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Li Y, Zhang B, Xu J, Jiang X, Jing L, Tian Y, Wang K, Zhang J. Inhibiting the JNK Signaling Pathway Attenuates Hypersensitivity and Anxiety-Like Behavior in a Rat Model of Non-specific Chronic Low Back Pain. J Mol Neurosci 2024; 74:73. [PMID: 39046556 DOI: 10.1007/s12031-024-02252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
Low back pain (LBP) has become a leading cause of disability worldwide. Astrocyte activation in the spinal cord plays an important role in the maintenance of latent sensitization of dorsal horn neurons in LBP. However, the role of spinal c-Jun N-terminal kinase (JNK) in astrocytes in modulating pain behavior of LBP model rats and its neurobiological mechanism have not been elucidated. Here, we investigate the role of the JNK signaling pathway on hypersensitivity and anxiety-like behavior caused by repetitive nerve growth factor (NGF) injections in male non-specific LBP model rats. LBP was produced by two injections (day 0, day 5) of NGF into multifidus muscle of the low backs of rats. We observed prolonged mechanical and thermal hypersensitivity in the low backs or hindpaws. Persistent anxiety-like behavior was observed, together with astrocyte, p-JNK, and neuronal activation and upregulated expression of monocyte chemoattractant protein-1 (MCP-1), and chemokine (C-X-C motif) ligand 1 (CXCL1) proteins in the spinal L2 segment. Second, the JNK inhibitor SP600125 was intrathecally administrated in rats from day 10 to day 12. It attenuated mechanical and thermal hypersensitivity of the low back or hindpaws and anxiety-like behavior. Meanwhile, SP600125 decreased astrocyte and neuronal activation and the expression of MCP-1 and CXCL1 proteins. These results showed that hypersensitivity and anxiety-like behavior induced by NGF in LBP rats could be attenuated by the JNK inhibitor, together with downregulation of spinal astrocyte activation, neuron activation, and inflammatory cytokines. Our results indicate that intervening with the spinal JNK signaling pathway presents an effective therapeutic approach to alleviating LBP.
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Affiliation(s)
- Yifan Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China
| | - Bingyu Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China
| | - Jie Xu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China
| | - Xiao Jiang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, China
| | - Liang Jing
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China
- The Second Affiliated Hospital of Anhui Medical University, Hefei, 230000, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230000, China
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Hefei, 230000, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, 230000, China
| | - Juanjuan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230000, Anhui Province, China.
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Yang S, Tang J, Yang Z, Jin H, Wang Q, Wang H. Effect of thoracolumbar fascia injury on reported outcomes after percutaneous vertebroplasty. Front Surg 2024; 11:1379769. [PMID: 38817944 PMCID: PMC11137208 DOI: 10.3389/fsurg.2024.1379769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Thoracolumbar fascia injury is often associated with poor early pain relief after percutaneous vertebroplasty (PVP). This study will evaluate the effects of thoracolumbar fascia injury on early pain relief and time to get out of bed after PVP. Methods A total of 132 patients treated with PVP for osteoporotic vertebral compression fractures (OVCF) were included and divided into injured group (52 cases) and non-injured group (80 cases) according to the existence of thoracolumbar fascia injury. Before surgery, 1 day, 3 days, 1 week, 1 month, and 3 months after surgery, and at the last follow-up, the primary patient-reported outcome measures (PROMs) were the visual analogue scale (VAS) of pain while rolling over and standing, and the secondary PROMs was the Oswestry disability index (ODI). Meanwhile, the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) of the above measures in both groups was evaluated at the last follow-up. Results Except for the postoperative 3 months and the last follow-up, there were statistically significant differences in VAS-standing and ODI between the two groups at other time points after surgery (P < 0.05), and the non-injured group was significantly better than the injured group. At the last follow-up, there was no statistically significant difference in the MCID and PASS achievement rates of the above measures between the two groups (P > 0.05). In addition, the proportion of patients who got out of bed 1 and 3 days after surgery in the non-injury group was significantly higher than that in the injury group (P = 0.000 for both). Conclusion Thoracolumbar fascia injury significantly affected early pain relief and extended time of getting out of bed after PVP. Attention should be paid to preoperative evaluation of thoracolumbar fascial injury in order to better predict the postoperative efficacy of PVP.
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Affiliation(s)
| | | | | | | | | | - Huiming Wang
- Department of Orthopedics, Beijing Geriatric Hospital, Beijing, China
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Harper BA, Steinbeck L. Short-Term Benefits from Manual Therapy as an Adjunct Treatment for Persistent Postural-Perceptual Dizziness Symptoms: A Preliminary Prospective Case Series. J Funct Morphol Kinesiol 2024; 9:82. [PMID: 38804448 PMCID: PMC11130853 DOI: 10.3390/jfmk9020082] [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] [Received: 03/22/2024] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation® method (FM®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients with persistent complaints of dizziness who received systematic application of manual therapy to improve fascial mobility after previously receiving vestibular rehabilitation. The manual therapy consisted of strategic assessment and palpation based on the model proposed in the FM® Stecco Method. This model utilizes tangential oscillations directed toward the deep fascia at strategic points. Six males (n = 6) and females (n = 6) were included with a mean age of 68.3 ± 19.3 years. The average number of interventions was 4.5 ± 0.5. Nonparametric paired sample t-tests were performed. Significant improvements were observed toward the resolution of symptoms and improved outcomes. The metrics included the Dizziness Handicap Inventory and static and dynamic balance measures. The Dizziness Handicap Inventory scores decreased (i.e., improved) by 43.6 points (z = -3.1 and p = 0.002). The timed up and go scores decreased (i.e., improved) by 3.2 s (z = -2.8 and p = 0.005). The tandem left increased (i.e., improved) by 8.7 s (z = 2.8 and p = 0.005) and the tandem right increased (i.e., improved) by 7.5 s (z = 2.8 and p = 0.005). Four to five manual therapy treatment sessions appear to be effective for short-term improvements in dizziness complaints and balance in those with 3PD. These results should be interpreted with caution as future research using rigorous methods and a control group must be conducted.
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Affiliation(s)
- Brent A. Harper
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA
- Department of Physical Therapy, Radford University, Roanoke, VA 24013, USA
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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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Warneke K, Rabitsch T, Dobert P, Wilke J. The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study. Eur J Appl Physiol 2024:10.1007/s00421-024-05495-2. [PMID: 38689040 DOI: 10.1007/s00421-024-05495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
AIM Previous stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM). METHODS Forty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer. RESULTS STAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11-0.41). While both conditions showed significant increases in the KtW (d = 0.43-0.46, p = 0.02-0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = - 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13-0.40). CONCLUSION Our study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.
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Affiliation(s)
- Konstantin Warneke
- Institute of Human Movement Science, Sport and Health, University of Graz, 8020, Graz, Austria.
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria.
| | - Thomas Rabitsch
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
| | - Patrik Dobert
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
| | - Jan Wilke
- Institute of Sport Science, Alpen-Adria University Klagenfurt, 9020, Klagenfurt am Wörthersee, Austria
- Department of Neuromotorics and Movement, University of Bayreuth, 95447, Bayreuth, Germany
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6
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Liu Y, Wang Y. Study on the effect of blood flow restriction training combined with IASTAM on ankle strength and function intervention in athletes with chronic ankle instability in sport dance events. BMC Sports Sci Med Rehabil 2024; 16:81. [PMID: 38605396 PMCID: PMC11007892 DOI: 10.1186/s13102-024-00873-x] [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: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Athletes engaged in sports dance frequently encounter the potential for ankle injuries and instability, factors that may contribute to diminished training efficacy, compromised athletic performance, prolonged recuperation, and heightened susceptibility to recurring injuries. OBJECTIVE The objective of this study was to investigate the impact of an exercise intervention (comprising blood flow restriction training combined with low-load ankle muscle strength training and balance training) as well as instrument-assisted soft tissue mobilization (IASTM) on the foot and ankle function, strength, and range of motion in sports dance athletes exhibiting ankle instability (CAI). METHODS Thirty participants exhibiting ankle instability, restriction, or discomfort were recruited and randomly assigned to two groups: the Test group (comprising blood flow restriction training combined with IASTM, n = 15) and the traditional ankle strength training group (n = 15). The intervention spanned 4 weeks, with one session per week. Assessment of the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), and ankle range of motion occurred at three time points: pre-intervention, immediately following the initial intervention, and after 4 weeks of intervention. Ankle strength testing was conducted solely before and after the intervention for comparative analysis. RESULTS There were no significant variances in baseline characteristics between the two intervention groups. In terms of CAIT scores, both groups exhibited notably higher scores following the initial intervention and after 4 weeks of intervention compared to pre-intervention (P < 0.05). The Test group displayed higher CAIT scores than the control group, signifying a more pronounced enhancement in ankle stability among patients in the Test group. Concerning FAAM scores, both groups significantly enhanced ankle function in CAI patients (P < 0.05), with the Test group demonstrating notably higher FAAM-SPORT scores than the control group (P < 0.05), indicating superior restoration of athletic capability in the Test group. As for improvements in ankle range of motion, both groups demonstrated significant enhancements compared to pre-intervention (P < 0.05). The Test group exhibited significantly superior improvements in dorsiflexion, eversion, and inversion range of motion compared to the control group (P < 0.05), while the control group did not exhibit significant enhancements in plantarflexion and eversion range of motion (P > 0.05). Both groups displayed enhanced ankle strength in CAI patients following the intervention (P < 0.05), with the Test group manifesting notably higher dorsiflexion and inversion strength than the control group (P < 0.05). CONCLUSION Both blood flow restriction training combined with IASTM and traditional ankle strength and stability training have shown significant improvements in stability, function, strength, and range of motion in CAI patients. Furthermore, the Test group exhibits superior efficacy in ankle stability, daily functional movement, dorsiflexion, and eversion range of motion compared to the control group. CLINICAL TRIAL REGISTRATION 9 February 2024, ClinicalTrials.gov, ID; NCT06251414.
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Affiliation(s)
- Yang Liu
- Graduate School, School of Arts, Wuhan Sports University, 430079, Wuhan, China
| | - Ying Wang
- Graduate School, School of Arts, Wuhan Sports University, 430079, Wuhan, China.
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Nijs J, Kosek E, Chiarotto A, Cook C, Danneels LA, Fernández-de-Las-Peñas C, Hodges PW, Koes B, Louw A, Ostelo R, Scholten-Peeters GGM, Sterling M, Alkassabi O, Alsobayel H, Beales D, Bilika P, Clark JR, De Baets L, Demoulin C, de Zoete RMJ, Elma Ö, Gutke A, Hanafi R, Hotz Boendermaker S, Huysmans E, Kapreli E, Lundberg M, Malfliet A, Meziat Filho N, Reis FJJ, Voogt L, Zimney K, Smeets R, Morlion B, de Vlam K, George SZ. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. THE LANCET. RHEUMATOLOGY 2024; 6:e178-e188. [PMID: 38310923 DOI: 10.1016/s2665-9913(23)00324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/20/2023] [Accepted: 12/06/2023] [Indexed: 02/06/2024]
Abstract
The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alessandro Chiarotto
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Lieven A Danneels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Bart Koes
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands; Research Unit of General Practice, Department of Public Health and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Adriaan Louw
- Department of Pain Science, Evidence in Motion, Story City, IA, USA
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
| | - Michele Sterling
- RECOVER Injury Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Othman Alkassabi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physiotrio, Riyadh, Saudi Arabia; Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hana Alsobayel
- Research Chair for Healthcare Innovation, College of Applied Medical Sciences, Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Darren Beales
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Paraskevi Bilika
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Jacqui R Clark
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Pains and Brains specialist pain physiotherapy clinic, Tauranga, New Zealand
| | - Liesbet De Baets
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liège, Belgium
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Ömer Elma
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Annelie Gutke
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rikard Hanafi
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Sabina Hotz Boendermaker
- University of Applied Sciences ZHAW, School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland
| | - Eva Huysmans
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Greece
| | - Mari Lundberg
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation-Flanders, Brussels, Belgium
| | - Ney Meziat Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta-UNISUAM, Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; Physical Therapy Department of Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lennard Voogt
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium; University of Applied Sciences, Rotterdam, Netherlands
| | - Kory Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | - Rob Smeets
- Maastricht University, Maastricht, Netherlands; Clinics in Rehabilitation, Eindhoven, Netherlands
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, Unit Anaesthesiology and Algology, KU Leuven, Belgium
| | - Kurt de Vlam
- Division of Rheumatology, University Hospitals Leuven, Belgium; Skeletal Biology and Engineering Research Center, Dept of Development and Regeneration, KU Leuven, Belgium
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA
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8
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Brandl A, Wilke J, Egner C, Schmidt T, Schilder A, Schleip R. Pain quality patterns in delayed onset muscle soreness of the lower back suggest sensitization of fascia rather than muscle afferents: a secondary analysis study. Pflugers Arch 2024; 476:395-405. [PMID: 38102488 PMCID: PMC10847203 DOI: 10.1007/s00424-023-02896-8] [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: 08/07/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Delayed onset muscle soreness (DOMS) of the lower back is considered a surrogate for acute low back pain (aLBP) in experimental studies. Of note, it is often unquestioningly assumed to be muscle pain. To date, there has not been a study analyzing lumbar DOMS in terms of its pain origin, which was the aim of this study. Sixteen healthy individuals (L-DOMS) were enrolled for the present study and matched to participants from a previous study (n = 16, L-PAIN) who had undergone selective electrical stimulation of the thoracolumbar fascia and the multifidus muscle. DOMS was induced in the lower back of the L-DOMS group using eccentric trunk extensions performed until exhaustion. On subsequent days, pain on palpation (100-mm analogue scale), pressure pain threshold (PPT), and the Pain Sensation Scale (SES) were used to examine the sensory characteristics of DOMS. Pain on palpation showed a significant increase 24 and 48 h after eccentric training, whereas PPT was not affected (p > 0.05). Factor analysis of L-DOMS and L-PAIN sensory descriptors (SES) yielded a stable three-factor solution distinguishing superficial thermal ("heat pain ") from superficial mechanical pain ("sharp pain") and "deep pain." "Heat pain " and "deep pain" in L-DOMS were almost identical to sensory descriptors from electrical stimulation of fascial tissue (L-PAIN, all p > 0.679) but significantly different from muscle pain (all p < 0.029). The differences in sensory description patterns as well as in PPT and self-reported DOMS for palpation pain scores suggest that DOMS has a fascial rather than a muscular origin.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148, Hamburg, Germany.
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992, Munich, Germany.
- Vienna School of Osteopathy, 1130, Vienna, Austria.
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, 9020, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, 37242, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457, Hamburg, Germany
| | - Andreas Schilder
- Department of Orthopaedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992, Munich, Germany
- Department of Movement Sciences, University of Klagenfurt, 9020, Klagenfurt, Austria
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9
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Fu C, Xia Y, Wang B, Zeng Q, Pan S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 2024; 15:67. [PMID: 38424366 PMCID: PMC10904698 DOI: 10.1186/s13244-024-01619-6] [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: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The main generator of delayed onset muscle soreness (DOMS) is still unknown. This study aimed to clarify the main generator of DOMS. METHODS Twelve participants performed eccentric exercise (EE) on lower legs. MRI and ultrasound were used to assess changes of calf muscle and deep fascia before and after EE. These results were then compared to the muscle pain level. RESULTS Compared to baseline, muscle pain peaked at 24-48 h after EE (downstairs 22.25 ± 6.196, 57.917 ± 9.298, F = 291.168, p < 0.01; resting 5.833 ± 1.899, 5.083 ± 2.429, F = 51.678, p < 0.01). Shear wave speed (SWE) of the deep fascia and T2 values of the gastrocnemius muscle and deep fascia all increased and peaked at 48 h after EE (1.960 ± 0.130, F = 22.293; 50.237 ± 2.963, F = 73.172; 66.328 ± 2.968, F = 231.719, respectively, p < 0.01). These measurements were positively correlated with DOMS (downstairs: r = 0.46, 0.76, 0.87, respectively, p < 0.001; resting: r = 0.42, 0.70, 0.77, respectively, p < 0.001). There was a significant positive correlation between SWE and T2 values of deep fascia (r = 0.54, p < 0.01). CONCLUSION DOMS is a common result of muscle and fascia injuries. Deep fascia edema and stiffness play a crucial role in DOMS, which can be effectively evaluated MR-T2 and SWE. CRITICAL RELEVANCE STATEMENT Delayed-onset muscle soreness is a common result of muscle and deep fascia injuries, in which the edema and stiffness of the deep fascia play a crucial role. Both MRI and shear wave elastography can be effectively used to evaluate soft tissue injuries. KEY POINTS • The deep fascia is the major pain generator of delayed-onset muscle soreness. • There is a significant correlation between fascia injury and delayed-onset muscle soreness. • MRI and shear wave elastography are preferred methods for assessing fascia injuries.
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Affiliation(s)
- Congcong Fu
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yu Xia
- Department of Medical Ultrasonic, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bingshan Wang
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qiang Zeng
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China.
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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10
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Tu W, Niu Y, Su P, Liu D, Lin F, Sun Y. Establishment of a risk prediction model for residual low back pain in thoracolumbar osteoporotic vertebral compression fractures after percutaneous kyphoplasty. J Orthop Surg Res 2024; 19:41. [PMID: 38184651 PMCID: PMC10771681 DOI: 10.1186/s13018-024-04528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE This study aims to identify potential independent risk factors for residual low back pain (LBP) in patients with thoracolumbar osteoporotic vertebral compression fractures (OVCFs) following percutaneous kyphoplasty (PKP) treatment. Additionally, we aim to develop a nomogram that can accurately predict the occurrence of residual LBP. METHODS We conducted a retrospective review of the medical records of thoracolumbar OVCFs patients who underwent PKP treatment at our hospital between July 2021 and December 2022. Residual LBP was defined as the presence of moderate or greater pain (VAS score ≥ 4) in the low back one day after surgery, and patients were divided into two groups: the LBP group and the non-LBP group. These patients were then randomly allocated to either a training or a validation set in the ratio of 7:3. To identify potential risk factors for residual LBP, we employed lasso regression for multivariate analysis, and from this, we constructed a nomogram. Subsequently, the predictive accuracy and practical clinical application of the nomogram were evaluated through a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve analysis (DCA). RESULTS Our predictive model revealed that five variables-posterior fascial oedema, intravertebral vacuum cleft, time from fracture to surgery, sarcopenia, and interspinous ligament degeneration-were correlated with the presence of residual LBP. In the training set, the area under the ROC was 0.844 (95% CI 0.772-0.917), and in the validation set, it was 0.842 (95% CI 0.744-0.940), indicating that the model demonstrated strong discriminative performance. Furthermore, the predictions closely matched actual observations in both the training and validation sets. The decision curve analysis (DCA) curve suggested that the model provides a substantial net clinical benefit. CONCLUSIONS We have created a novel numerical model capable of accurately predicting the potential risk factors associated with the occurrence of residual LBP following PKP in thoracolumbar OVCFs patients. This model serves as a valuable tool for guiding specific clinical decisions for patients with OVCFs.
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Affiliation(s)
- Weiqiao Tu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Yanping Niu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Peng Su
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Di Liu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Fanguo Lin
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China.
| | - Yongming Sun
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
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11
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Cortez I, Gaffney CM, Crelli CV, Lee E, Nichols JM, Pham HV, Mehdi S, Janjic JM, Shepherd AJ. Sustained pain and macrophage infiltration in a mouse muscle contusion model. Muscle Nerve 2024; 69:103-114. [PMID: 37929655 DOI: 10.1002/mus.28001] [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: 02/10/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION/AIMS Prior studies have emphasized the role of inflammation in the response to injury and muscle regeneration, but little emphasis has been placed on characterizing the relationship between innate inflammation, pain, and functional impairment. The aim of our study was to determine the contribution of innate immunity to prolonged pain following muscle contusion. METHODS We developed a closed-impact mouse model of muscle contusion and a macrophage-targeted near-infrared fluorescent nanoemulsion. Closed-impact contusions were delivered to the lower left limb. Pain sensitivity, gait dysfunction, and inflammation were assessed in the days and weeks post-contusion. Macrophage accumulation was imaged in vivo by injecting i.v. near-infrared nanoemulsion. RESULTS Despite hindpaw hypersensitivity persisting for several weeks, disruptions to gait and grip strength typically resolved within 10 days of injury. Using non-invasive imaging and immunohistochemistry, we show that macrophage density peaks in and around the affected muscle 3 day post-injury and quickly subsides. However, macrophage density in the ipsilateral sciatic nerve and dorsal root ganglia (DRG) increases more gradually and persists for at least 14 days. DISCUSSION In this study, we demonstrate pain sensitivity is influenced by the degree of lower muscle contusion, without significant changes to gait and grip strength. This may be due to modulation of pain signaling by macrophage proliferation in the sciatic nerve, upstream from the site of injury. Our work suggests chronic pain developing from muscle contusion is driven by macrophage-derived neuroinflammation in the peripheral nervous system.
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Affiliation(s)
- Ibdanelo Cortez
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caitlyn M Gaffney
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caitlin V Crelli
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Eric Lee
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James M Nichols
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hoang Vu Pham
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Syed Mehdi
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jelena M Janjic
- Graduate School of Pharmaceutical Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Andrew J Shepherd
- The MD Anderson Pain Research Consortium and the Laboratories of Neuroimmunology, Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Nešporová K, Matonohová J, Husby J, Toropitsyn E, Stupecká LD, Husby A, Suchánková Kleplová T, Streďanská A, Šimek M, Nečas D, Vrbka M, Schleip R, Velebný V. Injecting hyaluronan in the thoracolumbar fascia: A model study. Int J Biol Macromol 2023; 253:126879. [PMID: 37709215 DOI: 10.1016/j.ijbiomac.2023.126879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Hyaluronan (HA) has been recently identified as a key component of the densification of thoracolumbar fascia (TLF), a potential contributor to non-specific lower back pain (LBP) currently treated with manual therapy and systemic or local delivery of anti-inflammatory drugs. The aim of this study was to establish a novel animal model suitable for studying ultrasound-guided intrafascial injection prepared from HA with low and high Mw. Effects of these preparations on the profibrotic switch and mechanical properties of TLF were measured by qPCR and rheology, respectively, while their lubricating properties were evaluated by tribology. Rabbit proved to be a suitable model of TLF physiology due to its manageable size enabling both TLF extraction and in situ intrafascial injection. Surprisingly, the tribology showed that low Mw HA was a better lubricant than the high Mw HA. It was also better suited for intrafascial injection due to its lower injection force and ability to freely spread between TLF layers. No profibrotic effects of either HA preparation in the TLF were observed. The intrafascial application of HA with lower MW into the TLF appears to be a promising way how to increase the gliding of the fascial layers and target the myofascial LBP.
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Affiliation(s)
| | - Jana Matonohová
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - Jarmila Husby
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | | | | | - Aaron Husby
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - Tereza Suchánková Kleplová
- Department of Dentistry, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, 500 05 Hradec Kralové, Czech Republic
| | - Alexandra Streďanská
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Matěj Šimek
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - David Nečas
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Martin Vrbka
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Robert Schleip
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
| | - Vladimír Velebný
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
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13
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van Amstel R, Noten K, Malone S, Vaes P. Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method ® and Exercise Therapy. Life (Basel) 2023; 14:7. [PMID: 38276256 PMCID: PMC10820544 DOI: 10.3390/life14010007] [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: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. METHODS A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. RESULTS Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L. CONCLUSIONS The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.
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Affiliation(s)
- Robbert van Amstel
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Karl Noten
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Shaun Malone
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, 2000 Antwerpen, Belgium
| | - Peter Vaes
- Faculty of Rehabilitation Science and Physical Therapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
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14
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Creighton D, Fausone D, Swanson B, Young W, Nolff S, Ruble A, Hassan N, Soley E. Myofascial and discogenic origins of lumbar pain: A critical review. J Man Manip Ther 2023; 31:435-448. [PMID: 37503571 PMCID: PMC10642329 DOI: 10.1080/10669817.2023.2237739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
The purpose of this three-part narrative review is to examine the anatomy of, and the research which supports, either the lumbar myofascia or intervertebral disc (IVD) as principal sources of our patient's low back pain. A comprehensive understanding of anatomical lumbar pain generators in combination with the current treatment-based classification system will further improve and enhance clinical decision-making skills. Section I reviews the anatomy of the spinal myofascia, myofascial sources of lumbar pain, and imaging of myofascial tissues. Part II reviews the anatomy of the IVD, examines the IVD as a potential lumbar pain generator, and includes detailed discussion on Nerve Growth Factor, Inflammatory Cytokines, Vertebral End Plates and Modic change, Annular tears, and Discogenic instability. Part III looks at the history of myofascial pain, lab-based research and myofascial pain, and various levels of discogenic pain provocation research including animal, laboratory and human subjects. Our review concludes with author recommendations on developing a comprehensive understanding of altered stress concentrations affecting the posterior annulus fibrosis, neo-innervation of the IVD, inflammatory cytokines, discogenic instability, and how this knowledge can complement use of the Treatment-Based Classification System.
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15
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Liu Y, Wang Y. A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain. Front Med (Lausanne) 2023; 10:1305733. [PMID: 38020090 PMCID: PMC10679753 DOI: 10.3389/fmed.2023.1305733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. Methods In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. Results There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Conclusion Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. Clinical trial registration www.isrctn.com, ISRCTN88098928.
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Affiliation(s)
- Yang Liu
- SchoolGraduate School of Wuhan Sports University, Wuhan Sports University, Wuhan, China
| | - Yidan Wang
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
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16
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Song MX, Yang H, Yang HQ, Li SS, Qin J, Xiao Q. MR Imaging Radiomics Analysis Based on Lumbar Soft Tissue to Evaluate Lumbar Fascia Changes in Patients with Low Back Pain. Acad Radiol 2023; 30:2450-2457. [PMID: 37003877 DOI: 10.1016/j.acra.2023.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/21/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023]
Abstract
RATIONALE AND OBJECTIVES Clinicians must precisely pinpoint the etiology of low back pain as the number of people suffering from it increases to provide targeted care. The purpose of this paper was to use MR imaging radiomics based on lumbar soft tissue to analyze changes in the lumbar fascia of patients with low back pain. MATERIALS AND METHODS We retrospectively analyzed the lumbar MRI of 197 patients with low back pain. Patients were randomly assigned to either the training (n = 138) or validation (n = 59) cohorts. Multivariate logistic regression analysis was used to create radiomics model and combined nomogram model and their predictive performance were evaluated using receiver operating characteristic curves. RESULTS Seven radiomics features based on lumbar soft tissue MRI images were established, which performed well in distinguishing between low back pain patients with fascial changes and normal individuals demonstrated an excellent ability to identify differences, with an Area Under Curve (AUC) of 0.92 (95% CI, 0.88-0.96) in the training cohort and 0.84 (95% CI, 0.73-0.96) in the validation cohort, which performed better than the clinical model significantly only. CONCLUSION The nomogram based on clinical features and radiomics features of MR images had a good predictive ability to differentiate fascial alterations in patients with low back pain from normal subjects. It had the potential to be used as a decision support tool to assist clinicians in determining the etiology of patients with lower back pain and managing patients promptly, particularly in the early stage of the fasciitis when significant abnormalities on imaging were difficult to detect.
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Affiliation(s)
- Ming-Xin Song
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
| | - Hui Yang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
| | - He-Qi Yang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
| | - Shan-Shan Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
| | - Qiang Xiao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Shandong First Medical University, No.366 Taishan Street, Tai'an 271000, China.
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Smith SA, Norbury R, Hunt AJ, Mauger AR. Intra- and interindividual reliability of muscle pain induced by an intramuscular injection of hypertonic saline injection into the quadriceps. Eur J Pain 2023; 27:1216-1225. [PMID: 37376739 DOI: 10.1002/ejp.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 05/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Intramuscular injections of hypertonic saline are commonly used to induce experimental muscle pain, but reliability data on this technique are lacking. This study investigated the intra- and interindividual reliability of pain measures from a hypertonic saline injection into the vastus lateralis. METHODS Fourteen healthy participants (6 female) attended three laboratory visits where they received an intramuscular injection of 1 mL hypertonic saline into the vastus lateralis. Changes in pain intensity were recorded on an electronic visual analogue scale, and pain quality was assessed after pain had resolved. Reliability was assessed with the coefficient of variation (CV), minimum detectable change (MDC) and intraclass correlation coefficient (ICC) with 95% CIs. RESULTS Mean pain intensity displayed high levels of intraindividual variability (CV = 16.3 [10.5-22.0]%) and 'poor' to 'very good' relative reliability (ICC = 0.71 [0.45-0.88]) but had a MDC of 11 [8-16] au (out of 100). Peak pain intensity exhibited high levels of intraindividual variability (CV = 14.8 [8.8-20.8]%) with 'moderate' to 'excellent' levels of relative reliability (ICC = 0.81 [0.62-0.92]), whereas the MDC was 18 [14-26] au. Measures of pain quality exhibited good reliability. Interindividual variability in pain measures was high (CV > 37%). CONCLUSIONS Intramuscular injections of 1 mL of hypertonic saline into the vastus lateralis display substantial levels of interindividual variability, but MDC is below the clinically important changes in pain. This model of experimental pain is suitable for studies involving repeated exposures. SIGNIFICANCE Many pain research studies have performed intramuscular injections of hypertonic saline to investigate responses to muscle pain. However, the reliability of this technique is not well established. We examined the pain response over three repeated sessions of a hypertonic saline injection. The pain induced by hypertonic saline has considerable interindividual variability but has largely acceptable intraindividual reliability. Therefore, the injections of hypertonic saline to induce muscle pain are a reliable model of experimental muscle pain.
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Affiliation(s)
- Samuel A Smith
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - Ryan Norbury
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
- Faculty of Sport, Allied Health, and Performance Science, St Mary's University, Twickenham, UK
| | - Adam J Hunt
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
| | - Alexis R Mauger
- School of Sport and Exercise Sciences, University of Kent, Canterbury, UK
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18
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Streuli D, Nyirö L, Rosner J, Schilder A, Csato M, Schweinhardt P. Intra- and inter-session reliability of electrical detection and pain thresholds of cutaneous and muscle primary afferents in the lower back of healthy individuals. Pflugers Arch 2023; 475:1211-1223. [PMID: 37624386 PMCID: PMC10499933 DOI: 10.1007/s00424-023-02851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
To advance evidence-based practice and targeted treatments of low back pain (LBP), a better pathophysiological understanding and reliable outcome measures are required. The processing of nociceptive information from deeper somatic structures (e.g., muscle, fascia) might play an essential role in the pathophysiology of LBP. In this study, we measured the intra- and inter-session reliability of electrical detection and pain thresholds of cutaneous and muscle primary afferents of the lower back. Twenty healthy participants attended two study visits separated by 27.7 ± 1.7 days. To determine the location-specific electrical detection threshold (EDT) and pain threshold (EPT), needle electrodes were inserted in the epidermal layer over, and in the lumbar erector spinae muscle. Additionally, established quantitative sensory testing (QST) parameters were assessed. Reliability was determined by differences between measurements, intraclass correlation coefficients (ICC2,1), Bland-Altman plots, and standard error of measurement (SEM). Correspondence between QST parameters and electrical thresholds was assessed using Pearson's correlation. Except for cutaneous EPT, no significant (p ≤ 0.05) intra- and inter-session differences were observed. Excellent intra-session reliability was shown for cutaneous and intramuscular electrical stimulations and all QST parameters (ICC: 0.76-0.93). Inter-session reliabilities were good (ICC: 0.74-0.75) except for electrical stimulations (ICC: 0.08-0.36). Limits of agreement and SEM were higher for inter-session than intra-session. A medium to strong relationship was found between electrical and mechanical/pressure pain thresholds. In conclusion, cutaneous and intramuscular electrical stimulation will potentially close an important diagnostic gap regarding the selective examination of deep tissue afferents and provide location-specific information for the excitability of non-nociceptive and nociceptive afferents.
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Affiliation(s)
- Daniel Streuli
- Department of Chiropractic Medicine, Integrative Spinal Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luana Nyirö
- Department of Chiropractic Medicine, Integrative Spinal Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Andreas Schilder
- Department of Orthopaedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Miklos Csato
- Department of Chiropractic Medicine, Integrative Spinal Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Liu Y, Wu L. Effect of instrument-assisted soft tissue mobilization combined with blood flow restriction training on function, pain and strength of patients with patellofemoral joint pain. BMC Musculoskelet Disord 2023; 24:698. [PMID: 37653489 PMCID: PMC10469828 DOI: 10.1186/s12891-023-06701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Patellofemoral pain syndrome is a prevalent sports injury that affects athletes both in their daily lives and during training. This condition causes pain in the area where the kneecap and thigh bone meet, and it can be quite debilitating. Whether an athlete is simply going about their day or pushing themselves to the limit during a workout, patellofemoral pain can be a significant hindrance. PURPOSE The purpose of this study is to investigate the impact of combining Instrument-Assisted Soft Tissue Mobilization (IASTM) treatment with blood flow restriction training on individuals with patellofemoral pain. Specifically, the study will assess improvements in pain levels, functional ability, strength, and joint mobility resulting from this treatment approach. METHODS Twenty-six patients diagnosed with patellofemoral pain were selected as observation subjects and randomly divided into two groups: the IASTM combined with blood flow restriction training treatment group (n = 13) and the IASTM treatment group alone (n = 13). The treatment period was 4 weeks. In this study, we conducted a comparison and analysis of the knee's visual analogue pain scale (VAS), Lysholm score, and a modified version of the Thomas test (MTT) at three different time points.In this subject paper, we compared and analyzed the VAS score of the knee, Lysholm score of the knee, and MTT at three different time points-before treatment, immediately after the first treatment, and after four weeks of treatment. Additionally, we recorded data using a maximum isometric muscle strength testing system for the lower extremity extensors four weeks before and after treatment. RESULTS In comparing the Lysholm scores within the groups, a significant difference was observed between the two groups following the initial treatment and after 4 weeks of treatment (p < 0.05). The scores increased, indicating a significant improvement in function. The VAS scores significantly differed after the first treatment and 4 weeks of treatment compared to before treatment (p < 0.05), indicating a significant improvement in pain. Additionally, after 4 weeks of treatment, the strength of the extensor muscle in the lower extremity significantly improved (p < 0.001). However, there was no significant difference in the strength test between the groups (p > 0.05). The MTT test revealed significant changes in the three joint angles before and after treatment (p > 0.05), suggesting an improvement in joint mobility. Overall, these results demonstrate the effectiveness of the treatment in improving pain and muscle strength in the lower extremity. CONCLUSION The combination of IASTM treatment and blood flow restriction has been shown to significantly reduce pain and improve periprosthetic soft tissue flexibility. Additionally, IASTM treatment alone was found to be more effective in improving knee pain and muscle flexibility, ultimately leading to increased knee strength in a pain-free state. In terms of the overall treatment outcome, it was found that the combined treatment was significantly more effective than the adjuvant soft tissue release treatment alone.
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Affiliation(s)
- Yang Liu
- Wuhan Institute of Sports, No. 461 Luoyu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Lianqing Wu
- Wuhan Institute of Sports, No. 461 Luoyu Road, Hongshan District, Wuhan, Hubei Province, China.
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Du Y, Cai X, Xu B, Wu Y, Chen M, Wang J, Yuan B, Zhang W, Zhu J, Yang C. Global Status and Future Trends of Fascia and Pain Research in 2013-2022: Bibliometric Analysis Based on CiteSpace and VOSviewer. J Pain Res 2023; 16:2633-2653. [PMID: 37538250 PMCID: PMC10394092 DOI: 10.2147/jpr.s412161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
Background Fascial pathological pain is the main type of chronic pain in older adults today, and studying the relationship between fascia and pain can help in the clinical search for effective treatments. However, in the face of the vast amount of research findings, there is no systematic assessment of the relationship between fascia and pain in a bibliometric analysis. Therefore, the purpose of this study is to analyze studies on fascia and pain using CiteSpace and VOSviewer to identify research hotspots and future directions. Materials and Methods A total of 744 papers related to fascia and pain from 2013 to 2022 were collected from the core collection database of Web of Science, and the authors, countries, institutions, keyword co-occurrence, keyword clustering, and keyword emergence were analyzed by CiteSpace and VOSviewer to construct a knowledge map. Results Literature publication has shown an overall upward trend over the past decade, but there have been some fluctuations. Carmelo Pirri, Caterina Fede, and Raffaele De Caro are the top three authors with the most articles. The United States, China, and Spain are major contributors to fascial and pain research. The University of Padua, Universidad Complutense and Harvard Medical School are leading institutions in this field. However, it is noteworthy that the collaboration between authors, countries and institutions is not active. Keyword analysis showed that hot spots and trends in research on fascia and pain focused on hot diseases, major interventions, and mechanism exploration. Conclusion This analysis identifies the most influential authors, institutions, and countries in the field of fascial and pain research and provides a reference for assessing their academic impact. The analysis of keywords and co-cited literature is useful for analyzing research hotspots and their evolution, as well as for predicting future trends.
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Affiliation(s)
- Yikuan Du
- Central Laboratory, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, 523059, People’s Republic of China
| | - Xiaolin Cai
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bijun Xu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Yuqing Wu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Mianhai Chen
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinjin Wang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Bing Yuan
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Weichui Zhang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Jinfeng Zhu
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
| | - Chun Yang
- Dongguan Key Laboratory of Chronic Inflammatory Diseases, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, People’s Republic of China
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Liptan G. The widespread myofascial pain of fibromyalgia is sympathetically maintained and immune mediated. J Bodyw Mov Ther 2023; 35:394-399. [PMID: 37330799 DOI: 10.1016/j.jbmt.2023.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/07/2023] [Accepted: 04/19/2023] [Indexed: 06/19/2023]
Abstract
The recent demonstration of antibody-induced passive transfer of pain hypersensitivity from fibromyalgia (FM) subjects to mice brings renewed focus to the role of the immune system in generating FM pain. However, this data must be interpreted in the context of known myofascial pathology in FM, which includes impaired muscle relaxation and elevated intramuscular pressure. In addition, FM fascial biopsies demonstrate elevated inflammatory and oxidative stress markers and increased endomysial collagen deposition. This article proposes a unifying hypothesis for FM pain generation that connects known muscle and fascia abnormalities with the newly discovered role of antibodies. FM is characterized by persistent sympathetic nervous system hyperactivity which results in both pathologic muscle tension and an impaired tissue healing response. Although autoantibodies play a key role in normal tissue healing, sympathetic nervous system hyperactivity impairs the resolution of inflammation, and promotes autoimmunity and excessive autoantibody production. These autoantibodies can then bind with myofascial-derived antigen to create immune complexes, which are known to trigger neuronal hyperexcitability in the dorsal root ganglion. These hyperexcited sensory neurons activate the surrounding satellite glial cells and spinal microglia leading to pain hypersensitivity and central sensitization. Although immune system modulation may become an important treatment tool in FM, direct manual treatments that lessen myofascial inflammation and tension must not be neglected. Myofascial release therapy significantly reduces FM pain, with residual benefits even after the conclusion of treatment. Self-myofascial release techniques and gentle stretching programs also ease fibromyalgia pain, as do trigger point injections and dry-needling.
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Pirri C, Pirri N, Guidolin D, Macchi V, Porzionato A, De Caro R, Stecco C. Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a "Frozen Back"? Diagnostics (Basel) 2023; 13:diagnostics13081436. [PMID: 37189537 DOI: 10.3390/diagnostics13081436] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
The thoracolumbar fascia (TLF) plays an important role in lower back pain (LBP). Recent studies have revealed an association between increases in TLF thickness and reduced TLF gliding in patients with LBP. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the TLF at the bilateral L3 level of the lumbar spine in the longitudinal and transverse axes in chronic non-specific LBP and in healthy subjects. A cross-sectional study was performed using US imaging to measure the longitudinal and transverse axes with a new protocol in a sample of 92 subjects: 46 chronic non-specific LBP patients and 46 healthy participants. The findings for TLF thickness revealed statistically significant differences (p < 0.05) in the longitudinal and transverse axes between the two groups. Moreover, in the healthy group, a statistically significant difference was found between the longitudinal and transverse axes (p = 0.001 for left and p = 0.02 for right), which was not evident in the LBP patients. These findings suggest that the LBP patients lost anisotropy of the TLF, with it becoming homogeneously thicker and losing adaptability in the transversal direction. The US imaging evaluation suggests that TLF thickness behavior points out altered fascial remodelling compared to healthy subjects, a sort of "frozen back".
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padua, 35121 Padova, Italy
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padua, Italy
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23
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Devantéry K, Morin M, Grimard J, Gaudreault N. Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study. Bioengineering (Basel) 2023; 10:bioengineering10030332. [PMID: 36978723 PMCID: PMC10045407 DOI: 10.3390/bioengineering10030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
The thoracolumbar fascia (TLF) may be a pain generator, given its rich innervation. Structural and biomechanical changes have also been documented in adults with chronic non-specific low back pain (LBP). Myofascial techniques (MFTs) are commonly used in manual therapy and are hypothesized to reduce tissue stiffness and pain. However, evidence for these effects is limited. The objective of this study was to evaluate the immediate effects of a standardized MFT compared to a simulated MFT on: (1) the stiffness of the TLF and erector spinae muscles (shear-wave sonoelastography), (2) the thickness of the TLF (B-mode ultrasound), and (3) pain intensity (numerical rating scale). Forty-nine participants with chronic non-specific LBP were included in a randomized before-and-after experimental study. Outcome measures were collected before (T0) and immediately after the intervention (T1). Pain intensity was also assessed on day two (T2) and seven (T7). The MFT group showed a significant decrease in left erector spinae muscle stiffness and left TLF thickness compared to the simulated group. In addition, there was a significant reduction in pain intensity in the MFT group compared to the simulated group at T1 and T2. The results of this study suggest that MFT results in immediate tissue changes and transient pain reduction in patients with LBP.
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Myofascial force transmission between the calf and the dorsal thigh is dependent on knee angle: an ultrasound study. Sci Rep 2023; 13:3738. [PMID: 36878944 PMCID: PMC9988973 DOI: 10.1038/s41598-023-30407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
A recent in-vivo experiment has shown that force can be transmitted between the gastrocnemius and the hamstring muscles due to a direct tissue continuity. However, it remains unclear if this mechanical interaction is affected by the stiffness of the structural connection. This study therefore aimed to investigate the impact of the knee angle on myofascial force transmission across the dorsal knee. A randomized, cross-over study was performed, including n = 56 healthy participants (25.36 ± 3.9 years, 25 females). On two separate days, they adopted a prone position on an isokinetic dynamometer (knee extended or 60° flexed). In each condition, the device moved the ankle three times from maximal plantarflexion to maximal dorsal extension. Muscle inactivity was ensured using EMG. High-resolution ultrasound videos of the semimembranosus (SM) and the gastrocnemius medialis (GM) soft tissue were recorded. Maximal horizontal tissue displacement, obtained using cross-correlation, was examined as a surrogate of force transmission. SM tissue displacement was higher at extended (4.83 ± 2.04 mm) than at flexed knees (3.81 ± 2.36 mm). Linear regression demonstrated significant associations between (1) SM and GM soft tissue displacement (extended: R2 = 0.18, p = 0.001; flexed: R2 = 0.17, p = 0.002) as well as (2) SM soft tissue displacement and ankle range of motion (extended: R2 = 0.103, p = 0.017; flexed: R2 = 0.095, p = 0.022). Our results further strengthen the evidence that local stretching induces a force transmission to neighboring muscles. Resulting remote exercise effects such as increased range of motion, seem to depend on the stiffness of the continuity.Trial registration: DRKS (Deutsches Register Klinischer Studien), registration number DRKS00024420, first registered 08/02/2021, https://drks.de/search/de/trial/DRKS00024420 .
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Stecco A, Giordani F, Fede C, Pirri C, De Caro R, Stecco C. From Muscle to the Myofascial Unit: Current Evidence and Future Perspectives. Int J Mol Sci 2023; 24:ijms24054527. [PMID: 36901958 PMCID: PMC10002604 DOI: 10.3390/ijms24054527] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
The "motor unit" or the "muscle" has long been considered the quantal element in the control of movement. However, in recent years new research has proved the strong interaction between muscle fibers and intramuscular connective tissue, and between muscles and fasciae, suggesting that the muscles can no longer be considered the only elements that organize movement. In addition, innervation and vascularization of muscle is strongly connected with intramuscular connective tissue. This awareness induced Luigi Stecco, in 2002, to create a new term, the "myofascial unit", to describe the bilateral dependent relationship, both anatomical and functional, that occurs between fascia, muscle and accessory elements. The aim of this narrative review is to understand the scientific support for this new term, and whether it is actually correct to consider the myofascial unit the physiological basic element for peripheral motor control.
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Affiliation(s)
- Antonio Stecco
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Federico Giordani
- Department of Rehabilitation Medicine, Padova University, 35141 Padova, Italy
| | - Caterina Fede
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35141 Padova, Italy
| | - Carmelo Pirri
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35141 Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35141 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35141 Padova, Italy
- Correspondence: ; Tel.: +39-04-9827-2315
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Repová K, Čief L. Fascial manipulation and its application for low back pain treatment. SLOVAK JOURNAL OF SPORT SCIENCE 2023. [DOI: 10.24040/sjss.2022.8.2.2-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Low back pain is one of the most common musculosceletal disorder and it has multifactorial etiology. It is considered to be the leading cause of global disability. It is the most frequent cause of activity limitation that can, eventually, result in disability, decreased quality of life, and work absenteeism. Low back pain manifests in different forms - acute, subacute and chronic. Within clinical examination it is a collected anamnesis, a general examination and functional testing from each patient. The importance of physical activity in the treatment of low back pain is generally accepted. However, an increase in physical activity has been suggested to be both a preventive factor and a possible risk factor for low back pain. There is an evidence for an association between high physical workloads and back injury. Treatment of low back pain includes many different types of exercises and physical therapy. Fascial manipulations has showed a great effectiveness in the treatment of low back pain in the general population, but also among the athletes.
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Yang C, Huang X, Li Y, Sucharit W, Sirasaporn P, Eungpinichpong W. Acute Effects of Percussive Massage Therapy on Thoracolumbar Fascia Thickness and Ultrasound Echo Intensity in Healthy Male Individuals: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1073. [PMID: 36673829 PMCID: PMC9859515 DOI: 10.3390/ijerph20021073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 05/13/2023]
Abstract
Percussive massage therapy (PT) has been widely used by therapists and the fitness population to treat myofascial-related conditions. However, there is no evidence to confirm the effects of PT on the fascia. This study aimed to investigate the effects of PT on thoracolumbar fascia (TLF) morphology and other related outcomes. METHODS Sixty-six healthy males participated and were randomly allocated into a percussive massage group (PT group) and a control group. The PT group received 15 min of back percussion massage, while the control group rested prone lying in the same environment for 15 min. Thoracolumbar fascia (TLF) thickness and echo intensity, perceived stiffness, lumbar flexibility, and skin temperature were measured in both groups before and immediately after the intervention. RESULT TLF thickness and lumbar flexibility did not change when compared in the two groups. However, the echo intensity (left side, difference -3.36, 95% CI -5.1 to -1.6; right side, difference -4.39, 95% CI -6.1 to -2.7) and perceived stiffness (difference, -1.18, 95% CI -1.84 to -0.52) in the TLF region were significantly lower in the PT group than in the control group and were accompanied by increased skin temperature (difference 0.29, 95% CI 0.11 to 0.48). CONCLUSION We suggest that a 15 min PT with 30 Hz on the back region could reduce TLF echo intensity and perceived stiffness and increase skin temperature in healthy men individual.
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Affiliation(s)
- Chao Yang
- Department of Exercise and Sport Sciences, Faculty of Graduate School, Khon Kaen University, Khon Kaen 40002, Thailand
- Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen 40002, Thailand
| | - Xingyu Huang
- Department of Human Movement Sciences, Faculty of Physical Education, Gan Nan Normal University, Ganzhou 341000, China
| | - Ying Li
- School of Rehabilitation Medicine, Gan Nan Medical University, Ganzhou 341000, China
| | - Wiraphong Sucharit
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Division of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Patpiya Sirasaporn
- Department of Rehabilitation Medicine Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wichai Eungpinichpong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Division of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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Tenberg S, Nosaka K, Wilke J. The Relationship Between Acute Exercise-Induced Changes in Extramuscular Connective Tissue Thickness and Delayed Onset Muscle Soreness in Healthy Participants: A Randomized Controlled Crossover Trial. SPORTS MEDICINE - OPEN 2022; 8:57. [PMID: 35482217 PMCID: PMC9050985 DOI: 10.1186/s40798-022-00446-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022]
Abstract
Background The extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS). Methods Eleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined. Results Palpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05). Conclusion Collectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.
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Luomala T. Clinical Application of Myofascial Therapy in Horses. Vet Clin North Am Equine Pract 2022; 38:493-507. [DOI: 10.1016/j.cveq.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Myofascial force transmission between the ankle and the dorsal knee: A study protocol. PLoS One 2022; 17:e0276240. [PMID: 36327229 PMCID: PMC9632914 DOI: 10.1371/journal.pone.0276240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Connective tissue links the skeletal muscles, creating a body-wide network of continuity. A recent in-vivo experiment demonstrated that passive elongation of the calf caused a caudal displacement of the semimembranosus muscle, indicating force transmission across the dorsal knee joint. However, it remains unclear as to whether this observation is dependent on the joint angle. If force would not be transmitted at flexed knees, this would reduce the number of postures and movements where force transmission is of relevance. Our trial, therefore, aims to investigate the influence of passive calf stretching with the knee in extended and flexed position on dorsal thigh soft tissue displacement. METHODS Participants are positioned prone on an isokinetic dynamometer. The device performs three repetitions of moving the ankle passively (5°/s) between plantar flexion and maximum dorsiflexion. With a washout-period of 24 hours, this procedure is performed twice in randomised order, once with the knee extended (0°) and once with the knee flexed (60°). Two high-resolution ultrasound devices will be used to visualize the soft tissue of the calf and dorsal thigh during the manoeuvre. Maximal horizontal displacement of the soft tissue [mm] during ankle movement will be quantified as a surrogate of force transmission, using a frame-by-frame cross-correlation analysis of the obtained US videos. DISCUSSION Understanding myofascial force transmission under in-vivo conditions is a pre-requisite for the development of exercise interventions specifically targeting the fascial connective tissue. Our study may thus provide health and fitness professional with the anatomical and functional basis for program design. TRIAL REGISTRATION The study is registered at the German Clinical Trials Register (TRN: DRKS00024420), registered 8 Februar 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024420.
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Pressure pain threshold map of thoracolumbar paraspinal muscles after lengthening contractions in young male asymptomatic volunteers. Sci Rep 2022; 12:15825. [PMID: 36138196 PMCID: PMC9499944 DOI: 10.1038/s41598-022-20071-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to characterise topographic distribution of pressure pain thresholds (PPTs) of thoracolumbar paraspinal muscles and its change after lengthening contractions (LCs) of the back muscles. Using young male asymptomatic participants in Experiment 1, we systematically examined the distribution of PPTs bilaterally in the range of Th1–L5 at measurement points 2 and 4 cm from the midline. PPTs were found to be higher in the lumbar segments of the paraspinal muscles than in the thoracic segments, and in muscles closer to the vertebrae (2 vs. 4 cm from the midline). The PPTs did not differ between the left and right sides in each segment. In Experiment 2, LC was applied by asking a part of participants recruited in Experiment 1 to fall their trunk from a starting position (parallel to the floor) to 40° flexed position, and then made it back as quickly as possible to the starting position. This cycle was repeated until participants could not keep contractions (30 times/set, 25.4 ± 10.6 sets). PPTs of the LC group decreased prominently in the lower thoracic and lumbar segments, and the decrease was more evident 24 h after LC compared to that 48 h after. In contrast, PPTs in the control group without LC remained unchanged. These results provided broad topographic images of PPTs in the thoracolumbar paraspinal muscles of young male participants with and without LC, and the obtained PPT maps could be a useful guide for better treatment of exercise-induced myofascial pain in the lower back.
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Differential Sensitization of Muscle versus Fascia in Individuals with Low Back Pain. Bioengineering (Basel) 2022; 9:bioengineering9090440. [PMID: 36134986 PMCID: PMC9495767 DOI: 10.3390/bioengineering9090440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Muscles and the deep fascia surrounding them have been suggested to play an important role in various musculoskeletal pain conditions including low back pain. Both have been shown to host rich nociceptive innervation and to undergo changes in individuals with chronic pain. However, evidence for the respective contribution of muscle and fascia sensitization in humans with myofascial pain syndrome is lacking. Here, we studied the sensitization of muscle and fascia in individuals with myofascial low back pain. Twenty individuals with acute (5) and chronic (15) myofascial low back pain of the quadratus lumborum muscle and a matched control group of twenty healthy individuals were recruited and clinically evaluated. All participants underwent ultrasound-guided needling of their subcutaneous tissue, deep fascia and quadratus lumborum muscle. Reported pain intensity and episodes of muscle twitching were recorded and analyzed. Among pain patients, both muscles and deep fascia demonstrated pain hypersensitivity, but muscles were significantly more sensitized than the deep fascia. No difference between acute- or chronic-pain patients was observed. Results of this study suggest that while both deep fascia and muscle show pain sensitization in both early and chronic stages of low back pain, muscles are more sensitized than fascia.
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Chronic musculoskeletal pain: traps and pitfalls in classification and management of a major global disease burden. Pain Rep 2022; 7:e1023. [PMID: 35975138 PMCID: PMC9371524 DOI: 10.1097/pr9.0000000000001023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Mary-Ann Fitzcharles et al. propose to introduce “regional fibromyalgia” as a new diagnosis. This commentary summarizes why this term is misleading but nonetheless the article may pave the way towards useful concepts for myofascial pains.
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Fascial Innervation: A Systematic Review of the Literature. Int J Mol Sci 2022; 23:ijms23105674. [PMID: 35628484 PMCID: PMC9143136 DOI: 10.3390/ijms23105674] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
Currently, myofascial pain has become one of the main problems in healthcare systems. Research into its causes and the structures related to it may help to improve its management. Until some years ago, all the studies were focused on muscle alterations, as trigger points, but recently, fasciae are starting to be considered a new, possible source of pain. This systematic review has been conducted for the purpose of analyze the current evidence of the muscular/deep fasciae innervation from a histological and/or immunohistochemical point of view. A literature search published between 2000 and 2021 was made in PubMed and Google Scholar. Search terms included a combination of fascia, innervation, immunohistochemical, and different immunohistochemical markers. Of the 23 total studies included in the review, five studies were performed in rats, four in mice, two in horses, ten in humans, and two in both humans and rats. There were a great variety of immunohistochemical markers used to detect the innervation of the fasciae; the most used were Protein Gene Marker 9.5 (used in twelve studies), Calcitonin Gene-Related Peptide (ten studies), S100 (ten studies), substance P (seven studies), and tyrosine hydroxylase (six studies). Various areas have been studied, with the thoracolumbar fascia being the most observed. Besides, the papers highlighted diversity in the density and type of innervation in the various fasciae, going from free nerve endings to Pacini and Ruffini corpuscles. Finally, it has been observed that the innervation is increased in the pathological fasciae. From this review, it is evident that fasciae are well innerved, their innervation have a particular distribution and precise localization and is composed especially by proprioceptors and nociceptors, the latter being more numerous in pathological situations. This could contribute to a better comprehension and management of pain.
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Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life (Basel) 2022; 12:life12050743. [PMID: 35629410 PMCID: PMC9146519 DOI: 10.3390/life12050743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
- Museum of Human Anatomy "Filippo Civinini", University of Pisa, 56126 Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
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Bojairami IE, Driscoll M. Coordination Between Trunk Muscles, Thoracolumbar Fascia, and Intra-Abdominal Pressure Toward Static Spine Stability. Spine (Phila Pa 1976) 2022; 47:E423-E431. [PMID: 34545044 DOI: 10.1097/brs.0000000000004223] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Numerical in-silico human spine stability finite element analysis. OBJECTIVE The purpose of this study was to investigate the contribution of major torso tissues toward static spine stability, mainly the thoracolumbar fascia (TLF), abdominal wall with its intra-abdominal pressure (IAP), and spinal muscles inclusive of their intramuscular pressure. SUMMARY OF BACKGROUND DATA Given the numerous redundancies involved in the spine, current methodologies for assessing static spinal stability are limited to specific tissues and could lead to inconclusive results. A three-dimensional finite element model of the spine, with structured analysis of major torso tissues, allows for objective investigation of static spine stability. METHODS A novel previously fully validated spine model was employed. Major torso tissues, mainly the muscles, TLF, and IAP were individually, and in combinations, activated under a 350N external spine perturbation. The stability contribution exerted by these tissues, or their ability to restore the spine to the unperturbed position, was assessed in different case-scenarios. RESULTS Individual activations recorded significantly different stability contributions, with the highest being the TLF at 75%. Combined or synergistic activations showed an increase of up to 93% stability contribution when all tissues were simultaneously activated with a corresponding decrease in the tensile load exerted by the tissues themselves. CONCLUSION This investigation demonstrated torso tissues exhibiting different roles toward static spine stability. The TLF appeared able to dissipate and absorb excessive loads, the muscles acted as antagonistic to external perturbations, and the IAP played a role limiting movement. Furthermore, the different combinations explored suggested an optimized engagement and coordination between different tissues to achieve a specific task, while minimizing individual work.Level of Evidence: N/A.
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Affiliation(s)
- Ibrahim El Bojairami
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
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Kondrup F, Gaudreault N, Venne G. The Deep Fascia and its Role in Chronic Pain & Pathological Conditions: A Review. Clin Anat 2022; 35:649-659. [PMID: 35417568 DOI: 10.1002/ca.23882] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. MATERIALS AND METHODS A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. RESULTS We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. CONCLUSIONS The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
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Affiliation(s)
- Flemming Kondrup
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nathaly Gaudreault
- School of rehabilitation, Faculty of medicine and health sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Gabriel Venne
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Institute of Health Science Education, Faculty of Medicine, McGill University, Montreal, Canada
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Luo Y, Jiang T, Guo H, Lv F, Hu Y, Zhang L. Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty. BMC Musculoskelet Disord 2022; 23:343. [PMID: 35410277 PMCID: PMC8996573 DOI: 10.1186/s12891-022-05308-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 12/25/2022] Open
Abstract
Background To explore the risk factors involved in the induction of thoracolumbar fascia (TLF) injury by osteoporotic vertebral compression fracture (OVCF), and the association between the residual pain after percutaneous vertebroplasty (PVP) and fascial injury. Methods A total of 81 patients with single-segment OVCF, treated between January 2018 and January 2020 were included. The patients were grouped according to the existence of TLF injury. The patients’ general, clinical, and imaging data were accessed. Results There were 47 patients in the TLF group and 34 in the non-injury group (NTLF group). In the TLF group, BMI (Body mass index) was significantly lower, while the prevalence of hypertension and sarcopenia were significantly higher (P < 0.05). The vertebral compression degree was higher, and the kyphosis angle of the injured vertebra was greater in the TLF group (P < 0.05). Cobb’s angle was not significantly different between groups. At 3-d after the operation, the VAS (Visual analogue scale) was 4.64 ± 1.78 and 3.00 ± 1.71, and the ODI (Oswestry disability index) was 67.44 ± 11.37% and 56.73 ± 10.59% in TLF and NTLF group, respectively (P < 0.05). However, at 3-m after the operation, the differences in the VAS score and the ODI between groups were not statistically significant. The area of fascial edema was not significantly associated with the pre- and post-operative VAS or ODI, but was positively correlated with the vertebral body compression degree (R = 0.582, P = 0. 029). Conclusion Residual back pain after PVP is associated with TLF injury. Low BMI, hypertension and sarcopenia are risk factors of TLF injury, and sarcopenia may be the major factor.
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Affiliation(s)
- Yang Luo
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Tianyu Jiang
- Department of Rehabilitation, The Second Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Hui Guo
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Faqin Lv
- Department of Ultrasound, The Third Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Ying Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, P. R. China
| | - Lihai Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China.
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Dose-Dependent Pain and Pain Radiation after Chemical Stimulation of the Thoracolumbar Fascia and Multifidus Muscle: A Single-Blinded, Cross-Over Study Revealing a Higher Impact of Fascia Stimulation. Life (Basel) 2022; 12:life12030340. [PMID: 35330091 PMCID: PMC8954021 DOI: 10.3390/life12030340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Acute low back pain can be experimentally induced by injections of hypertonic saline into deep tissues of the back, such as fascia and muscle. The current study investigated the dose-dependency of peak-pain and spatial extent of concomitant radiating pain following 50, 200 and 800 μL bolus injections of hypertonic saline (5.8%) into the thoracolumbar fascia and multifidus muscle, since data on dose-dependency is lacking in humans. Sixteen healthy subjects rated (11 female, 5 male; 23.3 ± 3.1 years, mean ± SD) intensity and spatial extent of pain. Injections into the fascia resulted in significantly higher peak-pain (+86%, p < 0.001), longer pain durations (p < 0.05), and larger pain areas (+65%, p < 0.02) and were less variable than intramuscular injections. Peak-pain ratings and pain areas were 2−3-fold higher/larger for 200 μL vs. 50 μL. In contrast, peak pain increased only marginally at 800 μL by additional 20%, while pain areas did not increase further at all in both, fascia and muscle. Thus, higher injection volumes did also not compensate the lower sensitivity of muscle. Peak-pain ratings and pain areas correlated between fascia and muscle (r = 0.530, p < 0.001 and r = 0.337, p < 0.02, respectively). Peak-pain ratings and pain areas correlated overall (r = 0.490, p < 0.0001), but a weak correlation remained when the impact of between-tissue differences and different injection volumes were singled out (partial r = 0.261, p < 0.01). This study shows dose-dependent pain responses of deep tissues where an injection volume of 200 μL of hypertonic saline is deemed an adequate stimulus for tissue differentiation. We suggest that pain radiation is not simply an effect of increased peripheral input but may afford an individual disposition for the pain radiation response. Substantially higher pain-sensitivity and wider pain areas support fascia as an important contributor to non-specific low back pain.
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Evaluating the Effectiveness of Soft Tissue Therapy in the Treatment of Disorders and Postoperative Conditions of the Knee Joint-A Systematic Review. J Clin Med 2021; 10:jcm10245944. [PMID: 34945240 PMCID: PMC8704673 DOI: 10.3390/jcm10245944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
The term "soft tissue therapy" (STT) refers to mechanical methods of treatment involving passive kneading, pressing and stretching of pathologically tense tissues in supporting the process of recovery after surgery or trauma to the musculoskeletal system. The objective of this study was to review current scientific reports evaluating the effectiveness of the use of STT in patients with diseases or after surgical procedures of the knee joint. A systematic search of the popular scientific databases PubMed, Scopus and Embase was performed from inception to 15 October 2021. Eight articles met eligibility criteria and were included in the review. Six papers were related to disorders of the knee joint, while the remaining two studies were related to dysfunctions associated with the conditions after surgical intervention. The findings presented confirmed the effectiveness of STT in orthopaedic patients who showed an increase in lower limb functional parameters. The research has shown that the use of various methods of STT has a significant impact on increasing muscle activity and flexibility as well as increasing the range of motion in the knee joint. The physiotherapeutic methods used had a significant impact on reducing pain and increasing physical function and quality of life. The techniques used reduced the time to descend stairs in patients with knee osteoarthritis. This review summarises the effectiveness of STT as an important form of treatment for orthopaedic patients with various knee joint dysfunctions.
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Practitioner utilisation and perceptions of the clinical utility of Danis Bois Method (DBM) Fasciatherapy to pain management: A survey of French physiotherapists. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Weiss K, Kalichman L. Deep fascia as a potential source of pain: A narrative review. J Bodyw Mov Ther 2021; 28:82-86. [PMID: 34776204 DOI: 10.1016/j.jbmt.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/24/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The fascial component of the myofascial pain syndrome and the contribution of the deep fascia to various painful conditions has not been well-described and is still less understood. OBJECTIVES The aims of this study were to evaluate the possible role of the deep fascia on musculoskeletal pain, focusing on findings from histological and experimental studies; and to assess the nociceptive and associated responses of the deep fascia to experimentally-induced irritation. METHODS Narrative review of the English scientific literature. RESULTS AND CONCLUSIONS Different components of the deep fascia, both in humans and animals are richly innervated, with some differences between body segments. These fascial components usually exhibit dense innervation, encompassing amongst others, nociceptive afferents. The application of different types of stimuli, i.e., electrical, mechanical, and chemical to these fascial components produces long-lasting pain responses. In some cases, the intensity and severity of pain produced by the stimulation of fascia were higher than ones produced by the stimulation of the related muscular tissue. These observations may denote that the deep fascia and its various components could be a source of pain in different pathologies and various pain syndromes.
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Affiliation(s)
- Kobi Weiss
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Sinhorim L, Amorim MDS, Ortiz ME, Bittencourt EB, Bianco G, da Silva FC, Horewicz VV, Schleip R, Reed WR, Mazzardo-Martins L, Martins DF. Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies. J Clin Med 2021; 10:jcm10194342. [PMID: 34640360 PMCID: PMC8509394 DOI: 10.3390/jcm10194342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.
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Affiliation(s)
- Larissa Sinhorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Mayane dos Santos Amorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Human Movement Sciences Graduate Program, College of Health and Sport Science at Santa Catarina State University, Florianópolis 88080-350, Brazil
| | - Maria Eugênia Ortiz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Edsel Balduino Bittencourt
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Coastal Health Institute, Jacksonville, FL 32224, USA
| | - Gianluca Bianco
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, 00147 Rome, Italy
- Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, 00147 Roma, Italy
| | | | - Verônica Vargas Horewicz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, 80799 Munich, Germany
- Department for Medical Professions, DIPLOMA University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
- Correspondence: ; Tel.: +49-89-346016
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Rehabilitation Science Program, Departments of Physical and Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Daniel F. Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
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Is "Delayed Onset Muscle Soreness" a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort. Int J Mol Sci 2021; 22:ijms22179482. [PMID: 34502387 PMCID: PMC8431437 DOI: 10.3390/ijms22179482] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Strenuous and unaccustomed exercise frequently lead to what has been coined “delayed onset muscle soreness” (DOMS). As implied by this term, it has been proposed that the associated pain and stiffness stem from micro-lesions, inflammation, or metabolite accumulation within the skeletal muscle. However, recent research points towards a strong involvement of the connective tissue. First, according to anatomical studies, the deep fascia displays an intimate structural relationship with the underlying skeletal muscle and may therefore be damaged during excessive loading. Second, histological and experimental studies suggest a rich supply of algogenic nociceptors whose stimulation evokes stronger pain responses than muscle irritation. Taken together, the findings support the hypothesis that DOMS originates in the muscle-associated connective tissue rather than in the muscle itself. Sports and fitness professionals designing exercise programs should hence consider fascia-oriented methods and techniques (e.g., foam rolling, collagen supplementation) when aiming to treat or prevent DOMS.
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Roch M, Gaudreault N, Cyr MP, Venne G, Bureau NJ, Morin M. The Female Pelvic Floor Fascia Anatomy: A Systematic Search and Review. Life (Basel) 2021; 11:life11090900. [PMID: 34575049 PMCID: PMC8467746 DOI: 10.3390/life11090900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022] Open
Abstract
The female pelvis is a complex anatomical region comprising the pelvic organs, muscles, neurovascular supplies, and fasciae. The anatomy of the pelvic floor and its fascial components are currently poorly described and misunderstood. This systematic search and review aimed to explore and summarize the current state of knowledge on the fascial anatomy of the pelvic floor in women. Methods: A systematic search was performed using Medline and Scopus databases. A synthesis of the findings with a critical appraisal was subsequently carried out. The risk of bias was assessed with the Anatomical Quality Assurance Tool. Results: A total of 39 articles, involving 1192 women, were included in the review. Although the perineal membrane, tendinous arch of pelvic fascia, pubourethral ligaments, rectovaginal fascia, and perineal body were the most frequently described structures, uncertainties were identified in micro- and macro-anatomy. The risk of bias was scored as low in 16 studies (41%), unclear in 3 studies (8%), and high in 20 studies (51%). Conclusions: This review provides the best available evidence on the female anatomy of the pelvic floor fasciae. Future studies should be conducted to clarify the discrepancies highlighted and accurately describe the pelvic floor fasciae.
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Affiliation(s)
- Mélanie Roch
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.R.); (N.G.); (M.-P.C.)
| | - Nathaly Gaudreault
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.R.); (N.G.); (M.-P.C.)
| | - Marie-Pierre Cyr
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.R.); (N.G.); (M.-P.C.)
| | - Gabriel Venne
- Anatomy and Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 0C7, Canada;
| | - Nathalie J. Bureau
- Centre Hospitalier de l’Université de Montréal, Department of Radiology, Radio-Oncology, Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Mélanie Morin
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (M.R.); (N.G.); (M.-P.C.)
- Correspondence:
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Ökmen K, Gürbüz H, Özkan H. Unilateral rhomboid intercostal and subserratus plane block application for analgesia after laparoscopic cholecystectomy surgery :a quasi-experimental study. Korean J Anesthesiol 2021; 75:79-85. [PMID: 34283910 PMCID: PMC8831438 DOI: 10.4097/kja.21229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Interfascial plane block applications can be used for postoperative pain after laparoscopic surgery. We aimed to investigate the effect of ultrasound-guided unilateral rhomboid intercostal and subserratus plane (RISS) block after laparoscopic cholecystectomy operations on the amount of analgesic use. Methods 50 patients underwent laparoscopic cholecystectomy were included in the quasi-experimental study. Patients meeting the criteria were analyzed in two groups as experimental group (RISS block with 20 ml %0.25 bupivacaine+intravenous patient-controlled analgesia (IV-PCA) tramadol ; n = 25) and group Control (IV-PCA tramadol; n = 25).The primary outcome was the total amount of tramadol used over 24 hours.Secondary outcomes included the side effects, additional analgesic use and postoperative pain (during rest and activity) was at the 2nd, 6th, 12th, and 24th hours using the NRS scores . Results Postoperative tramadol consumption at the 24 hours was significantly lower in the Group RISS than the Group Control (p<0.001). The resting NRS scores at the 2nd and 6th hours were statistically significantly low in the Grup RISS. The NRS scores during movement in Grup RISS were significantly low at the postoperative 2nd, 6th, and 12th hours.There was no statistically significant difference in the rate of side effects and additional analgesic use between the groups (p>0.05). Conclusions In conclusion, unilateral RISS block is an effective method for pain management after laparoscopic cholecystectomy and can be used as a part of multimodal analgesia.
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Affiliation(s)
- Korgün Ökmen
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
| | - Hande Gürbüz
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
| | - Hakan Özkan
- Department of Anesthesiology and Reanimation , Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences , Bursa/TURKEY
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Fede C, Petrelli L, Guidolin D, Porzionato A, Pirri C, Fan C, De Caro R, Stecco C. Evidence of a new hidden neural network into deep fasciae. Sci Rep 2021; 11:12623. [PMID: 34135423 PMCID: PMC8209020 DOI: 10.1038/s41598-021-92194-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.
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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy.
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
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Li W, Gong Y, Liu J, Guo Y, Tang H, Qin S, Zhao Y, Wang S, Xu Z, Chen B. Peripheral and Central Pathological Mechanisms of Chronic Low Back Pain: A Narrative Review. J Pain Res 2021; 14:1483-1494. [PMID: 34079363 PMCID: PMC8166276 DOI: 10.2147/jpr.s306280] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/01/2021] [Indexed: 12/31/2022] Open
Abstract
Chronic low back pain (CLBP), lasting >3 months, is the end result of multiple pathogenic factors. Unfortunately, little is known about CLBP pathogenesis, which limits its advancements in clinical therapy and disease management. This paper summarizes the known pathological axes of CLBP, involving both peripheral and central systems. In particular, this paper details injurious nerve stimulation, inflammation-induced peripheral pathway, and central sensitization. Lumbar components, such as intervertebral disc (IVD), facet joints, muscles, fascia, ligaments, and joint capsules, contain pain receptors called nociceptors. Degeneration of the aforementioned lumbar components activates inflammatory pathways, which can directly damage nerves, lower nociceptor threshold to fire action potentials (AP), and cause pain. Additionally, damaged lumbar IVDs and endplates can also lead to the pathologic invasion of nerve growth and innervation, followed by the compression of herniated IVDs on nerve roots, thereby causing traumatic neuropathic pain. The central mechanism of CLBP involves alteration of the sensory processing of the brain and malfunction of the descending pain modulatory system, which facilitates pain amplification in the center nervous system (CNS). Lastly, abnormalities in the brain biochemical metabolism, activation of glial cells, and subsequent inflammation also play important roles in CLBP development. Taken together, inflammation plays an important role in both peripheral and central sensitization of CLBP. Due to the heterogeneity of CLBP, its pathological mechanism remains complex and difficult to understand. Therefore, it is a worthy field for future research into the subcomponents of CLBP pathogenesis, in order to distinguish the specific form of the disease, identify its origins, and develop corresponding highly effective comprehensive therapy against CLBP.
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Affiliation(s)
- Wei Li
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Yinan Gong
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Jingyi Liu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Yongming Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Huiling Tang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Siru Qin
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Yadan Zhao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Songtao Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Zhifang Xu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Bo Chen
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
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Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study. J Clin Med 2021; 10:jcm10092006. [PMID: 34067152 PMCID: PMC8125255 DOI: 10.3390/jcm10092006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 01/14/2023] Open
Abstract
Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.
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