Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain

Modeling of the Effect of Subperiosteal Hydrostatic Pressure Conductivity between Joints on Decreasing Contact Loads on Cartilage and of the Effect of Myofascial Relief in Treating Trigger Points: The Floating Skeleton Theory

Chronic overloading of the cartilage can lead to its irreversible destruction, as observed in people with osteoarthritis. The floating skeleton model previously introduced postulates that overloading begins and progresses when a joint is isolated from the hydrostatical connection with other joints. Such a connection occurs via the interstitial fluid in subperiosteal space and allows for pressure transmission between synovial capsules modulating intra-articular pressure. In the current study, a simple experiment was performed to model an obstruction in the subperiosteal hydrostatic pressure conductivity between joints to illustrate the effect of that obstruction on loads borne by the joint. When the obstruction was removed, the load experienced by the joint was reduced as it was redistributed throughout the model structure. The experiment demonstrated that contact pressures can be redistributed when the conditions of Pascal's Law are met.

Conservative Treatment Using Chiropractic Care and Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Case Report

Objective

The purpose of this case study was to describe the use of chiropractic care in the treatment of obstructive sleep apnea (OSA).

Clinical Features

A 42-year-old man with obesity presented for chiropractic care. He had OSA and was seeking a way to reduce snoring. The patient had a previous diagnosis of OSA and had been using a continuous positive airway pressure machine for over 5 years. The patient was a mouth breather, exhibiting poor oral and spinal posture.

Intervention and Outcome

The patient was treated for 90 days, which included chiropractic manipulation, orofacial myofunctional therapy exercises, nutritional modification, postural/ergonomic correction, and regular exercise. After a course of care, there was a drop in his apnea-hypopnea index from 55.4 events per hour to 3.4 events per hour. The patient lost 40 pounds, with an 8% reduction in body fat and an 8-point drop in his body mass index.

Conclusion

This patient's sleep apnea and other health outcomes improved under a course of a combination of chiropractic adjustments, orofacial myofunctional therapy, nutritional modification, postural/ergonomic correction, and exercise.

Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review

Cervical myofascial pain is a very common clinical condition in the daily practice of musculoskeletal physicians. Physical examination is currently the cornerstone for evaluating the cervical muscles and identifying the eventual presence of myofascial trigger points. Herein, the role of ultrasound assessment in precisely localizing them is progressively mounting in the pertinent literature. Moreover, using ultrasound, not only the muscle tissue but also the fascial and neural elements can be accurately located/evaluated. Indeed, several potential pain generators, in addition to paraspinal muscles, can be involved in the clinical scenario of cervical myofascial pain syndrome. In this article, the authors extensively reviewed the sonographic approach for cervical myofascial pain in order to better diagnose or guide different procedures that can be performed in the clinical practice of musculoskeletal physicians.

Reliability of a New Indentometer Device for Measuring Myofascial Tissue Stiffness

Changes in tissue stiffness are associated with pathological conditions such as myofascial pain and increased risk of muscle injury. Furthermore, they have been shown to modify performance indicators such as running economy or jump height. Indentometry is an affordable way to assess tissue stiffness. However, to date, there is a paucity of studies examining the measurement properties of available devices. With this trial, we aimed to evaluate the reliability of the “IndentoPro”. Two investigators repeatedly measured the stiffness of the lateral head of the gastrocnemius muscle in healthy participants (N = 35), using 5 and 10 mm indentation depths. Intraclass Correlation Coefficients (ICC) revealed moderate inter-rater reliability (5 mm: ICC3,1 0.74, 95%CI = 0.54 to 0.86, p < 0.001; 10 mm: ICC3,1 0.59, 95%CI = 0.27 to 0.78, p < 0.001) and good intra-rater reliability (5 mm: ICC3,1 0.84, 95%CI = 0.71 to 0.92, p < 0.001; 10 mm: ICC3,1 0.83, 95%CI = 0.69 to 0.91, p < 0.001). No correlations between age, height, weight, BMI, skinfold thickness and myofascial tissue stiffness were observed (p > 0.5). In conclusion, the IndentoPro is reliable in assessing calf tissue stiffness, but the predictors of stiffness remain unclear.