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Gabriel A, Ridge ST, Birth M, Horstmann T, Pohl T, Konrad A. Local and non-local effects (on the posterior chain) of four weeks of foot exercises: a randomized controlled trial. Sci Rep 2024; 14:22000. [PMID: 39317709 PMCID: PMC11422494 DOI: 10.1038/s41598-024-71585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
This study investigated the local, remote, and contralateral effects of a four-week intrinsic foot muscle exercise intervention in recreationally active participants on foot parameters, flexibility, and performance of the posterior chain (PC). Twenty-eight healthy participants (12f, 16m) were randomly assigned to a control group or performed 2 × 6 min of foot exercises twice daily unilaterally at least five days/week for four weeks. At baseline (M1), after the intervention (M2), and after a four-week wash-out period (M3), we assessed bilateral Foot Posture Index-6, medial longitudinal arch mobility, single-leg stance balance, range of motion (ROM) (first metatarsophalangeal joint and ankle), and flexibility and performance of the PC. The FPI-6 score changes over time differed significantly between groups for both legs, improving by 26% in the trained- (p < .001) and 11% in the untrained leg (p = .02) in the intervention group from M1 to M2. Improvements were maintained at M3 for the trained leg (p = .02). Ankle range of motion and balance of the trained leg improved from M1 to M2, yet only became significant at M3 (ROM: p = .02; balance: p = .007). The other parameters did not change significantly. A four-week foot exercise intervention might have local but no remote effects in healthy young adults.German Clinical Trial Register (DRKS00027923) (24/08/2022).
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Affiliation(s)
- Anna Gabriel
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Sarah T Ridge
- Department of Rehabilitation Sciences, College of Education, Nursing and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Michael Birth
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Thomas Horstmann
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Torsten Pohl
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
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Kellis E, Kekelekis A, Drakonaki EE. Paraspinal Muscle Stiffness during Hamstring Exercise Using Shear-Wave Elastography. Sports (Basel) 2024; 12:199. [PMID: 39195575 PMCID: PMC11360625 DOI: 10.3390/sports12080199] [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: 06/22/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
Soccer teams integrate specific exercises into their typical workout programs for injury prevention. This study examined the effects of hamstring exercise on paraspinal and hamstring stiffness. These findings can inform training and rehabilitation programs to improve muscle health and prevent injuries. Fifteen young, healthy males performed passive and active (submaximal) knee flexion efforts from 0°, 45°, to 90° angle of knee flexion from the prone position. Using shear-wave elastography (SWE) and surface electromyography, we measured the elastic modulus and root mean square (RMS) signal of the erector spinae (ES), multifidus (MF), semitendinosus (ST), and semimembranosus (SM) during different knee flexion angles. Passive SWE modulus at 0° was 12.44 ± 4.45 kPa (ES), 13.35 ± 6.12 kPa (MF), 22.01 ± 4.68 kPa (ST), and 21.57 ± 5.22 kPa (SM) and it was greater (p < 0.05) compared to 45° and 90°. The corresponding values during knee flexion contractions at 0° increased to 18.99 ± 6.11 kPa (ES), 20.65 ± 11.31 kPa (MF), 71.21 ± 13.88 kPa (ST), and 70.20 ± 14.29 kPa (SM) and did not differ between angles (p > 0.05). Compared to rest, the relative increase in the SWE modulus during active contraction had a median value (interquartile range) ranging from 68.11 (86.29) to 101.69 (54.33)% for the paraspinal muscles and it was moderately to strongly correlated (r > 0.672) with the corresponding increase of the hamstring muscles [ranging from 225.94 (114.72) to 463.16 (185.16)%]. The RMS signal was greater during active compared to passive conditions, and it was lower at 90° compared to 45° (for SM/ST) and 0° (for all muscles). The association between paraspinal and hamstring passive muscle stiffness indicates a potential transmission of forces through myofascial connections between the lumbar spine and the lower limbs. In this laboratory setting, hamstring exercises affected the stiffness of the paraspinal muscles.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece;
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece;
| | - Eleni E. Drakonaki
- Department of Anatomy, Medical School, University of Crete, 71110 Heraklion Crete, Greece;
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Kellis E, Kekelekis A, Drakonaki EE. Is thoracolumbar fascia shear-wave modulus affected by active and passive knee flexion? J Anat 2024; 244:438-447. [PMID: 37965913 PMCID: PMC10862179 DOI: 10.1111/joa.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
The purpose of this study was to examine the effect of passive and active knee flexion efforts on the stiffness of the thoracolumbar (TLF), semitendinosus (STF), and semimembranosus fascia (SMF). Fourteen young healthy males participated in this study. Using ultrasound shear-wave elastography, fascia elastic modulus was measured at rest (passive condition) and during submaximal isometric knee flexion efforts (active condition) with the hip at neutral position and the knee flexed at 0°, 45°, and 90°. Analysis of variance designs indicated that when the knee was passively extended from 90° to 0°, shear modulus of the TLF, SMF, and STF increased significantly (p < 0.05). Similarly, active knee flexion contractions caused a significant increase in TLF, SMF, and STF shear modulus (p < 0.001). Compared to hamstring fascia, the TLF showed greater thickness but a lower shear modulus (p < 0.05) while STF modulus was greater compared that to SMF during active contraction (p < 0.05). These results indicate that exercising the hamstring muscles can remotely influence the stiffness of the fascia which surrounds the lumbar area.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at SerresAristotle University of ThessalonikiSerresGreece
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at SerresAristotle University of ThessalonikiSerresGreece
| | - Eleni E. Drakonaki
- Department of Anatomy, Medical SchoolUniversity of CreteHeraklionCreteGreece
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Lu Y, Chen J, Zhang XL. Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis. J Sport Rehabil 2023; 32:818-826. [PMID: 37527818 DOI: 10.1123/jsr.2022-0367] [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: 10/16/2022] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. METHODS Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. RESULTS Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P < .001), decreased ankle plantar flexion range (P = .023), ankle resting position more inclined to dorsiflexion (P = .017), increased ankle dorsiflexion stiffness (P = .005), and lower ankle plantar flexion stiffness (P = .034). After exercise intervention, the knee OA group self-reported less knee pain (P < .001), improved physical function (P < .001), increased maximum dorsiflexion (P = .021), and increased plantar flexion range (P < .001). While plantar flexion stiffness increased (P = .037), dorsiflexion stiffness decreased (P = .015) and ankle resting position moved toward dorsiflexion (P = .002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. CONCLUSIONS The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension.
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Affiliation(s)
- Yao Lu
- Qilu Institute of Technology, Qufu, SD,China
| | - Jie Chen
- Qingdao Hengxing University of Science and Technology, Qingdao, SD,China
- Auckland Bioengineering Institute, The University of Auckland, Auckland,New Zealand
| | - Xue-Lin Zhang
- Department of Physical Science, Qufu Normal University, Qufu, SD,China
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Kweon M, Kim J. Comparison of immediate effects of myofascial release and fascial distortion model on the range of motion, pain pressure threshold, and balance in healthy adults. J Bodyw Mov Ther 2023; 35:33-37. [PMID: 37330789 DOI: 10.1016/j.jbmt.2023.04.067] [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: 04/14/2021] [Revised: 03/15/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Many fascial therapies have been demonstrated to positively affect the range of motion, pain sensitivity, balance, daily functioning, and participation in social activities. Among these therapies, myofascial release has been extensively studied and widely used in clinical trials. The fascial distortion model was recently introduced, and it has received much attention due to its rapid onset of action and ease of application. OBJECTIVE This study aims to compare the effects of myofascial release and the fascial distortion model on range of motion, pain sensitivity, and balance, with the goal of helping therapists select the most appropriate treatment. METHODS Sixteen healthy adults were included in a prospective, randomized, single-blind study. The subjects were randomly assigned to either the myofascial release or fascial distortion model groups. The outcome measures were functional reach test, pain pressure threshold, straight leg-raising test angle, and finger floor distance. RESULTS The myofascial release and fascial distortion model groups showed significantly increased straight leg-raising angle and finger floor distance, but no between-group differences were observed (p > .05). The fascial distortion model group demonstrated significantly better pain control (p < .05), which was also better than in the myofascial release group (p < .05). The myofascial release group showed significantly improved balance control (p < .05); however, there was no difference between the two groups (p > .05). CONCLUSIONS Either myofascial release or fascial distortion model can be chosen to improve the range of motion. However, if pain sensitivity is the goal, it is expected that the fascial distortion model will be more effective.
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Affiliation(s)
- Migyoung Kweon
- Department of Physical Therapy, Daegu University, Republic of Korea
| | - JiYoung Kim
- Department of Physical Therapy, Masan University, Republic of Korea.
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Güneş M, Yana M. Acute effects of thoracolumbar fascia release techniques on range of motion, proprioception, and muscular endurance in healthy young adults. J Bodyw Mov Ther 2023; 35:145-150. [PMID: 37330761 DOI: 10.1016/j.jbmt.2023.04.063] [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: 09/26/2022] [Revised: 02/06/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE This study investigates the acute effects of Graston and myofascial release on thoracolumbar fascia (TLF) on lumbar range of motion (ROM), lumbar and cervical proprioception, and trunk muscle endurance in healthy young adults. METHOD Twenty-four healthy young individuals were included in the study. Individuals were randomly divided into two groups as Graston technique (GT) (n = 12) and myofascial release (MFR) (n = 12). GT group received a fascial treatment with a graston instrument and the MFR group (n = 12) received manual myofascial treatment. Both techniques were applied for 10 min and as a single session. Lumbar ROM (goniometer), lumbar proprioception (digital inclinometer), cervical proprioception (CROM device), and trunk muscle endurance (with McGill Endurance Test) were evaluated before and after treatment. RESULTS Age, gender and body mass index of individuals in both groups were similar (p > 0.05). In both GT and MFR groups, an increase in ROM in the flexion direction (p < 0.05) and a decrease in the angle of deviation in proprioception in the flexion direction were determined (p < 0.05). Neither technique had a significant effect on cervical proprioception and trunk muscle endurance (p > 0.05). In addition, no difference was found between the effectiveness of Graston and myofascial release (p > 0.05). CONCLUSION This study showed that Graston and myofascial release applied to TLF in healthy young adults effectively improve lumbar ROM and proprioception in the acute period. Considering these results, both Graston and myofascial release can be used to provide elasticity of TLF and improve proprioceptive return.
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Affiliation(s)
- Musa Güneş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey.
| | - Metehan Yana
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karabuk University, Karabuk, Turkey.
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ERSİN A, KAYA M. Effect of thoracic mobilization exercises on hamstring flexibility: a randomized controlled trial. Turk J Med Sci 2023; 53:1293-1300. [PMID: 38813012 PMCID: PMC10763815 DOI: 10.55730/1300-0144.5695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/26/2023] [Accepted: 06/12/2023] [Indexed: 05/31/2024] Open
Abstract
Background and aim The aim was to investigate the effect of thoracic mobilization exercises on hamstring flexibility. Materials and methods One hundred twenty individuals with hamstring tightness were included in the study. The participants were randomized into two groups: the experimental group (EG) (n = 60) or the control group (CG) (n = 60). The EG performed a home-based thoracic mobilization exercise program comprising 2 sets with 10 repetitions, once a day, 3 days a week, for 4 weeks. The CG performed active-assisted stretching of the hamstring comprising 3 sets with 10 repetitions for 15 seconds. The active knee extension (AKE) test was used to measure hamstring flexibility, and self-reported hamstring pain intensity was evaluated with a visual analog scale (VAS). All evaluations were conducted at the beginning and end of the intervention. Results Both groups showed significant improvement in AKE (p<0.05). Pain intensity during the stretching exercises was significantly decreased only in the EG. The improvements in AKE and VAS score were greater in the EG than in the CG (p < 0.05). Between-group effect sizes were large for AKE (d = 1.075) and VAS score (d = 1.077). Conclusion The current study showed that thoracic mobilization exercises may increase hamstring flexibility and reduce pain intensity during hamstring stretch exercises.
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Affiliation(s)
- Aybüke ERSİN
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Atlas University, İstanbul,
Turkiye
| | - Meltem KAYA
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Atlas University, İstanbul,
Turkiye
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Ruiz JJB, Perez-Cruzado D, Llanes RP. Immediate effects of lumbar fascia stretching on hamstring flexibility: A randomized clinical trial. J Back Musculoskelet Rehabil 2023; 36:619-627. [PMID: 36872764 DOI: 10.3233/bmr-210274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The hamstring muscles have a great tendency to decrease their extensibility, a phenomenon that presents a distinct clinical entity called short hamstring syndrome (SHS), in addition to problems with adjacent structures. OBJECTIVE The objective of this study was to evaluate the immediate effect of lumbar fascia stretching on the flexibility of the hamstring musculature. METHODS A randomized controlled trial was carried out. Forty-one women between 18 and 39 years old were divided into two groups: the experimental group received a technique of fascial stretching in the lumbar area while the control group participated in a magnetotherapy machine that was turned off. Hamstring flexibility in both lower limbs was measured by the straight leg raising test (SLR) and the passive knee extension test (PKE). RESULTS The results showed statistically significant improvements (p< 0.05) in the SLR and the PKE for both groups. There was a large effect size (Cohen's d) for both tests. There was a statistically significant correlation between the International Physical Activity Questionnaire (IPAQ) and the SLR. CONCLUSION The inclusion of lumbar fascia stretching might be an effective part of a treatment protocol to increase the flexibility of the hamstring muscle observing an immediate result in healthy participants.
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Affiliation(s)
- Juan Javier Bru Ruiz
- Department of Physiotherapy, San Antonio Catholic University of Murcia, Murcia, Spain
| | - David Perez-Cruzado
- Department of Occupational Therapy, San Antonio Catholic University of Murcia, Murcia, Spain
| | - Raúl Pérez Llanes
- Department of Physiotherapy, San Antonio Catholic University of Murcia, Murcia, Spain
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Russo L, Montagnani E, Pietrantuono D, D’Angona F, Fratini T, Di Giminiani R, Palermi S, Ceccarini F, Migliaccio GM, Lupu E, Padulo J. Self-Myofascial Release of the Foot Plantar Surface: The Effects of a Single Exercise Session on the Posterior Muscular Chain Flexibility after One Hour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:974. [PMID: 36673731 PMCID: PMC9858880 DOI: 10.3390/ijerph20020974] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 05/31/2023]
Abstract
This study evaluated the effects of a single exercise session of Self-Myofascial Release (SMR) on the posterior muscular chain flexibility after one hour from the intervention. Thirty-six participants performed SMR using a rigid ball under the surface of both feet. Participants were tested with the Sit and Reach (S&R) test at four different times: before (T0), immediately after (T1), 30 (T2), and 60 (T3) minutes after the SMR intervention. The sample (n = 36) was categorized into three groups: (1) flexible, (2) average, and (3) stiff, based on the flexibility level at T0 (S&R values of >10 cm, >0 but <10 cm and <0 cm, respectively). For the whole sample, we detected significant improvements in the S&R test between the T1, T2, and T3 compared to T0. The stiff group showed a significant (p < 0.05) improvement between T1−T2 and T1−T3. Results were similar between the average group and the whole sample. The flexible group did not show any significant difference (p > 0.05) over time. In conclusion, this investigation demonstrated that an SMR session of both feet was able to increase posterior muscular chain flexibility up to one hour after intervention. Considering that a standard training session generally lasts one hour, our study can help professionals take advantage of SMR effects for the entire training period. Furthermore, our results also demonstrate that physical exercise practitioners should also assess individuals’ flexibility before training, as the SMR procedure used in this work does not seem necessary in flexible individuals.
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Affiliation(s)
- Luca Russo
- Department of Human Sciences, Università Telematica degli Studi IUL, 50122 Florence, Italy
| | - Eleonora Montagnani
- Department of Sports and Health Sciences, University of Brighton, Brighton BN2 4AT, UK
| | - Davide Pietrantuono
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Fabiola D’Angona
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Tommaso Fratini
- Department of Human Sciences, Università Telematica degli Studi IUL, 50122 Florence, Italy
| | - Riccardo Di Giminiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80132 Naples, Italy
| | - Francesco Ceccarini
- Department of Psychology, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates
| | | | - Elena Lupu
- Department of Motor Activities, Petroleum Gas University Ploiesti, 100600 Ploiesti, Romania
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
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The Effects of a Self-Myofascial Release Program on Isokinetic Hamstrings-to-Quadriceps Strength Ratio and Range of Motion of the Knee Joint Among Athletes With Hamstring Shortness. J Sport Rehabil 2022; 31:391-397. [PMID: 35078150 DOI: 10.1123/jsr.2020-0487] [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: 11/19/2020] [Revised: 10/28/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Range of motion (ROM) and muscular strength are the main factors that affect athletic performance. Self-myofascial release is a flexibility technique, which is used to inhibit overactive muscle fibers. OBJECTIVE To investigate the effects of the 8-week self-myofascial release on the isokinetic hamstrings-to-quadriceps strength ratio (H/QRatio) and the ROM of the knee joint among male athletes with the hamstring shortness. DESIGN A randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Twenty-four college-aged male athletes with hamstring shortness were selected for this study and were randomly assigned to a foam rolling group (FOAM, n = 12) and a control group (n = 12). INTERVENTIONS Participants in the FOAM group performed supervised self-myofascial release program 3 times per week for 8 weeks. The control group received no intervention. METHODS Data were analyzed via 2-way repeated-measure analysis of variance at the significance level of .05. MAIN OUTCOME MEASURES ROM and the H/QRatio at the velocities of 60°/s, 120°/s, and 180°/s were measured by an isokinetic dynamometer. RESULTS The results of 2-way repeated-measure analysis of variance demonstrated that hamstring ROM increased in FOAM group (P = .001). No significant changes were found in H/QRatio after self-myofascial release for FOAM group (P ≥ .05). CONCLUSIONS When compared with other methods of stretching, self-myofascial release with foam rolling may be beneficial in increasing ROM without decreasing H/QRatio in people with the hamstring shortness.
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Fauris P, López-de-Celis C, Canet-Vintró M, Martin JC, Llurda-Almuzara L, Rodríguez-Sanz J, Labata-Lezaun N, Simon M, Pérez-Bellmunt A. Does Self-Myofascial Release Cause a Remote Hamstring Stretching Effect Based on Myofascial Chains? A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12356. [PMID: 34886078 PMCID: PMC8656845 DOI: 10.3390/ijerph182312356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hamstring muscles are described as forming part of myofascial chains or meridians, and the superficial back line (SBL) is one such chain. Good hamstring flexibility is fundamental to sporting performance and is associated with prevention of injuries of these muscles. The aim of this study was to measure the effect of self-myofascial release (SMR) on hamstring flexibility and determine which segment of the SBL resulted in the greatest increase in flexibility. METHODS 94 volunteers were randomly assigned to a control group or to one of the five intervention groups. In the intervention groups, SMR was applied to one of the five segments of the SBL (plantar fascia, posterior part of the sural fascia, posterior part of the crural fascia, lumbar fascia or epicranial aponeurosis) for 10 min. The analyzed variables were hamstring flexibility at 30 s, 2, 5, and 10 min, and dorsiflexion range of motion before and after the intervention. RESULTS Hamstring flexibility and ankle dorsiflexion improved when SMR was performed on any of the SBL segments. The segments with the greatest effect were the posterior part of the sural fascia when the intervention was brief (30 s to 2 min) or the posterior part of the crural fascia when the intervention was longer (5 or 10 min). In general, 50% of the flexibility gain was obtained during the first 2 min of SMR. CONCLUSIONS The SBL may be considered a functional structure, and SMR to any of the segments can improve hamstring flexibility and ankle dorsiflexion.
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Affiliation(s)
- Paul Fauris
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
- Institut Universitari per a la Recerca a I’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Max Canet-Vintró
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Juan Carlos Martin
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
| | - Luis Llurda-Almuzara
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Noé Labata-Lezaun
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Mathias Simon
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Sant Cugat del Vallès, Spain; (P.F.); (C.L.-d.-C.); (M.C.-V.); (J.C.M.); (L.L.-A.); (J.R.-S.); (N.L.-L.); (M.S.)
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
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Dhiman NR, Das B, Mohanty C, Singh OP, Gyanpuri V, Raj D. Myofascial release versus other soft tissue release techniques along superficial back line structures for improving flexibility in asymptomatic adults: A systematic review with meta-analysis. J Bodyw Mov Ther 2021; 28:450-457. [PMID: 34776177 DOI: 10.1016/j.jbmt.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 05/18/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our review is aimed to find out the efficacy of Myofascial Release Technique (MFRT) based on the Randomised Controlled Trials, on flexibility when given along superficial back line (SBL) structures and to compare it with other soft tissue release techniques. DATA SOURCES A systematic literature search on MEDLINE (Pubmed), Google Scholar, Science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Clinical Trial Database in English; up to April 2020 was undertaken. STUDY SELECTION PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) was used for screening the relevant citations and reviewing the relevant studies. The literature searched total of 6,938 articles, however, only 68 were screened for eligibility. In the further screening, 16 studies fulfilled the inclusion criteria for our systematic review. DATA EXTRACTION Data were extracted into a table containing sample size, mean age of subjects, types of intervention, area to be treated, outcome measures used, and results of the accepted studies. DATA SYNTHESIS 16 randomized controlled trials and cross-over trials were found to be eligible for our review. Quality assessment of the RCTs was done with the PEDro scoring method. Randomised clinical trials that studied the comparative effect of Myofascial Release (MFRT) technique with different MFRT techniques, control/sham, and other soft tissue release techniques like stretching, were included. Results of this analysis showed little evidence proving the additional effectiveness of MFRT treatment compared to other soft tissue release techniques for improving flexibility so as to consider it as the preferred treatment. Methodological aspects of selected studies for further research are suggested. Study was registered in the PROSPERO database (CRD42020179118). CONCLUSION MFRT appears to be a good technique for improving flexibility. However, in comparison with other soft tissue release techniques, this therapy becomes less successful. More research is needed regarding its effectiveness.
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Affiliation(s)
- Neetu Rani Dhiman
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
| | - Bismay Das
- Heritage Institute of Medical Sciences, Varanasi, UP, India.
| | - C Mohanty
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
| | - O P Singh
- Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi UP, India.
| | - Vyom Gyanpuri
- Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
| | - Dharma Raj
- Department of Biostatistics and Bioinformatics, ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, Madhya Pradesh, India.
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de Souza Bezerra E, Lunardi M, Sakugawa RL, Diefenthaeler F. Acute effects of myofascial release with portable electric massager at different frequencies: A randomized pilot study. J Bodyw Mov Ther 2021; 28:225-230. [PMID: 34776145 DOI: 10.1016/j.jbmt.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/01/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The present study aimed to analyze the acute effects of a myofascial release session (MFR) with a portable electric massager (PEM) at different frequencies (25 Hz and 52 Hz) on the superficial and deep fascial motion. METHODS The limbs of fourteen participants (12 men and 2 women, age = 34 ± 10 years; height = 1.74 ± 0.09 m; weight = 72.77 ± 13.1 kg; right thigh fat thickness = 4.18 ± 3.49 mm; left thigh fat thickness = 4.13 ± 3.35 mm) were randomized to one of the two PEM frequencies (25 Hz vs. 52 Hz). All evaluations were carried out at the same time of day and by the same evaluator (blind). The protocol consisted of 9 min of MFR on the vastus lateralis, alternating between three sites of 5 cm. Before and after the MFR session, the fascial motion was measured in the vastus lateralis (superficial and deep layer) using B-mode ultrasound at two knee positions (0° and 45°). RESULTS The superficial and deep layers presented significant increases in fascia length after myofascial release with the knee extended 0° (p < 0.001) and flexed 45° (p < 0.001). In addition, the fascial motion was not influenced by the frequency applied during the experimental protocol and was independent of layer and knee position. However, the deep layer showed an increase at knee flexed at 45° compared to the superficial layer. On the other hand, there was no difference between layers when the knee was extended (0°). The findings of this study indicate that PEM appears to be effective in changing the fascial motion of the vastus lateralis.
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Affiliation(s)
- Ewertton de Souza Bezerra
- Human Performance Laboratory, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil; Programa de Pós Graduação Stricto Sensu em Ciências da Saúde, Faculdade de Medicina, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil; Programa de Pós Graduação Stricto Sensu em Ciências do Movimento Humano, Faculdade de Educação Física e Fisioterapia, Universidade Federal do Amazonas, Faculdade de Educação Física e Fisioterapia, Manaus, AM, Brazil
| | - Morgana Lunardi
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Raphael Luiz Sakugawa
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Fernando Diefenthaeler
- Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Effects of myofascial release on flexibility and electromyographic activity of the lumbar erector spinae muscles in healthy individuals. J Bodyw Mov Ther 2021; 27:322-327. [PMID: 34391252 DOI: 10.1016/j.jbmt.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/26/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effects of myofascial release on the flexibility and electromyographic activity of the lumbar erector spinae muscle in healthy individuals. METHODS Ten healthy subjects were recruited to an intervention protocol of myofascial release techniques: (1) superficial myofascial release; (2) deep myofascial release apply along 10 sessions, twice a week, with 40 min per sessions. The outcomes evaluated were flexibility (Toe-Touch Test) and electromyography activity (EMG) of the lumbar erector spinae muscle (Iliocostalis and Longissimus bilaterally) during the movement of extension-flexion of the trunk. Paired t-test was used to compare the electromyographic outcomes, while the Wilcoxon test was used to compare the flexibility outcomes. RESULTS The myofascial release techniques increased the flexibility (p = 0.005; r = 0.88) and have no influence over the electromyographic activity of the right iliocostalis (p = 0.179; r = 0.43), right longissimus (p = 0.877; r = 0.05), left iliocostalis (p = 0.386; r = 0.29) and left longissimus (p = 0.418; r = 0.27). CONCLUSIONS The application of myofascial release techniques increase flexibility and did not influence over the electromyographic activity of the lumbar erector spinae muscles in healthy individuals. Further studies should include a larger sample with a sham group and/or compare EMG activity of the lumbar erector spinae muscles with patients with low back pain during the movement of extension-flexion of the trunk.
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Kang HS, Kwon HW, Kim DG, Park KR, Hahm SC, Park JH. Effects of the Suboccipital Muscle Inhibition Technique on the Range of Motion of the Ankle Joint and Balance According to Its Application Duration: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9060646. [PMID: 34072454 PMCID: PMC8227022 DOI: 10.3390/healthcare9060646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effects of suboccipital muscle inhibition technique (SMIT) on active range of motion (AROM) of the ankle joint, lunge angle (LA), and balance in healthy adults, according to the duration of its application. A total of 80 participants were randomly allocated to the 4-min suboccipital muscle inhibition (SMI) group (SMI_4M, n = 20), 8-min SMI group (n = 20), 4-min sham-SMI (SSMI) group (n = 20), and 8-min SSMI group (n = 20). Accordingly, the SMIT and sham SMIT were applied for 4 min or 8 min in the respective groups. AROM of dorsiflexion and LA were assessed, and a single leg balance test (SLBT) was performed before and after the intervention. AROM (4 min, p < 0.001; 8 min, p < 0.001), LA (4 min, p < 0.001; 8 min, p < 0.001), and SLBT (4 min, p < 0.001; 8 min, p < 0.001) significantly improved after SMI application. Compared with the SSMI group, the SMI group showed a significant increase in AROM (p < 0.001), LA (p < 0.001), and SLBT (p < 0.001). Except for SLBT (p = 0.016), there were no significant interactions between intervention and application duration. The results suggest that the SMIT, at durations of both 4 and 8 min, could be effective tools for improving AROM, LA, and balance.
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Affiliation(s)
- Han-Sol Kang
- Graduate School of Integrative Medicine, CHA University, Seongnam 13488, Korea;
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (H.-W.K.); (D.-g.K.); (K.-R.P.)
| | - Hyung-Wook Kwon
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (H.-W.K.); (D.-g.K.); (K.-R.P.)
| | - Di-gud Kim
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (H.-W.K.); (D.-g.K.); (K.-R.P.)
| | - Kwang-Rak Park
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (H.-W.K.); (D.-g.K.); (K.-R.P.)
| | - Suk-Chan Hahm
- Graduate School of Integrative Medicine, CHA University, Seongnam 13488, Korea;
- Correspondence: (S.-C.H.); (J.-H.P.); Tel.: +82-31-881-7101 (S.-C.H.); +82-33-250-8814 (J.-H.P.); Fax: +82-31-881-7069 (S.-C.H.); ++82-33-259-5635 (J.-H.P.)
| | - Jeong-Hyun Park
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (H.-W.K.); (D.-g.K.); (K.-R.P.)
- Correspondence: (S.-C.H.); (J.-H.P.); Tel.: +82-31-881-7101 (S.-C.H.); +82-33-250-8814 (J.-H.P.); Fax: +82-31-881-7069 (S.-C.H.); ++82-33-259-5635 (J.-H.P.)
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Kerautret Y, Di Rienzo F, Eyssautier C, Guillot A. Selective Effects of Manual Massage and Foam Rolling on Perceived Recovery and Performance: Current Knowledge and Future Directions Toward Robotic Massages. Front Physiol 2020; 11:598898. [PMID: 33408640 PMCID: PMC7779631 DOI: 10.3389/fphys.2020.598898] [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: 08/28/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Manual massage and foam rolling are commonly used by athletes for warm-up and recovery, as well as by healthy individuals for well-being. Manual massage is an ancient practice requiring the intervention of an experienced physiotherapist, while foam rolling is a more recent self-administered technique. These two topics have been largely studied in isolation from each other. In the present review, we first provide a deep quantitative literature analysis to gather the beneficial effects of each technique through an integrative account, as well as their psychometric and neurophysiological evaluations. We then conceptually consider the motor control strategies induced by each type of massage. During manual massage, the person remains passive, lying on the massage table, and receives unanticipated manual pressure by the physiotherapist, hence resulting in a retroactive mode of action control with an ongoing central integration of proprioceptive feedback. In contrast, while performing foam rolling, the person directly exerts pressures through voluntary actions to manipulate the massaging tool, therefore through a predominant proactive mode of action control, where operations of forward and inverse modeling do not require sensory feedback. While these opposite modes of action do not seem to offer any compromise, we then discuss whether technological advances and collaborative robots might reconcile proactive and retroactive modes of action control during a massage, and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human-machine interactions.
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Affiliation(s)
- Yann Kerautret
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne Cedex, France
- Capsix Robotics, Lyon, France
| | - Franck Di Rienzo
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne Cedex, France
| | | | - Aymeric Guillot
- Univ Lyon, Université Claude Bernard Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité EA 7424, Villeurbanne Cedex, France
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Martínez-Lema D, Guede-Rojas F, González-Fernández K, Soto-Martínez A, Lagos-Hausheer L, Vergara-Ríos C, Márquez-Mayorga H, Mancilla CS. Immediate effects of a direct myofascial release technique on hip and cervical flexibility in inactive females with hamstring shortening: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:57-63. [PMID: 33992297 DOI: 10.1016/j.jbmt.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Currently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility. OBJECTIVE Our goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening. METHOD The sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group. RESULTS The mixed factorial ANOVA did not show significant intergroup differences (p > 0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p < 0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p < 0.001). CONCLUSIONS We conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.
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Affiliation(s)
- Daniel Martínez-Lema
- Kinesiology, Faculty of Health Sciences, GICAV, Universidad Arturo Prat, Victoria, Chile.
| | - Francisco Guede-Rojas
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | | | - Adolfo Soto-Martínez
- Kinesiology, Faculty of Health Sciences, Universidad de Las Américas, Concepción, Chile.
| | | | - César Vergara-Ríos
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | - Héctor Márquez-Mayorga
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | - Carlos S Mancilla
- Kinesiology, Faculty of Health Sciences, GICAV, Universidad Arturo Prat, Victoria, Chile.
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Ajimsha MS, Shenoy PD, Gampawar N. Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review. J Bodyw Mov Ther 2020; 24:423-431. [PMID: 33218543 DOI: 10.1016/j.jbmt.2020.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/19/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. METHODS A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring). RESULTS Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. CONCLUSION Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Pramod D Shenoy
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Neeraj Gampawar
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
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Abstract
Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
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Wilke J, Debelle H, Tenberg S, Dilley A, Maganaris C. Ankle Motion Is Associated With Soft Tissue Displacement in the Dorsal Thigh: An in vivo Investigation Suggesting Myofascial Force Transmission Across the Knee Joint. Front Physiol 2020; 11:180. [PMID: 32210836 PMCID: PMC7069338 DOI: 10.3389/fphys.2020.00180] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/17/2020] [Indexed: 12/23/2022] Open
Abstract
Experiments in cadavers have demonstrated significant mechanical interactions between constituents of myofascial chains. However, evidence for such force transmission effects is scarce under in vivo conditions. The purpose of this trial was to examine the impact of ankle motion on soft tissue displacement of the dorsal thigh. Eleven healthy active individuals (26.8 ± 4.3 years, six males), in prone position and with the knee extended, underwent passive calf stretches (ankle dorsal extension) imposed by an isokinetic dynamometer. High-resolution ultrasound was used to simultaneously capture the displacement of the semimembranosus muscle, which was quantified by means of cross-correlation analysis. Inactivity of the leg muscles was controlled using surface electromyography (EMG). One participant had to be excluded due to major EMG activity during the experiment. According to a one-sample t test testing the difference to the neutral zero position, ankle dorsal extension induced substantial caudal muscle displacements (5.76 ± 2.67 mm, p < 0.0001). Correlation analysis (Spearman), furthermore, revealed a strong association between maximal dorsal extension and semimembranosus motion (rho = 0.76, p = 0.02). In conclusion, the present trial provides initial in vivo evidence for a mechanical force transmission between serially connected skeletal muscles. This means that local alterations of the mechanical tissue properties may modify flexibility in neighboring (superior or inferior) joints.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Heloise Debelle
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sarah Tenberg
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrew Dilley
- Department of Neuroscience, University of Sussex, Brighton, United Kingdom
| | - Constantinos Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis. J Sport Rehabil 2019; 29:650-656. [PMID: 31629335 DOI: 10.1123/jsr.2019-0074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). OBJECTIVE To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. EVIDENCE ACQUISITION In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. EVIDENCE SYNTHESIS Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22-36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; -0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. CONCLUSIONS Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.
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Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Sports Med 2019; 49:1173-1181. [DOI: 10.1007/s40279-019-01149-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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