Proteomics analysis of deep fascia in acute compartment syndrome. PLoS One 2024; 19:e0305275. [PMID: 38950026 PMCID: PMC11216580 DOI: 10.1371/journal.pone.0305275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.
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Affiliation(s)
- Haofei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yan Liu
- Department of Endocrinology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Sujuan Xu
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- Department of Nephrology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Xiaojun Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huiyang Jia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Qi Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Heng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Shuai Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Cornfeld D, Condron P, Newburn G, McGeown J, Scadeng M, Bydder M, Griffin M, Handsfield G, Perera MR, Melzer T, Holdsworth S, Kwon E, Bydder G. Ultra-High Contrast MRI: Using Divided Subtracted Inversion Recovery (dSIR) and Divided Echo Subtraction (dES) Sequences to Study the Brain and Musculoskeletal System. Bioengineering (Basel) 2024; 11:441. [PMID: 38790308 PMCID: PMC11118255 DOI: 10.3390/bioengineering11050441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
Divided and subtracted MRI is a novel imaging processing technique, where the difference of two images is divided by their sum. When the sequence parameters are chosen properly, this results in images with a high T1 or T2 weighting over a small range of tissues with specific T1 and T2 values. In the T1 domain, we describe the implementation of the divided Subtracted Inversion Recovery Sequence (dSIR), which is used to image very small changes in T1 from normal in white matter. dSIR has shown widespread changes in otherwise normal-appearing white matter in patients suffering from mild traumatic brain injury (mTBI), substance abuse, and ischemic leukoencephalopathy. It can also be targeted to measure small changes in T1 from normal in other tissues. In the T2 domain, we describe the divided echo subtraction (dES) sequence that is used to image musculoskeletal tissues with a very short T2*. These tissues include fascia, tendons, and aponeuroses. In this manuscript, we explain how this contrast is generated, review how these techniques are used in our research, and discuss the current challenges and limitations of this technique.
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Affiliation(s)
- Daniel Cornfeld
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Department of Anatomy and Medical Imaging—Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland 1010, New Zealand
- Te Whatu Ora Tairawhiti, Gisborne 4010, New Zealand
| | - Paul Condron
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Department of Anatomy and Medical Imaging—Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland 1010, New Zealand
| | - Gil Newburn
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
| | - Josh McGeown
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging—Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland 1010, New Zealand
| | - Mark Bydder
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
| | - Mark Griffin
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Insight Research Services Associated, Gold Coast 4215, Australia
| | - Geoffrey Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | | | - Tracy Melzer
- Department of Medicine, University of Otago, Christchurch 8011, New Zealand
- New Zealand Brain Research Institute, Christchurch 8011, New Zealand
| | - Samantha Holdsworth
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Department of Anatomy and Medical Imaging—Faculty of Medical and Health Sciences & Centre for Brain Research, University of Auckland, Auckland 1010, New Zealand
| | - Eryn Kwon
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Graeme Bydder
- Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand
- Department of Radiology, University of California, San Diego, CA 92093, USA
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Marko D, Vymyslický P, Miřátský P, Bahenský P, Malý T, Vobr R, Krajcigr M. Effect of Floss Band on Anaerobic Exercise and Muscle Tissue Oxygenation. J Sport Rehabil 2024; 33:99-105. [PMID: 38176399 DOI: 10.1123/jsr.2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 01/06/2024]
Abstract
CONTEXT Flossing is still a relatively new technique that has yielded varied results in the research literature; therefore, it requires further investigation. Previous research has shown that thigh tissue flossing might improve performance in countermovement jump, sprint time, maximum voluntary contraction, and rate of force development. DESIGN The present study aims to investigate the effect of the floss band on performance during the Wingate test (30-WAT), muscle oxygen saturation (SpO2), and total hemoglobin in vastus lateralis. METHODS Twenty-two students of physical education and sport (11 men and 11 women) were randomly selected to complete either the Wingate test with the application of a floss band in warm-up or the Wingate test without the use of a floss band, followed by the alternative 24 hours apart. RESULTS Throughout the testing, the floss band did not affect performance values during the Wingate test (relative peak power, relative average power, and fatigue index). However, there was a medium to large effect difference during 1 minute prior to 30-WAT (PRE), during the 30-WAT, and 10-minute recovery (REC) in values of SpO2 and total hemoglobin. Use of floss band displayed a higher SpO2 during PRE, 30-WAT, and REC by ∼13.55%, d < 2; ∼19.06%, d = 0.89; and ∼8.55%, d = 0.59, respectively. CONCLUSION Collectively, these findings indicate that the application of thigh flossing during warm-up has no effect on 30-WAT performance; however, SpO2 was significantly increased in all stages of testing. This could lead to potential improvement in repeated anaerobic exercise due to increased blood flow. Increased muscle oxygen saturation can also lead to improved tissue healing as oxygen supply is essential for tissue repair, wound healing, and pain management.
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Affiliation(s)
- David Marko
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Patrik Vymyslický
- Department of Physiotherapy, Faculty of Sports, Physical Training and Education, Charles University, Prague, Czech Republic
| | - Petr Miřátský
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Petr Bahenský
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Tomáš Malý
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Radek Vobr
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Miroslav Krajcigr
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
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5
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Sánchez Vera MA, Jaimes Fernández DA, Schleip R. Efficacy of myofascial induction compared with its simulation on joint amplitude in people with axial spondylarthritis: Protocol of a randomized controlled clinical trial. PLoS One 2023; 18:e0286885. [PMID: 37796870 PMCID: PMC10553292 DOI: 10.1371/journal.pone.0286885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Axial spondyloarthritis (AxSpA) produces structural changes that cause alterations in body functions. One tissue that seems to have a predictive role in the etiology and progression of the disease is the soft tissue, particularly the fascia. However, little is known about the use of myofascial induction in people with AxSpA, and clinical evidence from physiotherapy regarding potential strategies is limited. OBJECTIVE To evaluate the efficacy of myofascial induction compared with its simulation on joint amplitude in people with AxSpA. METHODS In this randomized controlled parallel superiority clinical trial, 84 people with an AxSpA diagnosis confirmed by a rheumatologist will be randomly assigned to groups: the experimental group or the control group. The experimental group will receive myofascial induction, and the control group will undergo a simulation of the technique. Both groups will receive an examination session and six intervention sessions twice per week for three weeks. A baseline follow-up will be performed immediately after the intervention and four weeks after treatment. CONCLUSION The results of this study may contribute to a better understanding of the efficacy of myofascial induction for joint mobility in people with AxSpA. The implications of these results have a potential transformative effect on the understanding, analysis, evaluation, and physiotherapeutic treatment of this health condition. TRIAL REGISTRATION ClinicalTrials.gov NCT04424589. Registered 11 June 2020.
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Affiliation(s)
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Martínez‐Jiménez EM, Losa‐Iglesias ME, Mazoteras‐Pardo V, López‐López D, Pereiro‐Buceta H, Calvo‐Lobo C, Rodríguez‐Sanz D, Becerro‐de‐Bengoa‐Vallejo R, Navarro‐Flores E. Dry needling of the flexor digitorum brevis muscle reduces postural control in standing: A pre-post stabilometric study. J Anat 2023; 243:545-554. [PMID: 36924312 PMCID: PMC10439377 DOI: 10.1111/joa.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed.
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Affiliation(s)
| | - Marta Elena Losa‐Iglesias
- Nursing and Stomatology Department, Faculty of Health SciencesUniversidad Rey Juan CarlosMadridSpain
| | - Victoria Mazoteras‐Pardo
- Grupo de Investigación ENDOCU, Departamento Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia y Enfermería de ToledoUniversidad de Castilla‐La ManchaCiudad RealSpain
| | - Daniel López‐López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and PodiatryUniversidade da CoruñaIndustrial Campus of FerrolFerrol, Spain
| | - Héctor Pereiro‐Buceta
- Departamento de Enfermería y Fisioterapia, Facultad de Ciencias de la SaludUniversidad de LeónPonferradaSpain
| | - César Calvo‐Lobo
- Facultad de enfermería Fisioterapia y PodologíaUniversidad Complutense de MadridMadridSpain
| | - David Rodríguez‐Sanz
- Facultad de enfermería Fisioterapia y PodologíaUniversidad Complutense de MadridMadridSpain
| | | | - Emmanuel Navarro‐Flores
- Frailty Research Organized Group (FROG), Department of Nursing, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
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Li K, Zhu Y, Zhang Q, Shi Y, Yan T, Lu X, Sun H, Li T, Li Z, Shi X, Han D. Interstitial Injection of Hydrogels with High-Mechanical Conductivity Relieves Muscle Atrophy Induced by Nerve Injury. Adv Healthc Mater 2023; 12:e2202707. [PMID: 37409443 DOI: 10.1002/adhm.202202707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
Injectable hydrogels have been extensively used in tissue engineering where high mechanical properties are key for their functionality at sites of high physiological stress. In this study, an injectable, conductive hydrogel is developed exhibiting remarkable mechanical strength that can withstand a pressure of 500 kPa (85% deformation rate) and display good fatigue resistance, electrical conductivity, and tissue adhesion. A stable covalent cross-linked network with a slip-ring structure by threading amino β-cyclodextrin is formed onto the chain of a four-armed (polyethylene glycol) amino group, and then reacted with the four-armed (polyethylene glycol) maleimide under physiological conditions. The addition of silver nanowires enhances the hydrogel's electrical conductivity, enabling it to act as a good conductor in vivo. The hydrogel is injected into the fascial space, and the results show that the weight and muscle tone of the atrophied gastrocnemius muscle improve, subsequently alleviating muscle atrophy. Overall, this study provides a simple method for the preparation of a conductive hydrogel with high mechanical properties. In addition, the interstitial injection provides a strategy for the use of hydrogels in vivo.
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Affiliation(s)
- Kai Li
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Yuting Zhu
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Qiang Zhang
- Hebei Key Laboratory of Nanobiotechnology, Yanshan University, Qinhuangdao, 066004, China
| | - Yahong Shi
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Tun Yan
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Xi Lu
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Huizhen Sun
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Tingting Li
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Zhongxian Li
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
| | - Xiaoli Shi
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Dong Han
- College of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
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8
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Fukui S, Rokutanda R, Kawaai S, Suda M, Iwata F, Okada M, Kishimoto M. Current evidence and practical knowledge for ultrasound-guided procedures in rheumatology: Joint aspiration, injection, and other applications. Best Pract Res Clin Rheumatol 2023; 37:101832. [PMID: 37248141 DOI: 10.1016/j.berh.2023.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023]
Abstract
Ultrasound (US)-guided procedures have increasingly gained their role in the daily practice of rheumatology, owing to the growing evidence supporting their utility. The utilization of US guidance in procedures may enhance their accuracy, efficacy, and safety. This article presents a comprehensive review of the current evidence and practical knowledge pertaining to US-guided procedures in rheumatology, encompassing joint aspirations, injections, and other applications such as tendon sheath injections. We provide a detailed description of the US-guided procedure process and compare the in-plane and out-of-plane view methods, along with practical techniques based on existing evidence or our own expertise. For each joint, we summarize how to perform procedures with figures to facilitate a better understanding. Additionally, we introduce other applications of US-guided procedures for tendons, enthesis, bursae, and nerves as well as emerging therapies such as US-guided fascia hydrorelease. By utilizing these US techniques, rheumatologists can achieve the ability to manage a wider range of musculoskeletal conditions.
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Affiliation(s)
- Sho Fukui
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, USA; Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo, Japan; Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan.
| | - Ryo Rokutanda
- Division of Rheumatology, Department of Internal Medicine, Kameda Medical Center, Japan.
| | - Satoshi Kawaai
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Masei Suda
- Department of Rheumatology, Suwa Central Hospital, Nagano, Japan
| | - Futoshi Iwata
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
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9
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Jiang WB, Samuel OC, Li Z, Chen W, Sui HJ. Effectiveness of craniosacral therapy in the human suboccipital region on hamstring muscle: A meta-analysis based on current evidence. Medicine (Baltimore) 2023; 102:e32744. [PMID: 36749266 PMCID: PMC9901966 DOI: 10.1097/md.0000000000032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Craniosacral therapy (CST) has remained controversial in the treatment of musculoskeletal disorders. To our knowledge, there is no larger sample size of research to demonstrate the effectiveness of craniosacral therapy in the human suboccipital region on hamstring muscle. METHODS To study whether the CST in the human suboccipital region could have a remote effect on the flexibility of the hamstring muscles, the Cochrane Library, Medline/Pubmed, CNKI, Embase, and Google Scholar were searched. Clinical trials assessing the effects of CST in short hamstring syndrome patients were eligible. Mean differences (MD) and 95% confidence intervals (CI) were calculated for the straight leg raise test (primary outcomes). The quality of the included studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 software was used for data analysis. RESULTS Five controlled trials with a total of 238 participants were included. CST could effectively relieve the symptoms of short hamstring syndrome patients [the overall MD -9.47, 95% confidence interval (CI) -15.82 to -3.12, P < .000001]. The CST was better than the proprioceptive neuromuscular facilitation technique (MD 3.09, 95% CI 1.48-4.70, P = .0002). Sensitivity analysis shows that the frequency of treatment and who did the experiment might be the main sources of impact results. CONCLUSION CST could change the flexibility of the hamstring muscles. CST had a better curative effect when compared to proprioceptive neuromuscular facilitation technique on the hamstring muscles.
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Affiliation(s)
- Wen-Bin Jiang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | | | - Zhe Li
- Department of Anatomy, Guang Dong Medical University, Dong Guan, China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, China
- * Correspondence: Hong-Jin Sui, Department of Anatomy, Dalian Medical University, Dalian 116044, China (e-mail: )
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10
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Büyükşireci DE, Demirsoy N, Mit S, Geçioğlu E, Onurlu İ, Günendi Z. Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain. J Acupunct Meridian Stud 2022; 15:347-355. [PMID: 36537117 DOI: 10.51507/j.jams.2022.15.6.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acupuncture and myofascial meridians show great anatomical and clinical compatibility. Objectives We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. Methods We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Results Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Conclusion Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.
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Affiliation(s)
- Dilek Eker Büyükşireci
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Setenay Mit
- Traditional and Complementary Medical Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ersel Geçioğlu
- Traditional and Complementary Medical Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İlknur Onurlu
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
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11
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Reyes-Illg G, Martin JE, Mani I, Reynolds J, Kipperman B. The Rise of Heatstroke as a Method of Depopulating Pigs and Poultry: Implications for the US Veterinary Profession. Animals (Basel) 2022; 13:140. [PMID: 36611748 PMCID: PMC9817707 DOI: 10.3390/ani13010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Depopulation of food-producing animals is becoming increasingly common in response to both disease outbreaks and supply chain disruptions. In 2019, the American Veterinary Medical Association released depopulation guidelines classifying certain heatstroke-based killing methods as "permitted in constrained circumstances", when circumstances of the emergency constrain reasonable implementation of "preferred" methods. Since then, tens of millions of birds and pigs have been killed by such methods, termed ventilation shutdown (VSD) Plus Heat and VSD Plus High Temperature and Humidity. While no research using validated measures of animal welfare assessment has been performed on these methods, their pathophysiology suggests that animals are likely to experience pain, anxiety, nausea, and heat distress prior to loss of consciousness. Heatstroke-based methods may result in prolonged suffering and often do not achieve 100% mortality. Potential and available alternative depopulation methods are briefly reviewed. The veterinary profession's ethical obligation to protect animal welfare in the context of depopulations is discussed.
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Affiliation(s)
| | - Jessica E. Martin
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | | | - James Reynolds
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Barry Kipperman
- School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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12
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Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, Bianco A. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness. SPORTS MEDICINE - OPEN 2022; 8:71. [PMID: 35657537 PMCID: PMC9166919 DOI: 10.1186/s40798-022-00462-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
AbstractStiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.
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13
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Kimura H, Suda M, Kobayashi T, Suzuki S, Fukui S, Obata H. Effectiveness of ultrasound-guided fascia hydrorelease on the coracohumeral ligament in patients with global limitation of the shoulder range of motion: a pilot study. Sci Rep 2022; 12:19782. [PMID: 36396688 PMCID: PMC9671893 DOI: 10.1038/s41598-022-23362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
We conducted a prospective single-arm interventional study of the treatment efficacy of ultrasound-guided fascia hydrorelease (US-FHR) on the coracohumeral ligament (CHL) of patients with global limitation of shoulder range of motion (ROM) without local inflammation. The primary outcome was the change in passive ROM (pROM) of external rotation (ER) after first US-FHR. Secondary outcomes included the change in pROM of other directions from baseline, the pain visual analogue scale (pVAS) at the timepoints after each procedure (first, second US-FHR and rehabilitation) as well as the change in the Shoulder Pain and Disability Index (SPADI) from the first to the second visit. Eleven patients underwent US-FHR. The pROM of ER after the 1st US-FHR changed by a median of 7.1° (p < 0.01). There was a statistically significant improvement in the pROM of flexion, extension, abduction, external rotation, and internal rotation from baseline to each timepoints. The pVAS at rest showed no significant improvement, although the pVAS at maximal ER showed a trend towards improvement. The SPADI score decreased by a median of 13.4 (p < 0.01). No adverse events were observed. US-FHR on the CHL with or without rehabilitation might be an effective, less invasive treatment for patients with global limitation of shoulder ROM.
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Affiliation(s)
| | - Masei Suda
- Department of Rheumatology, Suwa Central Hospital, Chino-shi, Nagano, Japan.
- Immuno-Rheumatology Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Aomori, Japan
| | | | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Center for Clinical Epidemiology, St. Luke's International University, Chuo-ku, Tokyo, Japan
| | - Hideaki Obata
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe-shi, Saitama, Japan
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14
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Pinloche L, Souvignet S, Germain M, Monteil K, Hautier C. The short-term effect of a myofascial protocol versus light touch applied to the cervical spine towards the prevention of balance disorders in the elderly: protocol of a randomised controlled trial. Chiropr Man Therap 2022; 30:33. [PMID: 36045446 PMCID: PMC9429471 DOI: 10.1186/s12998-022-00446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Falling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem. Methods Interventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done. Discussion This study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022. Trial registration: Registered by the Comité de Protection des Personnes—Sud Méditerranée; under the title “Prévention des troubles de l’équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques», n° 19.12.27.47.259 in date of February 4, 2020. Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)”.
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15
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Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life (Basel) 2022; 12:life12050743. [PMID: 35629410 PMCID: PMC9146519 DOI: 10.3390/life12050743] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
- Museum of Human Anatomy "Filippo Civinini", University of Pisa, 56126 Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
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16
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Plaut S. Scoping review and interpretation of myofascial pain/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS One 2022; 17:e0263087. [PMID: 35171940 PMCID: PMC8849503 DOI: 10.1371/journal.pone.0263087] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. METHODS Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. FINDINGS 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. CONCLUSIONS MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue ("fascial armoring"). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A "global percutaneous needle fasciotomy" that respects tensegrity principles may treat MPS/fibromyalgia more effectively. "Functional-somatic syndromes" can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.
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Affiliation(s)
- Shiloh Plaut
- School of Medicine, St. George’s University of London, London, United Kingdom
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17
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Conde-Vázquez O, Mohíno-Fernández C. Intra- and inter-observer concordance of a fascial standing flexion test in children. J Bodyw Mov Ther 2022; 30:95-99. [DOI: 10.1016/j.jbmt.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/08/2021] [Accepted: 02/04/2022] [Indexed: 11/25/2022]
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18
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Zieliński G, Filipiak Z, Ginszt M, Matysik-Woźniak A, Rejdak R, Gawda P. The Organ of Vision and the Stomatognathic System-Review of Association Studies and Evidence-Based Discussion. Brain Sci 2021; 12:brainsci12010014. [PMID: 35053758 PMCID: PMC8773770 DOI: 10.3390/brainsci12010014] [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: 11/24/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
The stomatognathic system is a functional complex of tissues and organs located within the oral and craniofacial cavities. The craniofacial anatomical factors and the biomechanics of the temporomandibular joints affect many systems throughout the body, including the organ of vision. However, few scientific reports have shown a relationship between the organ of vision and the stomatognathic system. The purpose of this review is to provide an overview of connections along neural, muscle-fascial, and biochemical pathways between the organ of vision and the stomatognathic system. Based on the literature presented in this review, the connections between the organ of vision and the stomatognathic system seem undeniable. Understanding the anatomical, physiological, and biochemical interrelationships may allow to explain the interactions between the mentioned systems. According to the current knowledge, it is not possible to indicate the main linking pathway; presumably, it may be a combination of several presented pathways. The awareness of this relationship among dentists, ophthalmologists, physiotherapists, and optometrists should increase for the better diagnosis and treatment of patients.
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Affiliation(s)
- Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
- Correspondence:
| | - Zuzanna Filipiak
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Michał Ginszt
- Department of Rehabilitation and Physiotherapy, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Anna Matysik-Woźniak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland; (A.M.-W.); (R.R.)
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland; (A.M.-W.); (R.R.)
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland;
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Sinhorim L, Amorim MDS, Ortiz ME, Bittencourt EB, Bianco G, da Silva FC, Horewicz VV, Schleip R, Reed WR, Mazzardo-Martins L, Martins DF. Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies. J Clin Med 2021; 10:jcm10194342. [PMID: 34640360 PMCID: PMC8509394 DOI: 10.3390/jcm10194342] [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: 08/16/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.
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Affiliation(s)
- Larissa Sinhorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Mayane dos Santos Amorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Human Movement Sciences Graduate Program, College of Health and Sport Science at Santa Catarina State University, Florianópolis 88080-350, Brazil
| | - Maria Eugênia Ortiz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Edsel Balduino Bittencourt
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Coastal Health Institute, Jacksonville, FL 32224, USA
| | - Gianluca Bianco
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, 00147 Rome, Italy
- Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, 00147 Roma, Italy
| | | | - Verônica Vargas Horewicz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, 80799 Munich, Germany
- Department for Medical Professions, DIPLOMA University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
- Correspondence: ; Tel.: +49-89-346016
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Rehabilitation Science Program, Departments of Physical and Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Daniel F. Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
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Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review. Complement Ther Clin Pract 2021; 45:101477. [PMID: 34507243 DOI: 10.1016/j.ctcp.2021.101477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/02/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE There is limited evidence on the effects of myofascial release on fibromyalgia symptoms. This review aims to update the evidence on the effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome. METHODS The review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, Physiotherapy Evidence Database, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Complete, and ProQuest Medical library were searched from their inception to April 1, 2021 for randomized or nonrandomized clinical trials published in English. Studies consisting of myofascial release alone or in combination with exercise as the intervention were included. The quality of the studies was evaluated using Cochrane Risk of Bias 2.0. RESULTS Six studies, including a total of 279 participants, were included in the review. The meta-analysis showed a large significant effect of myofascial release on pain posttreatment (-0.81[95% CI = -1.15 to -0.47], p < 0.00001) and a moderate effect at 6 months post-treatment (-0.61, 95% CI = -0.95 to -0.28, p = 0.0003). CONCLUSION The review demonstrated moderate evidence for the effect of therapist administered and self-myofascial release in improving pain, sleep subscales, and quality of life against sham and no treatment, respectively, in fibromyalgia syndrome patients. However, more high-quality randomized controlled trials with manual control group are required to be conducted at different geographical locations to generalize the findings.
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Wu Z, Wang Y, Ye X, Chen Z, Zhou R, Ye Z, Huang J, Zhu Y, Chen G, Xu X. Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:697986. [PMID: 34395477 PMCID: PMC8355621 DOI: 10.3389/fmed.2021.697986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial. Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP. Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated. Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = -0.37, 95% CI (-0.67, -0.08), I 2 = 46%, P = 0.01] and physical function [SMD = -0.43, 95% CI (-0.75, -0.12), I 2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (-0.38, 0.64), I 2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (-0.49, 1.64), I 2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (-0.75, 0.69), I 2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (-0.09, 2.13), I 2 = 92%, P = 0.07] and mental health [SMD = -0.06, 95% CI (-0.83, 0.71), I 2 = 73%, P = 0.88]. Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Wang
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rui Zhou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinyou Huang
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Yue Zhu
- Baishui Health Center, Qujing, China
| | - Guocai Chen
- Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemeng Xu
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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22
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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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Martínez-Jiménez EM, Losa-Iglesias ME, Antolín-Gil MS, López-López D, Romero-Morales C, Benito-de-Pedro M, Calvo-Lobo C, Becerro-de-Bengoa-Vallejo R. Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study. Life (Basel) 2021; 11:life11010048. [PMID: 33451013 PMCID: PMC7830844 DOI: 10.3390/life11010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown. METHODS A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre-post study. MAIN FINDINGS We found differences in rearfoot maximum pressure (119.22-111.63 KPa; p = 0.025), midfoot maximum pressure (13.68-17.26 KPa; p = 0.077), midfoot medium pressure (4.75-6.24 KPa; p = 0.035) and forefoot surface (86.58-81.75 cm2; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase. CONCLUSIONS After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.
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Affiliation(s)
| | - Marta Elena Losa-Iglesias
- Nursing and Stomatology Department, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | | | - Daniel López-López
- Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | - Carlos Romero-Morales
- Villaviciosa de Odón Campus, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Correspondence:
| | - María Benito-de-Pedro
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
| | - César Calvo-Lobo
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de enfermería Fisioterapiay Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (M.B.-d.-P.); (C.C.-L.); (R.B.-d.-B.-V.)
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24
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020; 11:587373. [PMID: 33424619 PMCID: PMC7793886 DOI: 10.3389/fphys.2020.587373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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Affiliation(s)
- Maria Elisa Duarte França
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Larissa Sinhorim
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil.,Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Daniel Fernandes Martins
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany.,Department for Medical Professions, DIPLOMA Hochschule Bad Sooden-Allendorf, Bad Sooden-Allendorf, Germany
| | - Nicolas A M M Machado-Pereira
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Gabriel Melo de Souza
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Verônica Vargas Horewicz
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Gilmar Moraes Santos
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
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25
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020. [DOI: 10.58737310.3389/fphys.2020.587373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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26
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Arumugam K, Harikesavan K. Effectiveness of fascial manipulation on pain and disability in musculoskeletal conditions. A systematic review. J Bodyw Mov Ther 2020; 25:230-239. [PMID: 33714501 DOI: 10.1016/j.jbmt.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/17/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the effectiveness of Stecco's fascial manipulation technique in patients with musculoskeletal pain. DESIGN Systematic review of interventional studies. METHODS A systematic search of literatures was performed in the electronic databases: PubMed, Cochrane, Scopus, ScienceDirect, and Ovid from January 2005 to December 2019. Studies were included if they were followed stecco's fascial manipulation as an intervention for the musculoskeletal conditions. RCTs and Non RCTs both were included in this review. RESULTS Thirteen studies met the eligibility criteria [RCTs-8, Pre-Post studies-3, Case reports-2]. Stecco's FM technique was followed in all the included studies. Five studies applied FM technique alone, while two studies added exercise along with FM and one study substitute session with manual therapy. CONCLUSION This systematic review reported low to moderate quality evidence for the effect of FM in improving pain and disability in subjects with musculoskeletal pain conditions, when it is carried out as described in the Stecco's concept.
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Affiliation(s)
- Karthik Arumugam
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, India
| | - Karvannan Harikesavan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, India.
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27
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Larouche MC, Camiré Bernier S, Racine R, Collin O, Desmons M, Mailloux C, Massé-Alarie H. Stretch-induced hypoalgesia: a pilot study. Scand J Pain 2020; 20:837-845. [PMID: 32881712 DOI: 10.1515/sjpain-2020-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/10/2020] [Indexed: 01/07/2023]
Abstract
Objectives Stretching is an intervention often used in various kinds of rehabilitation protocols and the effects on pain sensitivity has sparsely been investigated, especially when addressing potential effects on pain. The objective is to investigate the immediate effects of an axial and peripheral prolonged stretch on pressure pain sensitivity (PPT) and temporal summation (TS) on local and distal sites in healthy subjects. Methods Twenty-two healthy volunteers were recruited to participate in this pilot study. Two prolonged stretching protocols were performed: low back and wrist extensors stretches. PPT and pinprick TS were measured pre- and post-intervention at local and remote sites. Repeated measures analysis of variance (ANOVA) was used to examine the effects and significance of the interventions. Results The low back stretch induced an increase in PPT for both local and remote sites, and the wrist stretch produced a PPT increase only at the local site. TS did not change. Conclusions Low back stretching induced an increase in PPT at both local and remote sites whereas the wrist stretch only increased PPT locally, suggesting hypoalgesia at these sites. Further studies are needed to confirm the effect and mechanisms using randomised, controlled and parallel study design. Considering that pain sensitivity is different than clinical pain, results are difficult to extrapolate to clinical practice. Future studies testing clinical pain are needed to better understand the clinical implication of these results.
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Affiliation(s)
| | | | - Rosalie Racine
- McGill University, School of Occupational and Physical Therapy, Montreal, Canada
| | - Olivier Collin
- McGill University, School of Occupational and Physical Therapy, Montreal, Canada
| | - Mikaël Desmons
- Cirris research centre, Université Laval, Quebec City, Canada
| | | | - Hugo Massé-Alarie
- Cirris research centre, Université Laval, Quebec City, Canada.,Rehabilitation Unit, Université Laval, Quebec City, Canada
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28
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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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Tissue Stiffness is Not Related to Pain Experience: An Individually Controlled Study in Patients with Chronic Neck and Back Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2019:1907168. [PMID: 31929809 PMCID: PMC6942862 DOI: 10.1155/2019/1907168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 12/21/2022]
Abstract
Background Massage therapies such as cupping are often applied in patients with chronic neck and back pain with the assumption that they can reduce increased tissue stiffness and, therefore, improve pain. The aim of this study was to clarify whether tissue stiffness is related to pain experience in patients with chronic (>3 months) back and neck pain and whether it can be altered by a cupping massage. Methods The tissue stiffness of the point of subjectively felt maximum pain intensity of 40 patients with neck (n = 20) or lower back pain (n = 20) was measured by a myometer. Exact contralateral side served as an individual control. Side of higher stiffness was then treated with a cupping massage. 5, 10, 15, and 20 minutes as well as 24 hours after treatment, tissue stiffness was measured again. Patients rated their pain on a standardized pain questionnaire (neck pain disability score (NDI) or Oswestry disability index (ODI), respectively) before and 24 hours after treatment. Results Compared to the contralateral control side, the more painful side did not exhibit an increased stiffness of myofascial tissue before treatment (p=0.827). The tissue stiffness and the side difference between treated and nontreated control sides decreased significantly after cupping (p=0.002 and p=0.001, respectively) but returned to baseline after 24 hours. NDI and ODI scores significantly decreased 24 hours after cupping (NDI: p=0.012, ODI: p=0.002). Conclusion Tissue stiffness might not be related to pain experience in patients with chronic neck and lower back pain. Trial registration: German Clinical Trial Register (DRKS00011281).
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Comparison of donor site complications of supra- versus subfascially harvested anterolateral thigh perforator free flaps: A meta-analysis. J Craniomaxillofac Surg 2020; 48:56-66. [DOI: 10.1016/j.jcms.2019.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/27/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022] Open
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Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2019; 21:1. [PMID: 31892357 PMCID: PMC6937867 DOI: 10.1186/s12891-019-3017-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/22/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain. METHODS PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool. RESULTS Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups. DISCUSSION In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain. PROTOCOL REGISTRATION AT PROSPERO CRD42018111975.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Romy Lauche
- Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
- Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Tobias Sundberg
- Nursing and Midwifery, Monash University, Melbourne, Australia
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
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Stephens CJ, Spector JA, Butcher JT. Biofabrication of thick vascularized neo-pedicle flaps for reconstructive surgery. Transl Res 2019; 211:84-122. [PMID: 31170376 PMCID: PMC6702068 DOI: 10.1016/j.trsl.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 01/01/2023]
Abstract
Wound chronicity due to intrinsic and extrinsic factors perturbs adequate lesion closure and reestablishment of the protective skin barrier. Immediate and proper care of chronic wounds is necessary for a swift recovery and a reduction of patient vulnerability to infection. Advanced therapies supplemented with standard wound care procedures have been clinically implemented to restore aberrant tissue; however, these treatments are ineffective if local vasculature is too compromised to support minimally-invasive strategies. Autologous "flaps", which are tissues equipped with their own hierarchical vascular supply, can be harvested from one region of the patient and transplanted to the wound where it is reperfused upon microsurgical anastomosis to appropriate recipient vessels. Despite the success of autologous flap transfer, these procedures are extremely invasive, incur obligatory donor-site morbidity, and require sufficient donor-tissue availability, microsurgical expertise, and specialized equipment. 3D-bioprinting modalities, such as extrusion-based bioprinting, can be used to address the clinical constraints of autologous flap transfer, primarily addressing donor-site morbidity and tissue availability. This advancement in regenerative medicine allows the biofabrication of heterogeneous tissue structures with high shape fidelity and spatial resolution to generate biomimetic constructs with the anatomically-precise geometries of native tissue to ensure tissue-specific function. Yet, meaningful progress toward this clinical application has been limited by the lack of vascularization required to meet the nutrient and oxygen demands of clinically relevant tissue volumes. Thus, various criteria for the fabrication of functional tissues with hierarchical, patent vasculature must be considered when implementing 3D-bioprinting technologies for deep, chronic wounds.
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Affiliation(s)
- Chelsea J Stephens
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Jason A Spector
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York; Division of Plastic Surgery, Weill Cornell Medical College, New York, New York
| | - Jonathan T Butcher
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.
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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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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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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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Abstract
CONTEXT Self-myofascial release (SMR) is an intervention popularly used by rehabilitation, fitness, and sports professionals to improve recovery and performance. In SMR, the athlete/patient applies pressure to the muscle and fascia using various tools, such as balls, rods, foam rolls, and massagers. OBJECTIVE This study aimed to evaluate the acute effect of 2 SMR protocols (short term and long term) of the posterior thigh and calf muscles on hip and ankle range of motion (ROM) in physically active men. PARTICIPANTS A total of 14 adult males (24.9 [3.2] y, 77.2 [13.2] kg, and 1.75 [0.06] m) who exercise regularly (at least twice a week, 45 min per session) participated in this study. INTERVENTIONS Participants performed a short-term SMR protocol (2 × 10 repetitions, SSMR) and a long-term SMR protocol (2 × 20 repetitions, LSMR) of the posterior thigh (using a foam roller) and calf (using a massage stick) muscles in counterbalanced order, on 2 different days with a 48-hour interval. MAIN OUTCOME MEASURES Ankle dorsiflexion and hip-flexion ROM, evaluated at 5 moments: pre- and post-SSMR, pre- and post-LSMR, and in the control condition, which was always performed at the first visit. RESULTS The SMR promoted significant gains for both dorsiflexion (F1,13 =202.67, P < .001, ηp2=.94 ) and hip flexion (F1,13 = 66.46, P < .001, ηp2=.84 ), regardless of the protocol and limb analyzed. The average increase for both limbs corresponded, approximately, to 11% for ankle dorsiflexion and to 6% for and in hip flexion. CONCLUSIONS The results suggest that SMR of the posterior thigh and calf muscles acutely increases the ROM of both hip flexion and ankle dorsiflexion and that duplicating the SMR volume from 10 to 20 repetitions per set seems not to promote additional gains.
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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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Coleman Wood KA, Lowndes BR, Buus RJ, Hallbeck MS. Evidence-based intraoperative microbreak activities for reducing musculoskeletal injuries in the operating room. Work 2018; 60:649-659. [DOI: 10.3233/wor-182772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Bethany R. Lowndes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ryan J. Buus
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - M. Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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De Coninck K, Hambly K, Dickinson JW, Passfield L. Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study. BMC Musculoskelet Disord 2018; 19:180. [PMID: 29859080 PMCID: PMC5984750 DOI: 10.1186/s12891-018-2088-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/15/2018] [Indexed: 01/16/2023] Open
Abstract
Background Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor. Ultrasound imaging has shown that people with chronic lower back pain demonstrate both a significant decrease in shear strain, and a 25% increase in thickness of the thoracolumbar fascia. There is sparse data on whether medical practitioners agree on the level of disorganisation in ultrasound images of thoracolumbar fascia. The purpose of this study was to establish inter-rater reliability of the ranking of architectural disorganisation of thoracolumbar fascia on a scale from ‘very disorganised’ to ‘very organised’. Methods An exploratory analysis was performed using a fully crossed design of inter-rater reliability. Thirty observers were recruited, consisting of 21 medical doctors, 7 physiotherapists and 2 radiologists, with an average of 13.03 ± 9.6 years of clinical experience. All 30 observers independently rated the architectural disorganisation of the thoracolumbar fascia in 30 ultrasound scans, on a Likert-type scale with rankings from 1 = very disorganised to 10 = very organised. Internal consistency was assessed using Cronbach’s alpha. Krippendorff’s alpha was used to calculate the overall inter-rater reliability. Results The Krippendorf’s alpha was .61, indicating a modest degree of agreement between observers on the different morphologies of thoracolumbar fascia.The Cronbach’s alpha (0.98), indicated that there was a high degree of consistency between observers. Experience in ultrasound image analysis did not affect constancy between observers (Cronbach’s range between experienced and inexperienced raters: 0.95 and 0.96 respectively). Conclusions Medical practitioners agree on morphological features such as levels of organisation and disorganisation in ultrasound images of thoracolumbar fascia, regardless of experience. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia.
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Affiliation(s)
- Kyra De Coninck
- School of Sport and Exercise Sciences, University of Kent, Medway Building, Chatham Maritime, Chatham, Kent, ME4 4AG, UK.
| | - Karen Hambly
- School of Sport and Exercise Sciences, University of Kent, Medway Building, Chatham Maritime, Chatham, Kent, ME4 4AG, UK
| | - John W Dickinson
- School of Sport and Exercise Sciences, University of Kent, Medway Building, Chatham Maritime, Chatham, Kent, ME4 4AG, UK
| | - Louis Passfield
- School of Sport and Exercise Sciences, University of Kent, Medway Building, Chatham Maritime, Chatham, Kent, ME4 4AG, UK
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Maulén-Yáñez M, Meeder-Bella W, Videla-Jiménez PJ, González-Arriagada WA. Assessment of association between muscular diagnosis in temporomandibular disorders with mandibular kinematics. Cranio 2018; 37:365-373. [PMID: 29734882 DOI: 10.1080/08869634.2018.1465513] [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] [Indexed: 12/17/2022]
Abstract
Objective: To study the association between mandibular kinematics and muscular diagnoses in temporomandibular disorders (TMD). Method: Retrospective, descriptive clinical study based on an analysis of 370 clinical records of muscle diagnoses in TMD. Statistical analysis was performed with the SPSS program. Results: Five different muscle diagnoses were considered. Myospasm and centrally mediated myalgia were discarded from the statistical analysis because of their low incidences. The diagnoses included in the analysis were protective co-contraction, myofascial pain, and myalgia. Decreased mandibular kinematics in the frontal and horizontal planes were related to myofascial pain. Mandibular kinematics with deflection in opening values decreased in the frontal plane, but intermediate or increased values in the horizontal plane were related to the protective co-contraction. Muscle pain with normal or increased mandibular kinematics was associated with a diagnosis of myalgia. Conclusion: Values of mandibular kinematics are correlated with the muscular diagnoses in TMD and are useful for diagnosis.
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Affiliation(s)
- Miguel Maulén-Yáñez
- Facultad de Odontología, Universidad de Valparaíso , Valparaíso , Chile.,Clinic of Temporomandibular Disorders and Orofacial Pain, Department of Dentistry, Gustavo Fricke Hospital , Viña del Mar , Chile
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42
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Schleip R, Wilke J, Schreiner S, Wetterslev M, Klingler W. Needle biopsy-derived myofascial tissue samples are sufficient for quantification of myofibroblast density. Clin Anat 2018; 31:368-372. [PMID: 29314236 DOI: 10.1002/ca.23040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 01/02/2023]
Abstract
Quantification of myofibroblasts is a promising method for assessing tissue properties in the field of fascia research. This is commonly performed by immunohistochemistry for α-smooth muscle actin. However, usually larger tissue samples sizes are required for quantification. The aim of this investigation was to explore whether a microscopic quantification of myofibroblasts can be conducted with fascial tissue samples derived via percutaneous needle biopsy. Fascial tissues were derived via percutaneous needle biopsy from the fascia lata of 11 persons (aged 19-40 years). Following immunohistochemistry, selected fields for photomicroscopic analysis were chosen by a Monte Carlo method based randomization procedure. On these fields, a digital quantification for the relative density of α-smooth muscle actin was attempted. The newly developed quantification method could successfully be applied in all tissue samples. The median α-smooth muscle actin density in the selected tissue samples ranged between 0% and 1.7% (median 0%, IQR 0%-0.001%). The applied protocol proved to be workable for the purpose of an estimation of the α-smooth muscle actin density in fascial tissue samples derived via percutaneous needle biopsy. Since this type of biopsy is less invasive than the commonly performed open muscle biopsy, this offers a new and useful perspective for future histological investigations of fascial tissue properties in living patients. Clin. Anat. 31:368-372, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- R Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany
| | - J Wilke
- Department of Sports Medicine, Institute of Sport Science, Goethe University Frankfurt, Germany
| | - S Schreiner
- Division of Neurophysiology, Ulm University, Ulm, Germany
| | - M Wetterslev
- Department of Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - W Klingler
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany
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Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil 2017; 32:440-450. [DOI: 10.1177/0269215517732820] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Katri Laimi
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Annika Mäkilä
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Esa Bärlund
- Turku University of Applied Sciences, Turku, Finland
| | | | - Airi Oksanen
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Valpuri Seikkula
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Expert Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Jari Karppinen
- Department of Expert Services, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Dry Needling in myofascial tracks in Non-Relaxing Pelvic Floor Dysfunction: A case study. J Bodyw Mov Ther 2017; 22:337-340. [PMID: 29861229 DOI: 10.1016/j.jbmt.2017.09.016] [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: 05/26/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this case report is to describe the use of Dry Needling (DN) in myofascial tracks related to the pelvic floor (PF) in the management of a male with Non-Relaxing Pelvic Floor Dysfunction (NRPFD). CLINICAL FEATURES A 42-year-old man, with a 20-year history of frequent urination, was referred to the physical therapy clinic by a urologist with diagnosis of NRPFD. The patient was suffering from a sense of incomplete evacuation and difficulty to start urination. He had to urinate every 30 min. The initiation of urination was so difficult that patient had to facilitate it by splashing warm water on his penis. INTERVENTION AND OUTCOME DN was performed for 10 sessions. The first three sessions were performed every other day in the same week. In the second week, DN was performed twice at three-day intervals, and the other sessions were performed such that one session was held per week. Selected stretching exercises were prescribed in the first session. The results showed that the patient had reported no urination during sleep, and urination six to eight times when was awake. A three-month follow-up with a telephone-based interview showed that the symptoms did not recur. CONCLUSION This study showed the possible efficacy of prescribing DN in myofascial tracks in the management of a male with NRPFD. More studies are required to clarify the issue.
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Anandkumar S, Manivasagam M. Effect of fascia dry needling on non-specific thoracic pain - A proposed dry needling grading system. Physiother Theory Pract 2017; 33:420-428. [PMID: 28481688 DOI: 10.1080/09593985.2017.1318423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This case report describes a 42-year-old female who presented with complaints of diffuse pain in her thoracic paraspinal region from T2 to T7. Physical examination revealed tenderness, increased turgor and restriction of her superficial fascia. A potential first time description of successful management utilizing fascia dry needling is described in this report with improvements noted in pain, range of motion, and functional activities. The patient was discharged from physiotherapy after four treatment sessions, and a follow-up after 3 months revealed that she was pain free and fully functional. A grading system (Sudarshan and Murugavel Dry Needling Grading Scale©) is proposed describing the various grades of dry needling to guide clinical reasoning and decision-making.
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Affiliation(s)
- Sudarshan Anandkumar
- a Registered Physiotherapist , CBI Health Centre , Chilliwack , British Columbia , Canada
| | - Murugavel Manivasagam
- b Physiotherapist, Rehabilitation Department , Brunei Jerudong Park Medical Centre , Jerudong Park , Brunei Darussalam
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Bernabei M, van Dieën JH, Maas H. Evidence of adaptations of locomotor neural drive in response to enhanced intermuscular connectivity between the triceps surae muscles of the rat. J Neurophysiol 2017; 118:1677-1689. [PMID: 28490645 DOI: 10.1152/jn.00625.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 01/13/2023] Open
Abstract
The aims of this study were to investigate changes 1) in the coordination of activation of the triceps surae muscle group, and 2) in muscle belly length of soleus (SO) and lateral gastrocnemius (LG) during locomotion (trotting) in response to increased stiffness of intermuscular connective tissues in the rat. We measured muscle activation and muscle belly lengths, as well as hindlimb kinematics, before and after an artificial enhancement of the connectivity between SO and LG muscles obtained by implanting a tissue-integrating surgical mesh at the muscles' interface. We found that SO muscle activation decreased to 62%, while activation of LG and medial gastrocnemius muscles increased to 134 and 125%, respectively, compared with the levels measured preintervention. Although secondary additional or amplified activation bursts were observed with enhanced connectivity, the primary pattern of activation over the stride and the burst duration were not affected by the intervention. Similar muscle length changes after manipulation were observed, suggesting that length feedback from spindle receptors within SO and LG was not affected by the connectivity enhancement. We conclude that peripheral mechanical constraints given by morphological (re)organization of connective tissues linking synergists are taken into account by the central nervous system. The observed shift in activity toward the gastrocnemius muscles after the intervention suggests that these larger muscles are preferentially recruited when the soleus has a similar mechanical disadvantage in that it produces an unwanted flexion moment around the knee.NEW & NOTEWORTHY Connective tissue linkages between muscle-tendon units may act as an additional mechanical constraint on the musculoskeletal system, thereby reducing the spectrum of solutions for performing a motor task. We found that intermuscular coordination changes following intermuscular connectivity enhancement. Besides showing that the extent of such connectivity is taken into account by the central nervous system, our results suggest that recruitment of triceps surae muscles is governed by the moments produced at the ankle-knee joints.
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Affiliation(s)
- Michel Bernabei
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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Proia AD. Periocular necrotizing fasciitis in an infant. Surv Ophthalmol 2017; 63:251-256. [PMID: 28300549 DOI: 10.1016/j.survophthal.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/18/2022]
Abstract
Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy.
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Affiliation(s)
- Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
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Szotek S, Dawidowicz J, Eyden B, Matysiak N, Czogalla A, Dudzik G, Leśniewicz A, Maksymowicz K. Morphological features of fascia lata in relation to fascia diseases. Ultrastruct Pathol 2016; 40:297-310. [PMID: 27762645 DOI: 10.1080/01913123.2016.1239665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fascia lata is an important element of the fascial system, which forms the continuum of connective tissue throughout the body. This deep fascia envelops the entire thigh and hip area and its main function is to transmit mechanical forces generated by the musculoskeletal system of the lower extremities. Fascia lata is also known as a useful and easily harvested graft material. Despite its crucial role in lower extremity biomechanics and wide-ranging applications in plastic and reconstructive surgery, both the structure of fascia lata and particularly the cells populating this tissue are relatively unexplored and therefore poorly understood. The aim of this study was to characterize the main cell populations encountered within human fascia lata and to try to understand their role in health and diseases. Pathologically unchanged human fascia lata was obtained post mortem from adult males. The specimens were analyzed under light, electron, and confocal microscopy. On the basis of different visualization techniques, we were able to characterize in detail the cells populating human fascia lata. The main cells found were fibroblasts, fibrocytes, mast cells, cells showing myoid differentiation, nerve cells, and most interestingly, telocytes. Our results supplement the formerly inadequate information in the literature regarding the cellular components of deep fascial structure, may contribute to a better understanding of the pathogenesis of fascial disorders and improve fascia lata application as a graft material.
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Affiliation(s)
- Sylwia Szotek
- a Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Faculty of Mechanical Engineering , Wrocław University of Science and Technology , Wrocław , Poland
| | | | - Brian Eyden
- c Christie NHS Foundation Trust , Manchester , United Kingdom
| | - Natalia Matysiak
- d Department of Histology and Embryology, School of Medicine with the Division of Dentistry in Zabrze , Medical University of Silesia , Zabrze , Poland
| | - Aleksander Czogalla
- e Department of Cytobiochemistry, Faculty of Biotechnology , University of Wrocław , Wrocław , Poland
| | - Grzegorz Dudzik
- f Chair of EM Field Theory, Electronic Circuits and Optoelectronics, Faculty of Electronics , Wrocław University of Science and Technology , Wrocław , Poland
| | - Anna Leśniewicz
- g Analytical Chemistry and Chemical Metallurgy Division, Faculty of Chemistry , Wrocław University of Science and Technology , Wrocław , Poland
| | - Krzysztof Maksymowicz
- h Department of Forensic Medicine, Faculty of Medicine , Wroclaw Medical University , Wrocław , Poland
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Alvira-Lechuz J, Espiau MR, Alvira-Lechuz E. Treatment of the scar after arthroscopic surgery on a knee. J Bodyw Mov Ther 2016; 21:328-333. [PMID: 28532876 DOI: 10.1016/j.jbmt.2016.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/12/2016] [Accepted: 07/26/2016] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to present a treatment for scars based on percutaneous traction. This is a structural technique in which movements are performed against the barriers detected in different planes. The stages of this technique are described in detail along with the results after applying it to a postarthroscopic scar on a knee. The active and passive mobility of femoro-tibial and femoro-patellar articulations improved substantially after the treatment, as verified by signs such as pain relief, greater flexibility, disappearance of inflammation and a major recovery of tissue elasticity. A sonoelastography study of the portals and patellar tendon was carried out before and after therapy, showing semiquantitatively the recovery of the viscoelastic properties of the tissue.
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Affiliation(s)
- Jacobo Alvira-Lechuz
- Madrid School of Osteopathy, University of Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Mercedes Roca Espiau
- Dr. Roca Center for Medical Diagnosis, La Carrera del Sábado, 4, 50006 Zaragoza, Spain
| | - Elena Alvira-Lechuz
- Department of Physics, University of La Laguna, Avenida Francisco Sánchez s/n, 38202 La Laguna, Tenerife, Spain.
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Abstract
Currently, the exact role of telocytes within fascial structures is unknown. The morphology, distribution and behaviour of fascial telocytes as well as the mutual relationship between telocytes and other cellular fascia constituents should be definitely a subject of further studies. It will contribute to better understanding of the role of the fascial system in health and diseases, may shed light on the regeneration potential of these tissues and may help to find targets for future treatments for locomotor disorders, including fascial diseases. Last but not least, confirmation of the presence of telocytes within fascia may contribute to optimise the use of fascia as a graft material.
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