Overuse Injury: The Result of Pathologically Altered Myofascial Force Transmission?

The effects of static and dynamic stretching on deep fascia stiffness: a randomized, controlled cross-over study

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.

A Comprehensive Analysis of Injuries During Army Basic Military Training

INTRODUCTION

The injury definitions and surveillance methods commonly used in Army basic military training (BMT) research may underestimate the extent of injury. This study therefore aims to obtain a comprehensive understanding of injuries sustained during BMT by employing recording methods to capture all physical complaints.

MATERIALS AND METHODS

Six hundred and forty-six recruits were assessed over the 12-week Australian Army BMT course. Throughout BMT injury, data were recorded via (1) physiotherapy reports following recruit consultation, (2) a member of the research team (third party) present at physical training sessions, and (3) recruit daily self-reports.

RESULTS

Two hundred and thirty-five recruits had ≥1 incident injury recorded by physiotherapists, 365 recruits had ≥1 incident injury recorded by the third party, and 542 recruits reported ≥1 injury-related problems via the self-reported health questionnaire. Six hundred twenty-one, six hundred eighty-seven, and two thousand nine hundred sixty-four incident injuries were recorded from a total of 997 physiotherapy reports, 1,937 third-party reports, and 13,181 self-reported injury-related problems, respectively. The lower extremity was the most commonly injured general body region as indicated by all three recording methods. Overuse accounted for 79% and 76% of documented incident injuries from physiotherapists and the third party, respectively.

CONCLUSIONS

This study highlights that injury recording methods impact injury reporting during BMT. The present findings suggest that traditional injury surveillance methods, which rely on medical encounters, underestimate the injury profile during BMT. Considering accurate injury surveillance is fundamental in the sequence of injury prevention, implementing additional injury recording methods during BMT may thus improve injury surveillance and better inform training modifications and injury prevention programs.

Acute Effects of Short-Term Massage Procedures on Neuromechanical Contractile Properties of Rectus Femoris Muscle

Background and Objectives: In many sports, maintaining muscle work at an optimal level despite fatigue is crucial. Therefore, it is essential to discover the most efficient way of recovery. This study aimed to evaluate and compare the acute effects of four different recovery methods on muscle neuromechanical properties. Materials and Methods: The research was conducted using a randomized, quasi-experimental, repeated-measures design. Fourteen healthy and active male students of the Faculty of Sport and Physical Education (age 25.1 ± 3.9 years) were included in this study. The tensiomyography was used to evaluate muscle responses after four different types of short-term recovery methods (passive rest, percussive mechanical, vibro-mechanical, and manual massage) on the rectus femoris muscle on four occasions: baseline, post fatigue, post recovery and prolonged recovery. Results: The ANOVA revealed that muscle fatigue decreased maximal vertical muscle displacement (Dm) and muscle contraction time (Tc) in post fatigue compared to the baseline. The most important finding shows that only the vibro-mechanical massage resulted in an increase in Tc in the prolonged recovery compared to the post fatigue (p = 0.028), whereas only manual massage showed no differences in Dm from the baseline in post-recovery (p = 0.148). Moreover, both manual and vibro-mechanical massages increased Dm and Tc in prolonged recovery, indicating no differences from the baseline (all p > 0.05), thus showing signs of muscle recovery. Percussion mechanical massage and passive rest did not show indices of muscle recovery. Conclusions: Manual massage could induce immediate positive changes in Dm by reducing muscle stiffness. In addition, vibro-mechanical and manual massage improved muscle tissue by rapidly returning Dm and Tc values to baseline at prolonged recovery measurement (5 min after the fatigue protocol). These findings can benefit sports practitioners, and physical therapists in developing the best recovery method after muscle fatigue.

Quantification of daily workload, energy expenditure, and sleep of US Marine recruits throughout a 10-week boot camp

BACKGROUND

During periods of high-volume vigorous exercise, United States Marine Corps recruits often experience musculoskeletal injuries. While the program of instruction (POI) for basic training is a defined training volume, the total workload of boot camp, including movements around the base, is unknown.

OBJECTIVE

The present study aimed to quantify the daily total workload, energy expenditure, and sleep during basic recruit training at Marine Corps Recruit Depot (MCRD) San Diego.

METHODS

Eighty-four male recruits from MCRD San Diego wore wrist wearable physiological monitors to capture their complete workload (mileage from steps), energy expenditure, and sleep throughout the 10-week boot camp.

RESULTS

Marine recruits traveled an average of 11.5±3.4 miles per day (M±SD), expended 4105±823 kcal per day, and slept an average of 5 : 48±1 : 06 hours and minutes per night. While the POI designates a total of 46.3 miles of running and hiking, the actual daily average miles yielded approximately 657.6±107.2 miles over the 10-week boot camp.

CONCLUSION

Recruit training requires high physical demand and time under tension due to the cumulative volume of movements around base in addition to the POI planned physical training.

Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis

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.

The effects of alteration in muscle activation on the iliotibial band during an exhaustive run

PURPOSE

Long exhausted running causes pain at the lateral femoral epicondyle for some runners. The pain has been revealed to be related to the behavior of the iliotibial band (ITB) during running. The purpose of this study is to examine the effects of in-series musculature on the behavior of the ITB in healthy participants during an exhaustive run.

METHODS

Twenty-five healthy participants (15 males, 10 females) were recruited in the current study. All participants performed a 30-minute exhaustive run at a self-selected speed with laboratory-provided footwear. Muscle activities of ITB-related muscles including tensor fascia latae (TFL), gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF), and vastus lateralis (VL) were recorded using surface electromyography (EMG).

RESULTS

Maximum amplitudes at the initial stage (the first minute), the mid stage (the 15-minute), and the end stage (the 30-minute) were compared during the exhaustive running. Significant decreases (p < 0.05) were observed in the maximum amplitudes of the TFL, Gmax, Gmed, and BF at the mid (decreased by ~ 15%) and end (decreased by ~ 30%) stages compared to the initial stage. The onset and the offset remained unaltered during the running (p ≥ 0.05).

CONCLUSION

The behavior of the healthy ITB might be altered due to the activities of the in-series musculature. Excessive compression forces might be applied to the lateral femoral epicondyle from the ITB to provide stability for the knee joint during an exhaustive run. The findings could provide a basic understanding of the behavior of healthy ITB.

Anatomical features of plantar fasciitis in various age cohorts: Based on magnetic resonance imaging

BACKGROUND

Due to the lack of further studies on the influence of age factors on plantar fasciitis, this study evaluates the characteristic observation points of magnetic resonance imaging in various age cohorts of patients with plantar fasciitis to help diagnosis.

METHODS

A retrospective analysis of 160 cases of plantar fasciitis patients and normal subjects (who have the disease unrelated to plantar fasciitis) who have undergone an MRI examination in our institution. The two groups were separately divided into young adult subjects (36 to 44 years old), middle age adult subjects (45 to 59 years old), and older adult subjects (60 to 79 years old). Data was gathered regarding plantar fascia thickness, the coronal length of the plantar fascia at the calcaneal origin, the signal intensity of plantar fascia and surrounding structures, and the presence or absence of plantar calcaneal spurs, all of which were assessed objectively by the investigators.

RESULTS

There were statistical differences in the thickness of plantar fascia between two groups of three age cohorts (Older adult patients: 0.59 ± 0.09 cm; Middle age adult patients: 0.49 ± 0.09 cm; Young adult patients: 0.47 ± 0.05 cm) (all p < 0.001). In addition, there were also statistical differences in the high signal intensity changes of the plantar fascia and surrounding soft tissues between two groups of three age cohorts (all p < 0.001). In older adult plantar fasciitis patients, with regard to plantar calcaneal spur discovery, there was a statistical difference between the two groups (Chi-square = 12.799. df = 1. p < 0.001).

CONCLUSION

In plantar fasciitis cases where a diagnosis is difficult, abnormalities in the soft tissue surrounding the plantar fascia in patients of low age are noteworthy. In older adult patients, the discovery of plantar calcaneal spurs with abnormal thickening of plantar fascia deserves attention, and abnormal MRI findings are more manifest. But the final diagnosis should be based on the medical history.

LEVEL OF EVIDENCE

Level 3.

The Use of Instrument-Assisted Soft-Tissue Mobilization for Manual Medicine: Aiding Hand Health in Clinical Practice

Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician’s hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.

Is "Delayed Onset Muscle Soreness" a False Friend? The Potential Implication of the Fascial Connective Tissue in Post-Exercise Discomfort

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.

Comparison of Interventional Strategies to Improve Recovery after Eccentric Exercise-Induced Muscle Fatigue

The aim of this study was to compare the effects of various recovery techniques on muscle tissue after eccentric exercise-induced muscle fatigue (EIMF). Forty subjects (24.3 ± 2.6 years; 77.45 ± 8.3 kg; 177.0 ± 6.4 cm; 24.66 ± 1.6 kg∙m^-2) were randomly assigned to one of the following groups: manual therapy (n =10, MT), mechanical vibration (n = 10, MV), percussion therapy (n = 10, PT) or foam roller (n = 10, FR). The contraction time (Tc) and the radial displacement (Dm) of the gastrocnemius was evaluated through tensiomyography (TMG). The application of the different techniques had positive effects for Tc and Dm in the treated leg compared to the untreated leg (F = 50.01, p < 0.01, η²p = 0.58 and F = 27.58, p < 0.01, η²p = 0.43, respectively) and for the interaction of the factors (Time x Leg x Therapy: F = 5.76, p < 0.01, η²p = 0.32 and F = 5.93, p < 0.01, η²p = 0.33, respectively). The results of the various methods used were similar: Tc (F = 0.17, p = 0.917; η²p = 0.01) and Dm (F = 3.30, p = 0.031, η²p = 0.22). PT interventions show potential for restoring muscle compliance and reducing stiffness, similar to MT and possibly more effective (cost-time relationship) compared to MV or FR.

Embryology of the Fascial System

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

Ankle Motion Is Associated With Soft Tissue Displacement in the Dorsal Thigh: An in vivo Investigation Suggesting Myofascial Force Transmission Across the Knee Joint

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.