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Kellis E, Kekelekis A, Drakonaki EE. Paraspinal Muscle Stiffness during Hamstring Exercise Using Shear-Wave Elastography. Sports (Basel) 2024; 12:199. [PMID: 39195575 PMCID: PMC11360625 DOI: 10.3390/sports12080199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/13/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
Soccer teams integrate specific exercises into their typical workout programs for injury prevention. This study examined the effects of hamstring exercise on paraspinal and hamstring stiffness. These findings can inform training and rehabilitation programs to improve muscle health and prevent injuries. Fifteen young, healthy males performed passive and active (submaximal) knee flexion efforts from 0°, 45°, to 90° angle of knee flexion from the prone position. Using shear-wave elastography (SWE) and surface electromyography, we measured the elastic modulus and root mean square (RMS) signal of the erector spinae (ES), multifidus (MF), semitendinosus (ST), and semimembranosus (SM) during different knee flexion angles. Passive SWE modulus at 0° was 12.44 ± 4.45 kPa (ES), 13.35 ± 6.12 kPa (MF), 22.01 ± 4.68 kPa (ST), and 21.57 ± 5.22 kPa (SM) and it was greater (p < 0.05) compared to 45° and 90°. The corresponding values during knee flexion contractions at 0° increased to 18.99 ± 6.11 kPa (ES), 20.65 ± 11.31 kPa (MF), 71.21 ± 13.88 kPa (ST), and 70.20 ± 14.29 kPa (SM) and did not differ between angles (p > 0.05). Compared to rest, the relative increase in the SWE modulus during active contraction had a median value (interquartile range) ranging from 68.11 (86.29) to 101.69 (54.33)% for the paraspinal muscles and it was moderately to strongly correlated (r > 0.672) with the corresponding increase of the hamstring muscles [ranging from 225.94 (114.72) to 463.16 (185.16)%]. The RMS signal was greater during active compared to passive conditions, and it was lower at 90° compared to 45° (for SM/ST) and 0° (for all muscles). The association between paraspinal and hamstring passive muscle stiffness indicates a potential transmission of forces through myofascial connections between the lumbar spine and the lower limbs. In this laboratory setting, hamstring exercises affected the stiffness of the paraspinal muscles.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece;
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Agios Ioannis, 62110 Serres, Greece;
| | - Eleni E. Drakonaki
- Department of Anatomy, Medical School, University of Crete, 71110 Heraklion Crete, Greece;
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Ficarra S, Scardina A, Nakamura M, Patti A, Şahin FN, Palma A, Bellafiore M, Bianco A, Thomas E. Acute effects of static stretching and proprioceptive neuromuscular facilitation on non-local range of movement. Res Sports Med 2024:1-13. [PMID: 38459925 DOI: 10.1080/15438627.2024.2326520] [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: 04/20/2023] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
Acute effects of static stretching (SS) and proprioceptive neuromuscular facilitation (PNF) on local and non-local range of motion (ROM) were assessed in 29 participants. Three evaluations were performed one week apart: week-1 Control session (CS); weeks 2-3 either SS or PNF interventions (randomized). Dominant and non-dominant limbs, local (hamstring extensibility) and non-local ROMs (Shoulder extension-ShE) were collected at baseline (T0), immediately after (T1), and fifteen minutes post-intervention (T2). No differences were found between time-points during the CS. Local-ROM significantly increased (p=0.0002, ES=0.74 and 0.0079, 0.56, for dominant and non-dominant lower limbs, respectively) after both SS and PNF. No interaction between time and treatment was detected for ShE in both limbs. However, post-hoc analysis revealed a significant increase in dominant upper limb ShE between T0 and T1 only after SS (p=0.002; +6.5%). Acute bouts of SS and PNF can increase local-ROM, however, no clear effects were observed for non-local ROM.
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Affiliation(s)
- Salvatore Ficarra
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonino Scardina
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishikyushu University, Kanzaki, Saga, Japan
| | - Antonino Patti
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Fatma Neşe Şahin
- Department of Coaching Education, Faculty of Sport Science, Ankara University, Ankara, Turkey
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Marianna Bellafiore
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Ewan Thomas
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Kellis E, Kekelekis A, Drakonaki EE. Is thoracolumbar fascia shear-wave modulus affected by active and passive knee flexion? J Anat 2024; 244:438-447. [PMID: 37965913 PMCID: PMC10862179 DOI: 10.1111/joa.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
The purpose of this study was to examine the effect of passive and active knee flexion efforts on the stiffness of the thoracolumbar (TLF), semitendinosus (STF), and semimembranosus fascia (SMF). Fourteen young healthy males participated in this study. Using ultrasound shear-wave elastography, fascia elastic modulus was measured at rest (passive condition) and during submaximal isometric knee flexion efforts (active condition) with the hip at neutral position and the knee flexed at 0°, 45°, and 90°. Analysis of variance designs indicated that when the knee was passively extended from 90° to 0°, shear modulus of the TLF, SMF, and STF increased significantly (p < 0.05). Similarly, active knee flexion contractions caused a significant increase in TLF, SMF, and STF shear modulus (p < 0.001). Compared to hamstring fascia, the TLF showed greater thickness but a lower shear modulus (p < 0.05) while STF modulus was greater compared that to SMF during active contraction (p < 0.05). These results indicate that exercising the hamstring muscles can remotely influence the stiffness of the fascia which surrounds the lumbar area.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at SerresAristotle University of ThessalonikiSerresGreece
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at SerresAristotle University of ThessalonikiSerresGreece
| | - Eleni E. Drakonaki
- Department of Anatomy, Medical SchoolUniversity of CreteHeraklionCreteGreece
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Bhatnagar T, Azim FT, Behrouzian M, Davies K, Wickenheiser D, Jahren G, West N, Leveille L, Lauder GR. Assessing changes in range of motion in adolescent patients undergoing myoActivation® for chronic pain related to myofascial dysfunction: a feasibility study. FRONTIERS IN PAIN RESEARCH 2023; 4:1225088. [PMID: 37954067 PMCID: PMC10634437 DOI: 10.3389/fpain.2023.1225088] [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: 05/18/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction myoActivation® assessment utilizes systemized movement tests to assess for pain and limitations in motion secondary to myofascial dysfunction. myoActivation needling therapy resolves the myofascial components of pain and is associated with immediately observed changes in pain, flexibility, and range of motion. The principal aim of this feasibility study was to objectively characterize the kinematic metrics of upper and lower body motion before and after myoActivation movement tests and therapy. Methods Five consecutive eligible adolescent participants considered appropriate for myoActivation were consented to receive their myoActivation intervention in a motion laboratory. Clinical motion analysis was used to measure the changes in maximum range of motion (maxROM) and maximum angular speed to maximum ROM (speedROM) of movement tests predicted to change. Metrics were analyzed to assess changes over specified time intervals - i) baseline to after initial myoActivation session, and ii) baseline to after complete myoActivation course. Each participant served as their own control. Results We demonstrated objective evidence of improved maxROM and/or speedROM in 63% of the movement tests predicted to change after just one session of myoActivation and in 77% of movement tests predicted to change over the complete course of treatment. The myoActivation clinician observed positive change in 11/19 of movement tests across all patients, that were predicted to change after the initial myoActivation session; 81% of these positive changes were confirmed by the kinematic data. Discussion Clinical motion analysis provides objective support to clinicians evaluating, treating, and teaching myofascial release. A larger, prospective clinical trial is warranted to explore the impact of myoActivation on movement. Refinement of observation techniques and outcome measures established in this feasibility study will strengthen future clinical motion analysis of the myoActivation process.
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Affiliation(s)
- Tim Bhatnagar
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Farah T. Azim
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Mona Behrouzian
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Karen Davies
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Diane Wickenheiser
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
| | - Gail Jahren
- Department of Nursing, BC Children’s Hospital, Vancouver, BC, Canada
| | - Nicholas West
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
| | - Lise Leveille
- The Motion Lab, Sunny Hill Centre at BC Children’s Hospital, Vancouver, BC, Canada
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada
| | - Gillian R. Lauder
- Research Institute, BC Children’s Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Lu Y, Chen J, Zhang XL. Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis. J Sport Rehabil 2023; 32:818-826. [PMID: 37527818 DOI: 10.1123/jsr.2022-0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. METHODS Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. RESULTS Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P < .001), decreased ankle plantar flexion range (P = .023), ankle resting position more inclined to dorsiflexion (P = .017), increased ankle dorsiflexion stiffness (P = .005), and lower ankle plantar flexion stiffness (P = .034). After exercise intervention, the knee OA group self-reported less knee pain (P < .001), improved physical function (P < .001), increased maximum dorsiflexion (P = .021), and increased plantar flexion range (P < .001). While plantar flexion stiffness increased (P = .037), dorsiflexion stiffness decreased (P = .015) and ankle resting position moved toward dorsiflexion (P = .002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. CONCLUSIONS The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension.
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Affiliation(s)
- Yao Lu
- Qilu Institute of Technology, Qufu, SD,China
| | - Jie Chen
- Qingdao Hengxing University of Science and Technology, Qingdao, SD,China
- Auckland Bioengineering Institute, The University of Auckland, Auckland,New Zealand
| | - Xue-Lin Zhang
- Department of Physical Science, Qufu Normal University, Qufu, SD,China
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Konrad A, Reiner MM, Gabriel A, Warneke K, Nakamura M, Tilp M. Remote effects of a 7-week combined stretching and foam rolling training intervention of the plantar foot sole on the function and structure of the triceps surae. Eur J Appl Physiol 2023; 123:1645-1653. [PMID: 36973555 PMCID: PMC10363033 DOI: 10.1007/s00421-023-05185-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
It is known that a single bout of foam rolling (FR) or stretching can induce changes in range of motion (ROM) and performance in non-directly adjoining areas of the dorsal chain (i.e., remote effects). However, to date, it is not known if such effects exist following long-term interventions. Thus, the purpose of this study was to investigate the remote effects of a 7-week combined stretching and FR training intervention of the plantar foot sole. Thirty-eight recreational athletes were randomly assigned to either an intervention (n = 20) or control (n = 18) group. The intervention group performed stretching and FR exercises of the plantar foot sole for 7 weeks. Before and after the intervention, the dorsiflexion ankle ROM, passive resistive torque at maximum angle (PRTmax) and at a fixed angle, as well as maximum voluntary isometric contraction (MVIC) torque, were measured with a dynamometer. Gastrocnemius medialis and lateralis stiffness was assessed with shear wave elastography. The results showed no interaction effect for any of the parameters. There was a time effect indicating an increase in MVIC and PRTmax, which was more pronounced in the intervention group (+ 7.4 (95% CI 2.5-12.4), + 4.5 (95% CI - 0.2-9.2)) than the control group (+ 3.6 (95% CI - 1.4-8.6), + 4.0 (95% CI - 2.2 to 10.2)). The results indicate no or minor remote effects of combined stretching and FR of the foot sole in the ankle joint. Potential non-significant changes in ROM were accompanied with an increase in stretch tolerance, but not with changes in muscle structure.
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Affiliation(s)
- Andreas Konrad
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - Marina Maren Reiner
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Anna Gabriel
- Professorship for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
| | - Konstantin Warneke
- Institute for Exercise, Sport and Health, Leuphana University, Lüneburg, Germany
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, Ozaki, Kanzaki, Saga, Japan
| | - Markus Tilp
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010, Graz, Austria
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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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The Effect of Remote Myofascial Release on Chronic Nonspecific Low Back Pain With Hamstrings Tightness. J Sport Rehabil 2023:1-8. [PMID: 36928003 DOI: 10.1123/jsr.2022-0141] [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: 04/08/2022] [Revised: 12/03/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023]
Abstract
CONTEXT Anatomy trains theory states that performing techniques in any part of the superficial myofascial backline can remotely treat other parts of this pathway. Due to the connections of different parts of the superficial backline, it is possible to influence the hamstring by performing the technique in the lumbar area. As chronic nonspecific low back pain (LBP) may lead to or be caused by hamstring tightness, remote myofascial release (MFR) techniques using the superficial backline can help improve hamstring tightness. OBJECTIVE This study aimed to evaluate the effect of remote MFR on hamstring tightness for those with chronic nonspecific LBP. DESIGN Single-blind, parallel design. SETTING The present study was performed at the clinical setting of Tarbiat Modares University in Iran. METHODS This study included 40 participants (20 males and 20 females) who were 40.5 (5.3) years old with chronic nonspecific LBP and hamstring tightness. INTERVENTIONS Participants were randomly divided into the lumbar MFR (remote area) and hamstring MFR groups. Participants underwent 4 sessions of MFR for 2 weeks. MAIN OUTCOME MEASURES A passive knee-extension (PKE) test was used for muscle tightness evaluation 3 times. RESULTS Repeated-measure analysis of variance test showed that after the lumbar and hamstring MFR, the PKE was significantly reduced in both legs: lumbar MFR (right knee: from 61.04° [2.17°] to 51.01° [4.11°], P ≤ .003 and left knee: from 63.02° [3.12°] to 52.09° [2.48°], P ≤ .004) and hamstring MFR (right knee: from 62.01° [4.32°] to 50.50° [7.18°], P ≤ .001 and left knee: from 63.11° [2.56°] to 51.32° [5.31°], P ≤ .002). Least Significant Difference (LSD) post hoc test results showed that the 2 groups were not significantly different after the MFR (P ≥ .05). Also, the intraclass correlation coefficient index showed that the PKE test has excellent reliability (intraclass correlation coefficient, .910 for the right limb and .915 for the left limb). The minimal detectable change at the 95% confidence interval indicated that a change greater than or equal to 6° is required to exceed the threshold of the error PKE test, respectively. CONCLUSION The present study showed that the remote MFR technique to the lumbar region demonstrated the same significant results in decreasing hamstring tightness as was noted in hamstring MFR to both limbs in patients with chronic nonspecific LBP.
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Büyükşireci DE, Demirsoy N, Mit S, Geçioğlu E, Onurlu İ, Günendi Z. Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain. J Acupunct Meridian Stud 2022; 15:347-355. [PMID: 36537117 DOI: 10.51507/j.jams.2022.15.6.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acupuncture and myofascial meridians show great anatomical and clinical compatibility. Objectives We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. Methods We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Results Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Conclusion Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.
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Affiliation(s)
- Dilek Eker Büyükşireci
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Setenay Mit
- Traditional and Complementary Medical Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ersel Geçioğlu
- Traditional and Complementary Medical Center, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İlknur Onurlu
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
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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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11
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Ličen T, Kalc M, Vogrin M, Bojnec V. Injury Prevention in Tennis Players, Linking the Kinetic Chain Approach With Myofascial Lines: A Narrative Review With Practical Implications. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Ajimsha M, Shenoy PD, Surendran PJ, Jacob P, Bilal MJ. Evidence of in-vivo myofascial force transfer in humans; a systematic scoping review. J Bodyw Mov Ther 2022; 32:183-195. [DOI: 10.1016/j.jbmt.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/16/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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13
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Coutinho Neta TCDM, Tenório ADS, Oliveira-Souza AIS, Chagas ACDS, Rocha-Filho PAS, Villela DW, de Oliveira DA. Neck and back muscle chains hypomobility in women with migraine. J Bodyw Mov Ther 2021; 28:470-477. [PMID: 34776180 DOI: 10.1016/j.jbmt.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free. METHODS This is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n = 24), chronic migraine (CMG, n = 36) and headache-free (CG, n = 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles). RESULTS Compared to woman headache-free, women with migraine (MD = -12° [CI95% = -19°, -5°] and chronic migraine (MD = -15° [CI95% = -21°, -8°] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD = -9° [CI95% = -15°, -2°]) and chronic migraine vs headache-free (MD = -10° [CI95% = -16°, -4°]) and in the back flexor muscle chain, migraine vs headache-free (MD = -6° [CI95% = -10°, -0.1°]) and chronic migraine vs headache-free (MD = -7 [CI95% = -11°, -2°]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain. CONCLUSION Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.
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Affiliation(s)
| | - Angélica da Silva Tenório
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, PE, Brazil.
| | | | | | | | - Débora Wanderley Villela
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Daniella Araújo de Oliveira
- Department of Physical Therapy, Health Sciences Center, Federal University of Pernambuco, Recife, PE, Brazil.
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14
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Behm DG, Alizadeh S, Drury B, Granacher U, Moran J. Non-local acute stretching effects on strength performance in healthy young adults. Eur J Appl Physiol 2021; 121:1517-1529. [PMID: 33715049 DOI: 10.1007/s00421-021-04657-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Static stretching (SS) can impair performance and increase range of motion of a non-exercised or non-stretched muscle, respectively. An underdeveloped research area is the effect of unilateral stretching on non-local force output. OBJECTIVE The objective of this review was to describe the effects of unilateral SS on contralateral, non-stretched, muscle force and identify gaps in the literature. METHODS A systematic literature search following preferred reporting items for systematic review and meta-analyses Protocols guidelines was performed according to prescribed inclusion and exclusion criteria. Weighted means and ranges highlighted the non-local force output response to unilateral stretching. The physiotherapy evidence database scale was used to assess study risk of bias and methodological quality. RESULTS Unilateral stretching protocols from six studies involved 6.3 ± 2 repetitions of 36.3 ± 7.4 s with 19.3 ± 5.7 s recovery between stretches. The mean stretch-induced force deficits exhibited small magnitude effect sizes for both the stretched (-6.7 ± 7.1%, d = -0.35: 0.01 to -1.8) and contralateral, non-stretched, muscles (-4.0 ± 4.9%, d = , 0.22: 0.08 to 1.1). Control measures exhibited trivial deficits. CONCLUSION The limited literature examining non-local effects of prolonged SS revealed that both the stretched and contralateral, non-stretched, limbs of young adults demonstrate small magnitude force deficits. However, the frequency of studies with these effects were similar with three measures demonstrating deficits, and four measures showing trivial changes. These results highlight the possible global (non-local) effects of prolonged SS. Further research should investigate effects of lower intensity stretching, upper versus lower body stretching, different age groups, incorporate full warm-ups, and identify predominant mechanisms among others.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's,, Newfoundland and Labrador, Canada
| | - Ben Drury
- Department of Applied Sport Sciences, Hartpury University, Gloucester, UK
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK
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15
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Behm DG, Alizadeh S, Anvar SH, Drury B, Granacher U, Moran J. Non-local Acute Passive Stretching Effects on Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis. Sports Med 2021; 51:945-959. [PMID: 33459990 DOI: 10.1007/s40279-020-01422-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stretching a muscle not only increases the extensibility or range of motion (ROM) of the stretched muscle or joint but there is growing evidence of increased ROM of contralateral and other non-local muscles and joints. OBJECTIVE The objective of this meta-analysis was to quantify crossover or non-local changes in passive ROM following an acute bout of unilateral stretching and to examine potential dose-response relations. METHODS Eleven studies involving 14 independent measures met the inclusion criteria. The meta-analysis included moderating variables such as sex, trained state, stretching intensity and duration. RESULTS The analysis revealed that unilateral passive static stretching induced moderate magnitude (standard mean difference within studies: SMD: 0.86) increases in passive ROM with non-local, non-stretched joints. Moderating variables such as sex, trained state, stretching intensity, and duration did not moderate the results. Although stretching duration did not present statistically significant differences, greater than 240-s of stretching (SMD: 1.24) exhibited large magnitude increases in non-local ROM compared to moderate magnitude improvements with shorter (< 120-s: SMD: 0.72) durations of stretching. CONCLUSION Passive static stretching of one muscle group can induce moderate magnitude, global increases in ROM. Stretching durations greater than 240 s may have larger effects compared with shorter stretching durations.
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Affiliation(s)
- David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Shahab Alizadeh
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Saman Hadjizadeh Anvar
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.,Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Ben Drury
- Department of Applied Sport Sciences, Hartpury University, Hartpury, UK
| | - Urs Granacher
- Division of Training and Movement Science, University of Potsdam, Potsdam, Germany
| | - Jason Moran
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Essex, UK.
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16
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Martínez-Lema D, Guede-Rojas F, González-Fernández K, Soto-Martínez A, Lagos-Hausheer L, Vergara-Ríos C, Márquez-Mayorga H, Mancilla CS. Immediate effects of a direct myofascial release technique on hip and cervical flexibility in inactive females with hamstring shortening: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:57-63. [PMID: 33992297 DOI: 10.1016/j.jbmt.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Currently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility. OBJECTIVE Our goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening. METHOD The sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group. RESULTS The mixed factorial ANOVA did not show significant intergroup differences (p > 0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p < 0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p < 0.001). CONCLUSIONS We conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.
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Affiliation(s)
- Daniel Martínez-Lema
- Kinesiology, Faculty of Health Sciences, GICAV, Universidad Arturo Prat, Victoria, Chile.
| | - Francisco Guede-Rojas
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | | | - Adolfo Soto-Martínez
- Kinesiology, Faculty of Health Sciences, Universidad de Las Américas, Concepción, Chile.
| | | | - César Vergara-Ríos
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | - Héctor Márquez-Mayorga
- Kinesiology, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepción, Chile.
| | - Carlos S Mancilla
- Kinesiology, Faculty of Health Sciences, GICAV, Universidad Arturo Prat, Victoria, Chile.
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17
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Ajimsha MS, Shenoy PD, Gampawar N. Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review. J Bodyw Mov Ther 2020; 24:423-431. [PMID: 33218543 DOI: 10.1016/j.jbmt.2020.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/19/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. METHODS A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring). RESULTS Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. CONCLUSION Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.
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Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar.
| | - Pramod D Shenoy
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Neeraj Gampawar
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
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18
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Lu L, Robinson M, Tan Y, Goonewardena K, Guo X, Mareels I, Oetomo D. Effective Assessments of a Short-Duration Poor Posture on Upper Limb Muscle Fatigue Before Physical Exercise. Front Physiol 2020; 11:541974. [PMID: 33132916 PMCID: PMC7579401 DOI: 10.3389/fphys.2020.541974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022] Open
Abstract
A forward head and rounded shoulder posture is a poor posture that is widely seen in everyday life. It is known that sitting in such a poor posture with long hours will bring health issues such as muscle pain. However, it is not known whether sitting in this poor posture for a short period of time will affect human activities. This paper investigates the effects of a short-duration poor posture before some typical physical activities such as push-ups. The experiments are set up as follows. Fourteen male subjects are asked to do push-ups until fatigue with two surface electromyography (sEMG) at the upper limb. Two days later, they are asked to sit in this poor posture for 15 min with eight sEMG sensors located at given back muscles. Then they do the push-ups after the short-duration poor posture. The observations from the median frequency of sEMG signals at the upper limb indicate that the short-duration poor posture does affect the fatigue procedure of push-ups. A significant decreasing trend of the performance of push-ups is obtained after sitting in this poor posture. Such effects indicate that some parts of the back muscles indeed get fatigued with only 15 min sitting in this poor posture. By further investigating the time-frequency components of sEMG of back muscles, it is observed that the low and middle frequencies of sEMG signals from the infraspinatus muscle of the dominant side are demonstrated to be more prone to fatigue with the poor posture. Although this study focuses only on push-ups, similar experiments can be arranged for other physical exercises as well. This study provides new insights into the effect of a short-duration poor posture before physical activities. These insights can be used to guide athletes to pay attention to postures before physical activities to improve performance and reduce the risk of injury.
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Affiliation(s)
- Lei Lu
- Melbourne School of Engineering, The University of Melbourne, Parkville, VIC, Australia.,School of Mechatronics Engineering, Harbin Institute of Technology, Harbin, China
| | - Mark Robinson
- Melbourne School of Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Ying Tan
- Melbourne School of Engineering, The University of Melbourne, Parkville, VIC, Australia
| | | | - Xinliang Guo
- Melbourne School of Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Iven Mareels
- IBM Research - Australia, Southbank, VIC, Australia
| | - Denny Oetomo
- Melbourne School of Engineering, The University of Melbourne, Parkville, VIC, Australia
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19
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Simatou M, Papandreou M, Billis E, Tsekoura M, Mylonas K, Fousekis K. Effects of the Ergon ® instrument-assisted soft tissue mobilization technique (IASTM), foam rolling, and static stretching application to different parts of the myofascial lateral line on hip joint flexibility. J Phys Ther Sci 2020; 32:288-291. [PMID: 32273652 PMCID: PMC7113418 DOI: 10.1589/jpts.32.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
[Purpose] This study was aimed to compare the effects of three soft tissue treatments in different parts of the myofascial lateral line (LL) on the hip adduction range of motion (ROM). [Participants and Methods] Thirty university students received Ergon® instrument-assisted soft tissue mobilization (IASTM) treatment, foam rolling, and static stretching on the upper or lower part of the LL on the side of their non-dominant lower limb, while the other body side served as control. The participants received one treatment per week for six weeks with a simultaneous pre-and post-therapy assessment of their hip adduction ROM. [Results] The hip adduction ROM was improved on the intervention side in all experimental groups. The gains were more significant in groups that received the Ergon treatment. All Ergon interventions, as well as foam rolling on the upper part of the LL, led to the greatest hip adduction ROM improvement compared to the control side. No differences were observed between the Ergon groups. [Conclusion] The findings suggest that the implementation of Ergon IASTM, foam rolling, and stretching can produce positive effects on the hip ROM. The Ergon Technique is more effective compared to foam rolling and stretching, irrespective of the application site.
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Affiliation(s)
- Maria Simatou
- Department of Physical Therapy, University of Patras: Psarron 6, Egio, Achaia 25100, Greece
| | - Maria Papandreou
- Department of Physical Therapy, University of West Attica, Greece
| | - Evdokia Billis
- Department of Physical Therapy, University of Patras: Psarron 6, Egio, Achaia 25100, Greece
| | - Maria Tsekoura
- Department of Physical Therapy, University of Patras: Psarron 6, Egio, Achaia 25100, Greece
| | - Konstantinos Mylonas
- Department of Physical Therapy, University of Patras: Psarron 6, Egio, Achaia 25100, Greece
| | - Konstantinos Fousekis
- Department of Physical Therapy, University of Patras: Psarron 6, Egio, Achaia 25100, Greece
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20
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Wilke J, Debelle H, Tenberg S, Dilley A, Maganaris C. Ankle Motion Is Associated With Soft Tissue Displacement in the Dorsal Thigh: An in vivo Investigation Suggesting Myofascial Force Transmission Across the Knee Joint. Front Physiol 2020; 11:180. [PMID: 32210836 PMCID: PMC7069338 DOI: 10.3389/fphys.2020.00180] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/17/2020] [Indexed: 12/23/2022] Open
Abstract
Experiments in cadavers have demonstrated significant mechanical interactions between constituents of myofascial chains. However, evidence for such force transmission effects is scarce under in vivo conditions. The purpose of this trial was to examine the impact of ankle motion on soft tissue displacement of the dorsal thigh. Eleven healthy active individuals (26.8 ± 4.3 years, six males), in prone position and with the knee extended, underwent passive calf stretches (ankle dorsal extension) imposed by an isokinetic dynamometer. High-resolution ultrasound was used to simultaneously capture the displacement of the semimembranosus muscle, which was quantified by means of cross-correlation analysis. Inactivity of the leg muscles was controlled using surface electromyography (EMG). One participant had to be excluded due to major EMG activity during the experiment. According to a one-sample t test testing the difference to the neutral zero position, ankle dorsal extension induced substantial caudal muscle displacements (5.76 ± 2.67 mm, p < 0.0001). Correlation analysis (Spearman), furthermore, revealed a strong association between maximal dorsal extension and semimembranosus motion (rho = 0.76, p = 0.02). In conclusion, the present trial provides initial in vivo evidence for a mechanical force transmission between serially connected skeletal muscles. This means that local alterations of the mechanical tissue properties may modify flexibility in neighboring (superior or inferior) joints.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Heloise Debelle
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sarah Tenberg
- Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrew Dilley
- Department of Neuroscience, University of Sussex, Brighton, United Kingdom
| | - Constantinos Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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21
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Bordoni B, Myers T. A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains. Cureus 2020; 12:e7092. [PMID: 32226693 PMCID: PMC7096016 DOI: 10.7759/cureus.7092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022] Open
Abstract
The fascial tissue includes solid and liquid fascia (body fluids such as blood and lymph). The fascia's nomenclature is the subject of debate in the academic world, as it is classified starting from different scientific perspectives. This disagreement is not a brake but is, in reality, the real wealth of research, the multidisciplinarity of thought and knowledge that leads to a deeper understanding of the topic. Another topic of discussion is the fascial model to conceptualize the human body, that is, how the fascial tissue fits into the living. Currently, there are some models: biotensegrity, fascintegrity, and myofascial chains. Biotensegrity is a mechanical model, which takes into consideration the solid fascia; fascintegrity considers the solid and the liquid fascia. Myofascial chains converge attention on the movement and transmission of force in the muscle continuum. The article is a reflection on fascial models and how these are theoretical-scientific visions that need to be further investigated.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Thomas Myers
- Anatomy, Anatomy Trains International, Walpole, USA
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22
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Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis. J Sport Rehabil 2019; 29:650-656. [PMID: 31629335 DOI: 10.1123/jsr.2019-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). OBJECTIVE To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. EVIDENCE ACQUISITION In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. EVIDENCE SYNTHESIS Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22-36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; -0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. CONCLUSIONS Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.
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23
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Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, Findley T, Barbe MF, Steinacker JM, Vleeming A, Bloch W, Schleip R, Hodges PW. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med 2018; 52:1497. [PMID: 30072398 PMCID: PMC6241620 DOI: 10.1136/bjsports-2018-099308] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 01/10/2023]
Abstract
The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.
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Affiliation(s)
- Martina Zügel
- Division of Sports Medicine, Ulm University, Ulm, Germany
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt, Germany
| | | | - Werner Klingler
- Department of Anesthesiology, BKH Günzburg, Günzburg, Germany
| | - Scott C Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Thomas Findley
- Department of Physical Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Andry Vleeming
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Medical University Ghent, Ghent, Belgium
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine, German Sport University Cologne, Cologne, Germany
| | - Robert Schleip
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Paul William Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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24
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Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals - A randomized clinical trial. J Bodyw Mov Ther 2018; 22:832-837. [PMID: 30100320 DOI: 10.1016/j.jbmt.2018.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND The existence of continuity between fascia and muscles that may be anatomically distant from each other is emphasized in the tensegrity principle. Despite evidence from in vitro studies, there is a dearth of literature concerning the in vivo behavior of these connections. AIM To compare the effect of Static Stretching (SS) of hamstrings with remote Myofascial Release (MFR) (bilateral plantar fascia and suboccipital region) and a combination of SS and remote MFR on hamstring flexibility. The secondary aim of this study was to investigate the difference between therapist administered and self-administered interventions. DESIGN Three arm assessor-blinded Randomized Clinical Trial (RCT). PARTICIPANTS Fifty-eight asymptomatic participants (16 Males; Mean age 22.69 ± 2.65 years). METHOD Participants with tight hamstrings defined by a passive Knee Extension Angle (KEA) > 20° were included in the study and were assigned to one of the three groups. Group A (n = 19) was SS, group B (n = 20) was remote MFR, group C (n = 19) was a combination group who received both SS and remote MFR. Seven sessions of therapist administered intervention were delivered over a period of 10 days, which was followed by a 2-week self-administered home program. KEA and Sit and Reach Test (SRT) were used as outcomes and measurements were performed at baseline, end of the seventh session and after atwo-week follow-up. RESULTS The results demonstrated that hamstring flexibility improved in all three groups after therapist administered interventions (p < 0.05), whereas, group C demonstrated additional benefits. None of the groups showed a statistically significant (p > 0.05) change in the KEA with self-intervention. CONCLUSION The findings of this study indicated that all three interventions were effective in improving hamstring flexibility in young asymptomatic individuals when performed by the therapist.
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Dischiavi S, Wright A, Hegedus E, Bleakley C. Biotensegrity and myofascial chains: A global approach to an integrated kinetic chain. Med Hypotheses 2018; 110:90-96. [DOI: 10.1016/j.mehy.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 01/13/2023]
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Wilke J, Schleip R, Yucesoy CA, Banzer W. Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol (1985) 2018; 124:234-244. [DOI: 10.1152/japplphysiol.00565.2017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent research indicates that fascia is capable of changing its biomechanical properties. Moreover, as it links the skeletal muscles, forming a body-wide network of multidirectional myofascial continuity, the classical conception of muscles as independent actuators has been challenged. Hence, the present synthesis review aims to characterize the mechanical relevance of the connective tissue for the locomotor system. Results of cadaveric and animal studies suggest a clinically relevant myofascial force transmission to neighboring structures within one limb (e.g., between synergists) and in the course of muscle-fascia chains (e.g., between leg and trunk). Initial in vivo trials appear to underpin these findings, demonstrating the existence of nonlocal exercise effects. However, the factors influencing the amount of transmitted force (e.g., age and physical activity) remain controversial, as well as the role of the central nervous system within the context of the observed remote exercise effects.
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Affiliation(s)
- Jan Wilke
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
| | - Robert Schleip
- Fascia Research Group, Neurosurgical Clinic Guenzburg of Ulm University, Ulm, Germany
| | - Can A. Yucesoy
- Institute of Biomedical Engineering, Bogazici University, Instanbul, Turkey
| | - Winfried Banzer
- Department of Sports Medicine, Goethe University, Frankfurt am Main, Germany
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