1
|
Pirri C, Torre DE, Stecco C. Fascial plane blocks: from microanatomy to clinical applications. Curr Opin Anaesthesiol 2024; 37:526-532. [PMID: 39108103 PMCID: PMC11356744 DOI: 10.1097/aco.0000000000001416] [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] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs. RECENT FINDINGS There is ample evidence to support the role of FPBs in pain management. However, the exact mechanism of action remains unclear. Fasciae are composed of various structural elements and display complex anatomical characteristics at the microscopic level. They include various cell types embedded within an extracellular matrix abundant in collagens and hyaluronan. Increasingly, numerous studies demonstrated their innervation that contributes to their sensory functions and their role in proprioception, motor coordination and pain perception. Lastly, the diversity of the cellular and extracellular matrix, with their viscoelastic properties, is essential to understanding the FPBs' mechanism of action. SUMMARY Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management.
Collapse
Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
| | - Debora Emanuela Torre
- Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell’Angelo, Venice Mestre, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
| |
Collapse
|
2
|
Li M, Freeman S, Franco-Barraza J, Cai KQ, Kim A, Jin S, Cukierman E, Ye K. A bioprinted sea-and-island multicellular model for dissecting human pancreatic tumor-stroma reciprocity and adaptive metabolism. Biomaterials 2024; 310:122631. [PMID: 38815457 PMCID: PMC11186049 DOI: 10.1016/j.biomaterials.2024.122631] [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: 01/11/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) presents a formidable clinical challenge due to its intricate microenvironment characterized by desmoplasia and complex tumor-stroma interactions. Conventional models hinder studying cellular crosstalk for therapeutic development. To recapitulate key features of PDAC masses, this study creates a novel sea-and-island PDAC tumor construct (s&i PTC). The s&i PTC consists of 3D-printed islands of human PDAC cells positioned within an interstitial extracellular matrix (ECM) populated by human cancer-associated fibroblasts (CAFs). This design closely mimics the in vivo desmoplastic architecture and nutrient-poor conditions. The model enables studying dynamic tumor-stroma crosstalk and signaling reciprocity, revealing both known and yet-to-be-discovered multicellular metabolic adaptations. Using the model, we discovered the orchestrated dynamic alterations of CAFs under nutrient stress, resembling critical in vivo human tumor niches, such as the secretion of pro-tumoral inflammatory factors. Additionally, nutrient scarcity induces dynamic alterations in the ECM composition and exacerbates poor cancer cell differentiation-features well-established in PDAC progression. Proteomic analysis unveiled the enrichment of proteins associated with aggressive tumor behavior and ECM remodeling in response to poor nutritional conditions, mimicking the metabolic stresses experienced by avascular pancreatic tumor cores. Importantly, the model's relevance to patient outcomes is evident through an inverse correlation between biomarker expression patterns in the s&i PTCs and PDAC patient survival rates. Key findings include upregulated MMPs and key ECM proteins (such as collagen 11 and TGFβ) under nutrient-avid conditions, known to be regulated by CAFs, alongside the concomitant reduction in E-cadherin expression associated with a poorly differentiated PDAC state under nutrient deprivation. Furthermore, elevated levels of hyaluronic acid (HA) and integrins in response to nutrient deprivation underscore the model's fidelity to the PDAC microenvironment. We also observed increased IL-6 and reduced α-SMA expression under poor nutritional conditions, suggesting a transition of CAFs from myofibroblastic to inflammatory phenotypes under a nutrient stress akin to in vivo niches. In conclusion, the s&i PTC represents a significant advancement in engineering clinically relevant 3D models of PDAC masses. It offers a promising platform for elucidating tumor-stroma interactions and guiding future therapeutic strategies to improve patient outcomes.
Collapse
Affiliation(s)
- Ming Li
- Department of Biomedical Engineering, Center of Biomanufacturing for Regenerative Medicine, Binghamton University, SUNY, Binghamton, NY, USA
| | - Sebastian Freeman
- Department of Biomedical Engineering, Center of Biomanufacturing for Regenerative Medicine, Binghamton University, SUNY, Binghamton, NY, USA
| | - Janusz Franco-Barraza
- Cancer Signaling and Microenvironment Program, Marvin and Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Lewis Katz Temple School of Medicine, Philadelphia, PA, USA
| | - Kathy Q Cai
- Cancer Signaling and Microenvironment Program, Marvin and Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Lewis Katz Temple School of Medicine, Philadelphia, PA, USA
| | - Amy Kim
- Department of Biomedical Engineering, Center of Biomanufacturing for Regenerative Medicine, Binghamton University, SUNY, Binghamton, NY, USA
| | - Sha Jin
- Department of Biomedical Engineering, Center of Biomanufacturing for Regenerative Medicine, Binghamton University, SUNY, Binghamton, NY, USA
| | - Edna Cukierman
- Cancer Signaling and Microenvironment Program, Marvin and Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Lewis Katz Temple School of Medicine, Philadelphia, PA, USA.
| | - Kaiming Ye
- Department of Biomedical Engineering, Center of Biomanufacturing for Regenerative Medicine, Binghamton University, SUNY, Binghamton, NY, USA.
| |
Collapse
|
3
|
Fusco P, Nazzarro E, De Sanctis F, Petroni GM. Can we consider the fascia as the target of our fascial block? Indian J Anaesth 2024; 68:832-833. [PMID: 39386395 PMCID: PMC11460811 DOI: 10.4103/ija.ija_521_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 10/12/2024] Open
Affiliation(s)
- Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit. SS. Filippo e Nicola Hospital, Avezzano, Italy
| | - Emanuele Nazzarro
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila AQ, Italy
| | - Francesca De Sanctis
- Department of Anesthesia and Intensive Care Unit, S. Maria Hospital, Terni, Italy
| | - Gian M. Petroni
- Department of Anesthesia and Intensive Care Unit, S. Maria Hospital, Terni, Italy
| |
Collapse
|
4
|
Slater AM, Barclay SJ, Granfar RMS, Pratt RL. Fascia as a regulatory system in health and disease. Front Neurol 2024; 15:1458385. [PMID: 39188704 PMCID: PMC11346343 DOI: 10.3389/fneur.2024.1458385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
Neurology and connective tissue are intimately interdependent systems and are critical in regulating many of the body's systems. Unlocking their multifaceted relationship can transform clinical understanding of the mechanisms involved in multisystemic regulation and dysregulation. The fascial system is highly innervated and rich with blood vessels, lymphatics, and hormonal and neurotransmitter receptors. Given its ubiquity, fascia may serve as a "watchman," receiving and processing information on whole body health. This paper reviews what constitutes fascia, why it is clinically important, and its contiguous and interdependent relationship with the nervous system. Unquestionably, fascial integrity is paramount to human locomotion, interaction with our environment, bodily sense, and general physical and emotional wellbeing, so an understanding of the fascial dysregulation that defines a range of pathological states, including hypermobility syndromes, autonomic dysregulation, mast cell activation, and acquired connective tissue disorders is critical in ensuring recognition, research, and appropriate management of these conditions, to the satisfaction of the patient as well as the treating practitioner.
Collapse
Affiliation(s)
- Alison M. Slater
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
| | - S. Jade Barclay
- Neuromuscular Imaging Research Lab, The Kolling Institute, St Leonards, NSW, Australia
- Hypermobility and Performance Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rouha M. S. Granfar
- School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | - Rebecca L. Pratt
- Department of Foundational Medical Studies, William Beaumont School of Medicine, Rochester, MI, United States
| |
Collapse
|
5
|
Fusco P, Stecco C, Maggiani C, Ciaschi W. Erector spinae plane block with warm saline solution for treating chronic myofascial pain. Minerva Anestesiol 2024; 90:217-218. [PMID: 38059746 DOI: 10.23736/s0375-9393.23.17738-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Pierfrancesco Fusco
- Department of Anesthesia, Intensive Care and Pain Medicine, SS. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Carla Stecco
- Faculty of Human Anatomy and Movement Science, University of Padua, Padua, Italy
| | - Chiara Maggiani
- Departement of Anesthesia, Intensive Care and Pain Medicine, Fabrizio Spaziani Hospital, Frosinone, Italy -
| | - Walter Ciaschi
- Departement of Anesthesia, Intensive Care and Pain Medicine, Fabrizio Spaziani Hospital, Frosinone, Italy
| |
Collapse
|
6
|
Fusco P, Pascarella G, Stecco C, Blanco R, Forero M, Pawa A, Tulgar S, Strumia A, Remore LM, DE Cassai A, Colantonio LB, Del Buono R, Fattorini F, Sepolvere G, Tedesco M, Petroni GM, Ciaschi W, Crassiti M, Costa F. Factors to consider for fascial plane blocks' success in acute and chronic pain management. Minerva Anestesiol 2024; 90:87-97. [PMID: 38197590 DOI: 10.23736/s0375-9393.23.17866-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The outcome of fascial plane blocks (FPBs) has a certain variability that may depend on many factors, which can be divided into three main categories: operator-related, patient-related and drug-related. Operator-related factors include personal skills, choice of needle and injection modalities. Patient variables include anthropometric features, the type of targeted fascia, anatomical variants, patient positioning, muscle tone and breathing. Ultimately, efficacy, onset, and duration of fascial blocks may be affected by characteristics of the injected solution, including the type of local anesthetic, volume, concentration, pH, temperature and the use of adjuvants. In this article, we investigated all the factors that may influence the outcome of FPBs from a generic perspective, without focusing on any specific technique. Also, we provided suggestions to optimize techniques for everyday practitioners and insights to researchers for future studies.
Collapse
Affiliation(s)
- Pierfrancesco Fusco
- Unit of Anesthesia and Intensive Care, SS Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Rafael Blanco
- Unit of Anesthesia and Intensive Care, King's College Hospital Dubai, Abu Dhabi, United Arab Emirates
| | - Mauricio Forero
- Faculty of Anesthesia and Pain Medicine, McMaster University, Hamilton, ON, Canada
| | - Amit Pawa
- Department of Anesthesia and Perioperative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Türkiye
| | - Alessandro Strumia
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Luigi M Remore
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Alessandro DE Cassai
- Unit of Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy
| | | | - Romualdo Del Buono
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, Milan, Italy
| | | | - Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
| | - Mario Tedesco
- Department of Anesthesia, Intensive Care and Pain Therapy, Mater Day Hospital, Bari, Italy
| | - Gian M Petroni
- Unit of Anesthesia and Intensive Care, S. Maria Hospital, Terni, Italy -
| | - Walter Ciaschi
- Unit of Anesthesia and Intensive Care, F. Spaziani Hospital, Frosinone, Italy
| | - Massimiliano Crassiti
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| | - Fabio Costa
- Unit of Anesthesia and Intensive Care, Campus Bio-Medico University Hospital, Rome, Italy
| |
Collapse
|
7
|
Liu Y, Wang Y. A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain. Front Med (Lausanne) 2023; 10:1305733. [PMID: 38020090 PMCID: PMC10679753 DOI: 10.3389/fmed.2023.1305733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. Methods In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. Results There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Conclusion Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. Clinical trial registration www.isrctn.com, ISRCTN88098928.
Collapse
Affiliation(s)
- Yang Liu
- SchoolGraduate School of Wuhan Sports University, Wuhan Sports University, Wuhan, China
| | - Yidan Wang
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Raja G P, Bhat S, Gangavelli R, Prabhu A, Stecco A, Pirri C, Jaganathan V, Fernández-de-Las-Peñas C. Effectiveness of Deep Cervical Fascial Manipulation ® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial. Life (Basel) 2023; 13:2173. [PMID: 38004313 PMCID: PMC10672322 DOI: 10.3390/life13112173] [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: 09/12/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP). METHOD Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken. RESULTS A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up. CONCLUSION FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.
Collapse
Affiliation(s)
- Prabu Raja G
- Department of Exercise and Sports Science, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - Shyamasunder Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal 576104, India
| | - Ranganath Gangavelli
- Department of Physiotherapy, GITAM School of Physiotherapy, GITAM University, Visakhapatnam 530045, India;
| | - Anupama Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University, New York, NY 10012, USA;
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy;
| | - Vennila Jaganathan
- Department of Statistics, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28008 Madrid, Spain;
| |
Collapse
|
9
|
Pirri C, Caroccia B, Angelini A, Piazza M, Petrelli L, Caputo I, Montemurro C, Ruggieri P, De Caro R, Stecco C. A New Player in the Mechanobiology of Deep Fascia: Yes-Associated Protein (YAP). Int J Mol Sci 2023; 24:15389. [PMID: 37895068 PMCID: PMC10607668 DOI: 10.3390/ijms242015389] [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: 08/20/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Recent studies have demonstrated that fascial fibroblasts are susceptible to mechanical stimuli, leading to the remodeling of the extracellular matrix (ECM). Moreover, the extensive literature on Yes-associated protein (YAP) has shown its role in cell mechanics, linking cell properties, such as shape, adhesion, and size, to the expression of specific genes. The aim of this study was to investigate the presence of YAP in deep fascia and its activation after a mechanical stimulus was induced via a focal extracorporeal shockwave (fESW) treatment. Thoracolumbar fascia (TLF) samples were collected from eight patients (age: 30-70 years; four males and four females) who had undergone spine elective surgical procedures at the Orthopedic Clinic of University of Padova. YAP was measured in both tissue and TLF-derived fibroblasts through immunoblotting. COL1A1 and HABP2 gene expression were also evaluated in fibroblasts 2, 24, and 48 h after the fESW treatment. YAP was expressed in all the examined tissues. The ratio between the active/inactive forms (YAP/p-YAP) of the protein significantly increased in fascial fibroblasts after mechanical stimulation compared to untreated cells (p = 0.0022). Furthermore, COL1A1 and HABP2 gene expression levels were increased upon treatment. These findings demonstrate that YAP is expressed in the deep fascia of the thoracolumbar region, suggesting its involvement in fascial mechanotransduction processes, remodeling, regeneration, and fibrogenesis. This study indicates, for the first time, that YAP is a "new player" in the mechanobiology of deep fascia.
Collapse
Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (R.D.C.); (C.S.)
| | - Brasilina Caroccia
- Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (B.C.); (M.P.); (L.P.); (I.C.)
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy; (A.A.); (P.R.)
| | - Maria Piazza
- Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (B.C.); (M.P.); (L.P.); (I.C.)
| | - Lucia Petrelli
- Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (B.C.); (M.P.); (L.P.); (I.C.)
| | - Ilaria Caputo
- Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (B.C.); (M.P.); (L.P.); (I.C.)
| | | | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy; (A.A.); (P.R.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (R.D.C.); (C.S.)
| |
Collapse
|
10
|
Bordoni B, Escher AR, Girgenti GT. Peritoneal Adhesions in Osteopathic Medicine: Theory, Part 1. Cureus 2023; 15:e42472. [PMID: 37502471 PMCID: PMC10369357 DOI: 10.7759/cureus.42472] [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] [Accepted: 07/26/2023] [Indexed: 07/29/2023] Open
Abstract
Peritoneal adhesions form as a result of trauma to the abdomen, injuries resulting from surgery, and infections. These tissutal neoformations are innervated and vascularized, and with lymphatic vessels, adherence becomes a new and independent structure, capable of negatively influencing visceral functions. Adherent neogenesis can be asymptomatic or can be a source of pain, limiting the patient's quality of life. Although adhesiolysis remains the elective approach to eliminate adhesions, this therapeutic route prepares the peritoneal anatomical area to recur. The article reviews information on adhesion formation and peritoneal anatomy, probable subjective predispositions, and pathways that carry nociception. The text aims to be a theoretical basis for making new treatment suggestions for non-invasive osteopathic medicine, through a second part will be discussed in another article.
Collapse
Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Gregory T Girgenti
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| |
Collapse
|
11
|
Yang C, Huang X, Li Y, Sucharit W, Sirasaporn P, Eungpinichpong W. Acute Effects of Percussive Massage Therapy on Thoracolumbar Fascia Thickness and Ultrasound Echo Intensity in Healthy Male Individuals: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1073. [PMID: 36673829 PMCID: PMC9859515 DOI: 10.3390/ijerph20021073] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 05/13/2023]
Abstract
Percussive massage therapy (PT) has been widely used by therapists and the fitness population to treat myofascial-related conditions. However, there is no evidence to confirm the effects of PT on the fascia. This study aimed to investigate the effects of PT on thoracolumbar fascia (TLF) morphology and other related outcomes. METHODS Sixty-six healthy males participated and were randomly allocated into a percussive massage group (PT group) and a control group. The PT group received 15 min of back percussion massage, while the control group rested prone lying in the same environment for 15 min. Thoracolumbar fascia (TLF) thickness and echo intensity, perceived stiffness, lumbar flexibility, and skin temperature were measured in both groups before and immediately after the intervention. RESULT TLF thickness and lumbar flexibility did not change when compared in the two groups. However, the echo intensity (left side, difference -3.36, 95% CI -5.1 to -1.6; right side, difference -4.39, 95% CI -6.1 to -2.7) and perceived stiffness (difference, -1.18, 95% CI -1.84 to -0.52) in the TLF region were significantly lower in the PT group than in the control group and were accompanied by increased skin temperature (difference 0.29, 95% CI 0.11 to 0.48). CONCLUSION We suggest that a 15 min PT with 30 Hz on the back region could reduce TLF echo intensity and perceived stiffness and increase skin temperature in healthy men individual.
Collapse
Affiliation(s)
- Chao Yang
- Department of Exercise and Sport Sciences, Faculty of Graduate School, Khon Kaen University, Khon Kaen 40002, Thailand
- Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen 40002, Thailand
| | - Xingyu Huang
- Department of Human Movement Sciences, Faculty of Physical Education, Gan Nan Normal University, Ganzhou 341000, China
| | - Ying Li
- School of Rehabilitation Medicine, Gan Nan Medical University, Ganzhou 341000, China
| | - Wiraphong Sucharit
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Division of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Patpiya Sirasaporn
- Department of Rehabilitation Medicine Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wichai Eungpinichpong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Division of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| |
Collapse
|