A unifying neuro-fasciagenic model of somatic dysfunction - underlying mechanisms and treatment - Part I

Osteopathic Manual Therapy for Infant Colic: A Randomised Clinical Trial

BACKGROUND

Infant colic is a multifactorial syndrome for which various therapeutic strategies have been proposed. In this study, we evaluate the effectiveness of osteopathic manual therapy in treating symptoms related to infant colic.

METHOD

A prospective, randomised, blinded clinical trial was conducted of patients diagnosed with infant colic. The treatment group were given osteopathic manual therapy, and their parents received two sessions of counselling. The control group received no such therapy, but their parents attended the same counselling sessions. The non-parametric Mann-Whitney U test was applied to determine whether there were significant differences between the groups for the numerical variables considered. For the qualitative variables, Fisher's exact test was used. The threshold assumed for statistical significance was 0.05.

RESULTS

A total of 42 babies were assigned to each group. Those in the experimental group presented less severe infant colic with a trend towards statistical significance after the first session (p = 0.09). In sucking, excretion, eructation and gas there were no significant differences between the groups. Crying was a statistically significant dimension both after the first intervention (p = 0.03) and two weeks after (p = 0.04). Regurgitation values were significantly lower in the experimental group during the three weeks of follow-up (p = 0.05). Values for sleep were lower in the experimental group, but the differences were not statistically significant. In both groups, colic severity decreased over time, with no side effects.

CONCLUSIONS

Treatment with osteopathic manual therapy alleviates the symptoms of infant colic and could be recommended for this purpose from the onset of the condition.

Reconceptualizing Somatic Dysfunction in the Light of a Neuroaesthetic Enactive Paradigm

Background: Palpatory findings are considered a central element of osteopathic practice, especially when associated with a patient's altered regulative functions than with named somatic dysfunctions. Although osteopathic theories for somatic dysfunction could be plausible, the clinical applicability of the concept is debated, especially because it is largely related to simple cause-effect models of osteopathic care. In contrast to a linear kind of diagnosis of a "tissue as a producer of symptoms", this perspective article aims to provide a conceptual and operational framework in which the somatic dysfunction evaluation process is seen as a neuroaesthetic (en)active encounter between osteopath and patient. Subsections relevant to the subject: To summarize all concepts of the hypothesis, the enactive neuroaesthetics principles are proposed as a critical foundation for the osteopathic assessment and treatment of the person, specifically addressing a new paradigm for somatic dysfunction. Conclusions, and future directions: The present perspective article represents a proposition to blend technical rationality informed by neurocognitive and social sciences, and professional artistry clinical experience informed by traditional tenets, to overcome the controversy around somatic dysfunction, rather than dismissing the concept.

Immediate Effects of Myofascial Release Treatment on Lumbar Microcirculation: A Randomized, Placebo-Controlled Trial

(1) Background: Inflammatory processes in the thoracolumbar fascia (TLF) lead to thickening, compaction, and fibrosis and are thought to contribute to the development of nonspecific low back pain (nLBP). The blood flow (BF) of fascial tissue may play a critical role in this process, as it may promote hypoxia-induced inflammation. The primary objective of the study was to examine the immediate effects of a set of myofascial release (MFR) techniques on the BF of lumbar myofascial tissue. The secondary objectives were to evaluate the influence of TLF morphology (TLFM), physical activity (PA), and body mass index (BMI) on these parameters and their correlations with each other. (2) Methods: This study was a single-blind, randomized, placebo-controlled trial. Thirty pain-free subjects (40.5 ± 14.1 years) were randomly assigned to two groups treated with MFR or a placebo intervention. Correlations between PA, BMI, and TLFM were calculated at baseline. The effects of MFR and TLFM on BF (measured with white light and laser Doppler spectroscopy) were determined. (3) Results: The MFR group had a significant increase in BF after treatment (31.6%) and at follow-up (48.7%) compared with the placebo group. BF was significantly different between disorganized and organized TLFM (p < 0.0001). There were strong correlations between PA (r = -0.648), PA (d = 0.681), BMI (r = -0.798), and TLFM. (4) Conclusions: Impaired blood flow could lead to hypoxia-induced inflammation, possibly resulting in pain and impaired proprioceptive function, thereby likely contributing to the development of nLBP. Fascial restrictions of blood vessels and free nerve endings, which are likely associated with TLFM, could be positively affected by the intervention in this study.

“What you feel under your hands”: exploring professionals’ perspective of somatic dysfunction in osteopathic clinical practice—a qualitative study

Background

Despite controversy regarding its validity and clinical usefulness, manual examination findings still have an important role for manipulative therapies. As an example, somatic dysfunction (SD) remains central to osteopathic practice.This study aims to explore the experienced osteopaths' attitudes concerning SD and its role in osteopathic practice. This qualitative research could contribute to building a consistent paradigm for manual intervention in all musculoskeletal manipulations.

Methods

A thematic analysis with grounded theory elements was used. Data were collected through semi-structured interviews carried out between February and April 2021. A purposive sample of twenty professional osteopaths with past experience in osteopathic care was chosen to reflect the phenomenon's variety. The data analysis was done inductively and in tandem with the recruiting to keep track of data saturation.

Results

Eleven osteopaths participated in the study. Three main themes emerged from the data analysis: (1) SD as a safe tissue-touch-based communication tool between operator and person complex adaptive health system; (2) The treatment of SD is shareable between osteopaths, other health professionals, and the patients involved in the therapeutic pathway improving body awareness and health; (3) The development of the SD concept in research and practice to better clarify osteopathic profession identity and definition.

Conclusions

A panel of expert osteopaths consider the concept of SD as a valuable tool integrated into the osteopathic evaluation and treatment process. The shared concept and clinical application of SD is informed by person-centered care concepts and from the fields of neuroscience, cognitive and complexity science. Our study reports a common need among osteopaths to develop an evidence-based framework of SD to allow the best development of the osteopathic profession.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00444-2.

Tissutal and Fluidic Aspects in Osteopathic Manual Therapy: A Narrative Review

Over the years, several authors have discussed the possibility of considering somatic dysfunction (SD) as a “nosological element” detectable on palpation. There are many aspects to consider regarding the etiology and diagnosis of SD, and the literature on osteopathic issues provides details on physiological signs that characterize it, including tissue texture changes. Recent knowledge suggests that how tissue and, in particular, connective tissue, responds to osteopathic treatment may depend on the modulation of the inflammation degree. Low-grade inflammation (LGI) may act on the extracellular matrix (ECM) and on cellular elements; and these mechanisms may be mediated by biological water. With its molecules organized in structures called exclusion zones (EZ), water could explain the functioning of both healthy and injured tissues, and how they can respond to osteopathic treatment with possible EZ normalization as a result. The relationship between inflammation and DS and the mechanisms involved are described by several authors; however, this review suggests a new model relating to the characteristics of DS and to its clinical implications by linking to LGI. Tissue alterations detectable by osteopathic palpation would be mediated by body fluids and in particular by biological water which has well-defined biophysical characteristics. Research in this area is certainly still to be explored, but our suggestion seems plausible to explain many dynamics related to osteopathic treatment. We believe that this could open up a fascinating scenario of therapeutic possibilities and knowledge in the future.

Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework

Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.

Impaired Lymphatic Drainage and Interstitial Inflammatory Stasis in Chronic Musculoskeletal and Idiopathic Pain Syndromes: Exploring a Novel Mechanism

A normal functioning lymphatic pump mechanism and unimpaired venous drainage are required for the body to remove inflammatory mediators from the extracellular compartment. Impaired vascular perfusion and/or lymphatic drainage may result in the accumulation of inflammatory substances in the interstitium, creating continuous nociceptor activation and related pathophysiological states including central sensitization and neuroinflammation. We hypothesize that following trauma and/or immune responses, inflammatory mediators may become entrapped in the recently discovered interstitial, pre-lymphatic pathways and/or initial lymphatic vessels. The ensuing interstitial inflammatory stasis is a pathophysiological state, created by specific pro-inflammatory cytokine secretion including tumor necrosis factor alpha, interleukin 6, and interleukin 1b. These cytokines can disable the local lymphatic pump mechanism, impair vascular perfusion via sympathetic activation and, following transforming growth factor beta 1 expression, may lead to additional stasis through direct fascial compression of pre-lymphatic pathways. These mechanisms, when combined with other known pathophysiological processes, enable us to describe a persistent feed-forward loop capable of creating and maintaining chronic pain syndromes. The potential for concomitant visceral and/or vascular dysfunction, initiated and maintained by the same feed-forward inflammatory mechanism, is also described.

The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies

Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.

What Does the Body Communicate With Postural Oscillations? A Clinical Investigation Hypothesis

The evolution of the foot and the attainment of the bipedia represent a distinctive characteristic of the human species. The force of gravity is dissipated through the tibial astragalic joints, and the movement of the ankle is manifested on a sagittal plane. However, this is in contrast with other studies that analyze the straight station in bipodalic support of the body. According to these studies, the oscillations of the body dissipated by the articulation of the ankle are greater on a frontal plane than on a sagittal plane. Probably, this can be deduced by analyzing the concept of "cone of economy (COE) and equilibrium;" a cone that has its base with the oscillations described by the 360° movement performed by the head and has its apex that supports polygon defined by the tibio-astragalic articulation. The purpose of this study was to evaluate a kind of communication between the oscillations of the COE and equilibrium and the main sphere of somatic dysfunction (structural, visceral, or cranial sacral), assessing the reliability of the "fascial compression test." The implications of this connection have been considered, while grounding the hypothesis in the ability of the human body to maintain its center of mass (COM) with minimum energy expenditure and with minimum postural influence. At the same time, the fascial compression test provides a dominant direction of fascial compartments in restriction of mobility.

Assessment of a taping method combined with manual therapy as a treatment of non-specific chronic low back pain - a randomized controlled trial

Background

Chronic low back pain is the most frequent medical problem and the condition with the most years lived with disability in Western countries. The objective of this study was to assess a new treatment, Medi-Taping, which aims at reducing complaints by treating pelvic obliquity with a combination of manual treatment of trigger points and kinesio taping in a pragmatic RCT with pilot character.

Methods

One hundred ten patients were randomized at two study centers either to Medi-Taping or to a standard treatment consisting of patient education and physiotherapy as control. Treatment duration was 3 weeks. Measures were taken at baseline, end of treatment and at follow-up after 2 months. Main outcome criteria were low back pain measured with VAS, the Chronic Pain Grade Scale (CPGS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ).

Results

Patients of both groups benefited from the treatment by medium to large effect sizes. All effects were pointing towards the intended direction. While Medi-Taping showed slightly better improvement rates, there were no significant differences for the primary endpoints between groups at the end of treatment (VAS: mean difference in change 0.38, 95-CI [− 0.45; 1.21] p = 0.10; ODQ 2.35 [− 0.77; 5.48] p = 0.14; CPGS − 0.19 [− 0.46; 0.08] p = 0.64) and at follow-up. Health-related quality of life was significantly higher (p = .004) in patients receiving Medi-Taping compared to controls.

Conclusions

Medi-Taping, a purported way of correcting pelvic obliquity and chronic tension resulting from it, is a treatment modality similar in effectiveness to complex physiotherapy and patient education.

Trial registration

This trial was registered retrospectively on July 24th, 2019 as Number DRKS00017051 in the German Register of Clinical Trials (Deutsches Register Klinischer Studien).

URL of trial registry record: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017051.

Manual Pressure Release and Low-Grade Electrical Peripheral Receptor Stimulation in Nonspecific Low Back Pain: A Randomized Controlled Trial

Chronic nonspecific low back pain is a frequent clinical condition affecting the general population and influencing disability level and quality of life. We performed a single-blinded, randomized, and controlled study to compare the effectiveness of manual pressure release (MPR) and electrical neuromodulation (ENM) treatments in the management of chronic low back pain. There were 20 patients with chronic low back pain randomly assigned to 6 treatment sessions with either technique. Both groups were treated for 2 days a week for 3 weeks. Myofascial trigger points (MTrPs) were identified and skin conductance, pressure-pain threshold, postural changes, and the Oswestry Disability Index were assessed before and after each treatment session, along with the protocol-end data compared against the baseline data in each group. We found an outstanding and about equal deactivation of MTrPs from pre- to post-treatment in both groups, reducing disability in patients with chronic low back pain. The study highlights the ENM as a reliable tool for the evaluation of MTrPs, given a high agreement with the MPR. The effect on the neuromuscular condition of treating the "key trigger points" found in this study advances the knowledge of medical rehabilitation.

Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review

INTRODUCTION

Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field.

METHODS

A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring).

RESULTS

Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment.

CONCLUSION

Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

A pilot study of the effects of suboccipital fascial release on heart rate variability in workers in the clothing industry: Randomized clinical trial

INTRODUCTION

The routine of work inside the clothing industry has been associated with high levels stress perceived by the worker. The parameters of heart rate variability (HRV) are objective markers of the organic response to stress.

OBJECTIVE

This trial evaluates if suboccipital fascial release (SFR) technique was able to influence HRV parameters in workers in the clothing industry.

METHODS

Randomized clinical trial. Forty women who worked in clothing industry were randomized into two groups, untreated group (UG, n = 15) and treated group (TG, n = 25). Heart rate (HR) and HRV parameters were measured using a heart rate monitor. Statistical analysis of data distribution and within group and between groups analysis were performed with α adjusted to 0.05.

RESULTS

Within group analysis in the TG showed significant changes in the following parameters: sympathovagal balance (low frequency/high frequency - LF/HF) (p ≤ 0.01), mean RR intervals (p ≤ 0.01), mean heart rate (Mean HR) (p ≤ 0.01), minimum heart rate (Min. HR) (p = 0.02) and maximum heart rate (Max. HR) (p ≤ 0.01). Between group analysis, on the other hand, showed significant variations in Very Low Frequency (VLF) (p = 0.04) and Max. HR (p = 0.03) in favor of the TG. No significant changes were observed in the UG during the same period.

CONCLUSION

The comparison between groups showed that SFR may influence HRV parameters more than rest in workers in the clothing industry and possibly may contribute to the improvement of the stress experienced by them.

The Vegetative Receptor-Vascular Reflex (VRVR) - A New Key to Regeneration

OBJECTIVE

We describe a potentially new physiological reflex path that has so far been neglected but which could be used for a novel therapeutic approach: The vegetative receptor-vascular reflex. This is a physiological response that starts from the connective tissue and influences the whole organism. We cross-fertilized various research areas with each other.

KEY FINDINGS

The matrix or the connective tissue forms a passive reservoir of substrate for the growth and development of cells, and functions as the primordial communication system of all living systems. It contains a continuous network of cells, such as fibroblasts, along with protein bundles made up of collagen that support electrical exchange through piezoelectric effects. This archaic vegetative system surrounds all cells, including neurons, and can thus be viewed as the primordial coordinating system in every organism. It is very likely the basis for a reflex which we describe here for the first time: the vegetative receptor vascular reflex. We also indicate some potential practical applications and test procedures.

CONCLUSION

The vegetative receptor vascular reflex describes the pathway from stimuli that originate in the connective tissue or the extracellular matrix toward organ systems. They might be chemical in nature or electrical via piezo-electric effects stimulating nerve endings, and thus can influence higher order processes such as regeneration or healing of tissue. Thus, this reflex lends itself to a novel therapeutic approach via certain types of manipulation of the connective tissue.

Embryology of the Fascial System

The fascial system is a link between the various body systems. Understanding the embryonic formation of the fascial system contributes to understanding the development of the whole body, helping to understand clinical phenomena. The text presents the concept of the fascial system and its interactions with the neural system. We describe the formation of musculoskeletal fascia from somites and mesenchymal cells of the cranial neural crest. Differences in the formation of the head, neck, trunk, and limbs and their respective embryonic relationships are presented. We detail the formation of visceral fascia and their corresponding innervations, from the tongue to the final portion of the digestive tract; the development of the genitourinary system that occurs later in the celomic cavity; and the formation of the cardiocirculatory and respiratory systems, with the development of their respective envelopes, associated with the corresponding innervation. The text covers the embryology of neural fasciae, both at the level of the central and peripheral nervous system. Finally, the development of derme and pannicular fascia is presented.

Mechanosensitivity of Cells and Its Role in the Regulation of Physiological Functions and the Implementation of Physiotherapeutic Effects (Review)

Regulatory signals in the body are not limited to chemical and electrical ones. There is another type of important signals for cells: those are mechanical signals (coming from the environment or arising from within the body), which have been less known in the literature. The review summarizes new information on the mechanosensitivity of various cells of connective tissue and nervous system. Participation of mechanical stimuli in the regulation of growth, development, differentiation, and functioning of tissues is described. The data focus on bone remodeling, wound healing, neurite growth, and the formation of neural networks. Mechanotransduction, cellular organelles, and mechanosensitive molecules involved in these processes are discussed as well as the role of the extracellular matrix. The importance of mechanical characteristics of cells in the pathogenesis of diseases is highlighted. Finally, the possible role of mechanosensitivity in mediating the physiotherapeutic effects is addressed.

Inhibitory Tests as Assessment Tools for Somatic Dysfunctions: Mechanisms and Practical Applications

The capital element in the field of osteopathy and several other manual therapy methods, is the somatic dysfunction (SD), a functional imbalance that can involve different tissues and mechanisms in its genesis and maintenance. The main challenges found in the clinical scope are to understand the interaction, hierarchy, and relevance of the SD. Several manual tests are available to functionally evaluate the SD, each one with its applicability to analyze the different parameters of the SD. The so-called inhibitory tests are a category of functional manual tests that can be added to the diagnostic context of the SD. It is a particular type of test in which the evaluator applies manual mechanical stimuli to dysfunctional tissues and assesses the biological responses that occur simultaneously with the application of the stimulus. Its use can consider biomechanical and neurological principles in such a way that different conditions can be analyzed. The objective of this article is to review well-established knowledge and recent scientific discoveries about the SD and its local and global repercussions, in an attempt to offer ideas that can be applied to better understand the mechanisms that imply the use of inhibitory tests as complementary clinical diagnostic tools. It will be discussed some of the possible mechanisms involved in the physiology of the inhibitory tests, their practical applications in some distinct conditions, as well as new proposals of utilization based on the sensitization of metameric related structures under a dysfunctional state.

The Intraosseous Dysfunction in the Osteopathic Perspective: Mechanisms Implicating the Bone Tissue

The somatic dysfunction (SD) is a protagonist in the context of theories and practices involving osteopathy and various other manual therapy methods. It is considered an obstacle to the body's inherent self-regulatory capabilities, and several tissues may be involved in this dysfunctional process, including the bone. The so-called intraosseous dysfunction refers to the restriction of natural flexibility of the fibrous components of the bone tissue matrix, or of the nonossified cartilaginous or membranous areas. Bone is a connective tissue composed of inorganic material and specialized cells organized in a hydrated extracellular matrix that provides the mechanical qualities to the tissue. The development of the bone tissue is a continuous process throughout life, and some bones fuse only years or decades after birth. It has microanatomical continuity with other adjacent structures and its different compartments are supplied by fluids, as well as somatic and autonomic innervation. Several studies show the phenomenon of bone tissue sensitization under traumatic, pathological conditions and also movement restriction. The purpose of the article is to review well-established knowledge and recent scientific findings regarding bone tissue anatomy and physiology, in an attempt to offer insights that could be applied to better understand the mechanisms implicating the intraosseus dysfunctions and its local and global repercussions.

Ergojump evaluation of the explosive strength in volleyball athletes pre- and post-fascial treatment

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.

Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation

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 (r_s = 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.

The indeterminable resilience of the fascial system

The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit several functions, such as motor, nervous, vascular and visceral. These microvacuoles (a repetition of polyhedral units of connective fibrils) under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos: it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell. The present commentary deals with this concept, providing clinical examples of different disease patterns, providing contrary examples in which this adaptability does not occur, and lastly suggesting considerations for the approach to manipulative therapy of the fascial tissue. The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time.

A.T. Still's Osteopathic Lesion Theory and Evidence-Based Models Supporting the Emerged Concept of Somatic Dysfunction

Andrew Taylor Still, MD, DO, coined the original idea of lesion based on the obstruction of flow of body fluids, but primarily referring to bony structures and more precisely to the spine. Throughout the 20th century, this idea was shaped and developed into the concept of somatic dysfunction, a term that is familiar to both US-trained osteopathic physicians and foreign-trained osteopaths and has been an essential cornerstone of osteopathic practice and teaching. The present historical narrative review offers an overview of the evolution of Still's original lesion concept, major evidence-based models of somatic dysfunction that attempt to explain the clinical findings, and a critique of the concept.

Fascial hierarchies and the relevance of crossed-helical arrangements of collagen to changes in shape; part II: The proposed effect of blood pressure (Traube-Hering-Mayer) waves on the fascia

Periodic changes in arterial pressure and volume have long been related to respiratory and sympathetic nerve activity (Traube-Hering-Mayer waves) but their origins and nomenclature have caused considerable confusion since they were first discovered in the eighteenth century. However, although they remain poorly understood and the underlying details of their control are complicated, these waves do provide valuable clinical information on the state of blood pressure regulation in both normal and pathological conditions; and a correlation with oscillatory motions observed by certain practitioners suggests that they may also have some physiological value that relates to changes in the volume of fascial 'tubes'. Part I of this paper (Scarr, 2016) described a complex fascial network of collagen-reinforced tubular sheaths that are an integral part of muscle structure and function, and continuous with 'higher-level' fascial tubes surrounding groups of muscles, the limbs and entire body. The anisotropic arrangements of collagen fibres within the walls of these tubes reflect the most efficient distribution of mechanical stresses and have been considered to coordinate changes in shape, and a proposed link between cyclic variations in arterial pressure and volume, and the behaviour of these fascial compartments is now described.

The biomechanical model in manual therapy: Is there an ongoing crisis or just the need to revise the underlying concept and application?

Different approaches to body biomechanics are based on the classical concept of "ideal posture" which is regarded as the state where body mass is distributed in such a way that ligamentous tensions neutralize the force of gravity and muscles retain their normal tone, as result of the integration of somatic components related to posture and balance mechanisms. When compromised, optimal posture can be restored through the balanced and effective use of musculoskeletal components; however, various research findings and the opinion of experts in this field suggest a move away from the dogmas that have characterized the idea of health dependent on ideal posture, to promote instead dynamic approaches based on the interdependency of the body systems as well as on the full participation of the person in the healing process. Following these concepts, this article proposes a revised biomechanical model that sees posture as the temporary result of the individual's current ability to adapt to the existing allostatic load through the dynamic interaction of extero-proprio-interoceptive information integrated at a neuromyofascial level. Treatments using this revised model aim to restore the optimal posture available to the person in that particular given moment, through the efficient and balanced use of neuro-myofascia-skeletal components in order to normalize aberrant postural responses, to promote interoceptive and proprioceptive integration and to optimize individual responses to the existing allostatic load. The latter is achieved via multimodal programs of intervention, in a salutogenic approach that, from a traditional perspective, evolves on an anthropological basis, to the point of centering its work on the person.