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Zullo A, Fleckenstein J, Schleip R, Hoppe K, Wearing S, Klingler W. Structural and Functional Changes in the Coupling of Fascial Tissue, Skeletal Muscle, and Nerves During Aging. Front Physiol 2020; 11:592. [PMID: 32670080 PMCID: PMC7327116 DOI: 10.3389/fphys.2020.00592] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Aging is a one-way process associated with profound structural and functional changes in the organism. Indeed, the neuromuscular system undergoes a wide remodeling, which involves muscles, fascia, and the central and peripheral nervous systems. As a result, intrinsic features of tissues, as well as their functional and structural coupling, are affected and a decline in overall physical performance occurs. Evidence from the scientific literature demonstrates that senescence is associated with increased stiffness and reduced elasticity of fascia, as well as loss of skeletal muscle mass, strength, and regenerative potential. The interaction between muscular and fascial structures is also weakened. As for the nervous system, aging leads to motor cortex atrophy, reduced motor cortical excitability, and plasticity, thus leading to accumulation of denervated muscle fibers. As a result, the magnitude of force generated by the neuromuscular apparatus, its transmission along the myofascial chain, joint mobility, and movement coordination are impaired. In this review, we summarize the evidence about the deleterious effect of aging on skeletal muscle, fascial tissue, and the nervous system. In particular, we address the structural and functional changes occurring within and between these tissues and discuss the effect of inflammation in aging. From the clinical perspective, this article outlines promising approaches for analyzing the composition and the viscoelastic properties of skeletal muscle, such as ultrasonography and elastography, which could be applied for a better understanding of musculoskeletal modifications occurring with aging. Moreover, we describe the use of tissue manipulation techniques, such as massage, traction, mobilization as well as acupuncture, dry needling, and nerve block, to enhance fascial repair.
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Affiliation(s)
- Alberto Zullo
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy
- CEINGE Advanced Biotechnologies, Naples, Italy
| | - Johannes Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University Frankfurt, Frankfurt, Germany
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller University Jena, Jena, Germany
| | - Kerstin Hoppe
- Department of Anaesthesiology, Würzburg University, Würzburg, Germany
| | - Scott Wearing
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
- Faculty of Health School, Queensland University of Technology, Brisbane, QLD, Australia
| | - Werner Klingler
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
- Faculty of Health School, Queensland University of Technology, Brisbane, QLD, Australia
- Fascia Research Group, Department of Experimental Anaesthesiology, Ulm University, Ulm, Germany
- Department of Anaesthesiology, SRH Hospital Sigmaringen, Sigmaringen, Germany
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Li Y, McPhee IC, Lau MPH, Pease LF. Biomimetic surgical mesh to replace fascia with tunable force-displacement. J Theor Biol 2019; 486:110058. [PMID: 31678097 DOI: 10.1016/j.jtbi.2019.110058] [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: 12/31/2018] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
Here we mimic the mechanical properties of native fascia to design surgical mesh for fascia replacement. Despite the widespread acceptance of synthetic materials as tissue scaffolds for pelvic floor disorders, mechanical property mismatch between mesh and adjacent native tissue drives fibrosis and erosion, leading the FDA to remove several surgical meshes from the market. However, autologous tissue does not induce either fibrosis or adjacent tissue erosion, suggesting the potential for biomimetic surgical mesh. In this study, we determined the design rules for mesh that mimics native fascia by mathematically modeling multi-component polymer networks, composed of elastin-like and collagen-like fibers, using a spring-network model. To validate the model, we measured the stress-strain curves of native bovine and nonhuman primate (Macaca mulatta) abdominal fascia in both toe and linear regions. We find that the stiffer collagen-like fibers must remain limp until the elastin-like fibers extend to the initial length of spanning collagen-like fibers under uniaxial tension. Comparing model results to experiment determines the product of fiber volume fraction and elastic modulus, a critical design parameter. Dual fiber mesh with mechanical properties that mimic fascia are feasible. These results have broad application to a wide range of soft tissue replacements including ~200,000 surgeries/year for pelvic floor disorders, because standard-of-care mesh contain only stiffer polymers that behave more like collagen than native tissue.
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Affiliation(s)
- Yuan Li
- Department of Chemical Engineering, College of Engineering, University of Utah, 50 S. Central Campus Drive, 3290 Merrill Engineering Building, Salt Lake City, UT 84112, USA
| | - Ian C McPhee
- Department of Chemical Engineering, College of Engineering, University of Utah, 50 S. Central Campus Drive, 3290 Merrill Engineering Building, Salt Lake City, UT 84112, USA
| | - Michael P H Lau
- Novo Contour, 7015 147th Street. SW, Edmonds, WA 98026, USA; Total Women's Health, 7500 212th Street. SW, Suite 214, Edmonds, WA 98026, USA
| | - Leonard F Pease
- Department of Chemical Engineering, College of Engineering, University of Utah, 50 S. Central Campus Drive, 3290 Merrill Engineering Building, Salt Lake City, UT 84112, USA; Novo Contour, 7015 147th Street. SW, Edmonds, WA 98026, USA; Department of Internal Medicine, Division of Gastroenterology, School of Medicine, University of Utah, 30 N. 1900 E., Salt Lake City, UT 84132, USA; Department of Pharmaceutics & Pharmaceutical Chemistry, College of Pharmacy, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, USA.
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Latorre M, Peña E, Montáns FJ. Determination and Finite Element Validation of the WYPIWYG Strain Energy of Superficial Fascia from Experimental Data. Ann Biomed Eng 2016; 45:799-810. [PMID: 27600686 DOI: 10.1007/s10439-016-1723-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
What-You-Prescribe-Is-What-You-Get (WYPIWYG) procedures are a novel and general phenomenological approach to modelling the behavior of soft materials, applicable to biological tissues in particular. For the hyperelastic case, these procedures solve numerically the nonlinear elastic material determination problem. In this paper we show that they can be applied to determine the stored energy density of superficial fascia. In contrast to the usual approach, in such determination no user-prescribed material parameters and no optimization algorithms are employed. The strain energy densities are computed solving the equilibrium equations of the set of experiments. For the case of superficial fascia it is shown that the mechanical behavior derived from such strain energies is capable of reproducing simultaneously the measured load-displacement curves of three experiments to a high accuracy.
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Affiliation(s)
- Marcos Latorre
- Escuela Técnica Superior de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Plaza Cardenal Cisneros, 3, 28040, Madrid, Spain
| | - Estefanía Peña
- Aragón Institute of Engineering Research (I3A), Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain.,CIBER de Bioingeniera, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Francisco J Montáns
- Escuela Técnica Superior de Ingeniería Aeronáutica y del Espacio, Universidad Politécnica de Madrid, Plaza Cardenal Cisneros, 3, 28040, Madrid, Spain.
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Welk AB, Haun DW, Clark TB, Kettner NW. Use of High-Resolution Ultrasound to Measure Changes in Plantar Fascia Thickness Resulting From Tissue Creep in Runners and Walkers. J Manipulative Physiol Ther 2015; 38:81-85. [DOI: 10.1016/j.jmpt.2014.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/25/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
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Abstract
This investigation is devoted to the study of the viscoelastic behavior of human abdominal fascia from the umbilical region. Seventeen samples 10 mm wide and up to 70 mm long were cut along the primary fiber direction (group FL) or perpendicular to it (group FT) and subjected to relaxation tests. The viscoelastic response of the tissue at three different strain levels (4%, 5%, and 6%) was investigated. The relaxation curves were fitted using a two-stage decaying exponential form. The following parameters were determined: initial stress σ(0), relaxation times τ(1) and τ(2), stress reduction Δσ, initial relaxation modulus E and equilibrium relaxation modulus E(eq), as well as the ratio E/E(eq). Fiber orientation and strain levels were varied to determine their influence on the viscoelastic properties of fascia. The results highlight the inherent viscoelastic mechanical properties of umbilical fascia. The values of the viscoelastic parameters determined for the longitudinal and transverse directions varied markedly. Significant differences were found between the two groups FL and FT for the initial stress at 5% and 6% strain (p < 0.038) and for the initial and equilibrium moduli at the 6% strain level (p < 0.046). The stress reduction in samples from the FL group (45-55%) was less than that in samples from the FT group (37-54%), but this difference was not significant (p > 0.388). The influence of strain level on the parameter values was not statistically significant (p > 0.121). The nonlinear response of the tissue was demonstrated over the chosen strain range.
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Affiliation(s)
- Miglena Kirilova
- Department of Biomechanics, Institute of Mechanics, Bulgarian Academy of Sciences, Sofia, Bulgaria.
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