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Overmann L, Schleip R, Anheyer D, Michalak J. Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis. Physiotherapy 2024; 123:56-68. [PMID: 38290198 DOI: 10.1016/j.physio.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p = 0.03), rotation to the right (p = 0.05), and lateral flexion to the right (p = 0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER What does the meta-analysis add to the current literature.
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Affiliation(s)
- Lea Overmann
- Department of Psychology, University of Witten-Herdecke, Germany.
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Germany
| | - Dennis Anheyer
- Department of Psychology, University of Witten-Herdecke, Germany
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Overmann L, Schleip R, Michalak J. Exploring fascial properties in patients with depression and chronic neck pain: An observational study. Acta Psychol (Amst) 2024; 244:104214. [PMID: 38461580 DOI: 10.1016/j.actpsy.2024.104214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Depressive disorder and chronic pain are prevalent conditions that often co-occur. The myofascial fascial continuum has been hypothesized to contribute to both conditions. However, limited research exists on the specific association between fascial properties and chronic pain and depression. OBJECTIVE This study aims to investigate the properties of the deep fascia of the M. trapezius and their relationship with depression, chronic neck pain, and cervical spine mobility. METHOD This study compared fascial properties between two groups: individuals with depression and chronic neck pain, and healthy individuals. Fascial thickness, elasticity, and stiffness were measured as primary outcomes using standardized techniques such as ultrasound imaging and compliance meter. Statistical analyses were conducted to identify potential differences and correlations in fascial properties between the two groups. RESULT Significant differences emerge in stiffness, tone, and fascia thickness in the deep fascia, alongside identified correlations between depression, chronic pain, and these variables. CONCLUSION The study highlights the impact of depression and chronic pain on fascial properties, emphasizing the need for further research in this domain to unravel the intricate connections and potential implications for treatment strategies.
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Affiliation(s)
- Lea Overmann
- Department of Psychology, University of Witten-Herdecke, Germany
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Germany
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Brandl A, Acikalin E, Bartsch K, Wilke J, Schleip R. Reliability and validity of an app-assisted tissue compliance meter in measuring tissue stiffness on a phantom model. PeerJ 2024; 12:e17122. [PMID: 38464760 PMCID: PMC10924762 DOI: 10.7717/peerj.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Background Most methods for soft tissue stiffness assessment require high financial resources, significant technical effort, or extensive therapist training. The PACT Sense device was developed to be used in a wide range of applications and user groups. However, to date, there are no data on its validity and reliability. The aim of this study was to investigate the validity and reliability of the PACT device. Methods A polyurethane phantom tissue model (PTM) mimicking the mechanical properties of the fascia profunda and the erector spinae muscle was used. Stiffness measurements with PACT were conducted by two independent investigators. For construct validity, correlations were calculated between the known stiffness of the PTM and values obtained with PACT. For concurrent validity, we determined the association between the PACT values and additional measurements with the established MyotonPRO device. To estimate interrater and intrarater (two measurements with an interval of 7 days) reliability, we used the intraclass correlation coefficient (ICC). Results Correlation analysis (PTM/PACT) revealed very high concurrent validity (r = 0.99; p < 0.001), construct validity (PACT/MyotonPRO) was 0.87, p < 0.001. Both, interrater reliability (ICC = 0.85; p = 0.036) and intrarater reliability were good (ICC = 0.89; p < 0.001). Conclusions The PACT provides valid and reliable stiffness measurements in tissue phantoms. Further studies in humans are needed to confirm its physiometric properties under in vivo conditions.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Eda Acikalin
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Katja Bartsch
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department of Sport Science and Sport, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Robert Schleip
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
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Brandl A, Wilke J, Egner C, Schmidt T, Schilder A, Schleip R. Pain quality patterns in delayed onset muscle soreness of the lower back suggest sensitization of fascia rather than muscle afferents: a secondary analysis study. Pflugers Arch 2024; 476:395-405. [PMID: 38102488 PMCID: PMC10847203 DOI: 10.1007/s00424-023-02896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
Delayed onset muscle soreness (DOMS) of the lower back is considered a surrogate for acute low back pain (aLBP) in experimental studies. Of note, it is often unquestioningly assumed to be muscle pain. To date, there has not been a study analyzing lumbar DOMS in terms of its pain origin, which was the aim of this study. Sixteen healthy individuals (L-DOMS) were enrolled for the present study and matched to participants from a previous study (n = 16, L-PAIN) who had undergone selective electrical stimulation of the thoracolumbar fascia and the multifidus muscle. DOMS was induced in the lower back of the L-DOMS group using eccentric trunk extensions performed until exhaustion. On subsequent days, pain on palpation (100-mm analogue scale), pressure pain threshold (PPT), and the Pain Sensation Scale (SES) were used to examine the sensory characteristics of DOMS. Pain on palpation showed a significant increase 24 and 48 h after eccentric training, whereas PPT was not affected (p > 0.05). Factor analysis of L-DOMS and L-PAIN sensory descriptors (SES) yielded a stable three-factor solution distinguishing superficial thermal ("heat pain ") from superficial mechanical pain ("sharp pain") and "deep pain." "Heat pain " and "deep pain" in L-DOMS were almost identical to sensory descriptors from electrical stimulation of fascial tissue (L-PAIN, all p > 0.679) but significantly different from muscle pain (all p < 0.029). The differences in sensory description patterns as well as in PPT and self-reported DOMS for palpation pain scores suggest that DOMS has a fascial rather than a muscular origin.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148, Hamburg, Germany.
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992, Munich, Germany.
- Vienna School of Osteopathy, 1130, Vienna, Austria.
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, 9020, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, 37242, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457, Hamburg, Germany
| | - Andreas Schilder
- Department of Orthopaedics and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992, Munich, Germany
- Department of Movement Sciences, University of Klagenfurt, 9020, Klagenfurt, Austria
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dos Santos Amorim M, Sinhorim L, Baptistella do Nascimento I, Wagner J, de Paula Lemos F, Duarte França ME, Schleip R, Sonza A, Moraes Santos G. Peripheral muscle oxygenation, pain, and disability indices in individuals with and without nonspecific neck pain, before and after myofascial reorganization®: A double-blind randomized controlled trial. PLoS One 2024; 19:e0292114. [PMID: 38335169 PMCID: PMC10857696 DOI: 10.1371/journal.pone.0292114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 09/12/2023] [Indexed: 02/12/2024] Open
Abstract
To investigate whether myofascial reorganization® in the trapezius muscle (MRT) improves peripheral muscle oxygenation and pain tolerance and decreases neck disability index (NDI) scores in individuals with and without nonspecific neck pain (NP) using a double-blind randomized controlled trial. Seventy-five subjects were equally and randomly assigned to three groups: the intervention groups (experimental [EG] and sham sSG]) and the control group (CG). Several inclusion criteria were applied to the intervention groups: male or female, aged 18-32 years, self-reported NP in the last 3 months without a defined cause; at least "soft" pain in session 1 of the NDI, and at least a score of 1 on the Visual Analogue Scale (VAS). The CG was required to have NDI and VAS scores of 0 at recruitment. Intervention: The EG underwent MRT for 10 min, once a week for 6 weeks. Patients with NP in the SG underwent classical massage for the same duration and frequency. Patients in the CG had no pain and underwent no intervention. Data collection was performed using the NDI Questionnaire, a pressure algometer for pain evaluation, and near-infrared spectroscopy for muscle oxygenation measurements. It was registered as NCT03882515 at ClinicalTrials.gov. The NDI score in both the EG (p<0.001) and SG (p<0.001) decreased after 6 weeks of intervention compared to the CG. The CG demonstrated a lower basal tissue saturation (TSI) index than the EG (p<0.001) and SG (p = 0.02). The EG demonstrated higher oxyhemoglobin values than the SG (p<0.001) and CG (p = 0.03). The CG had higher pain tolerance than the EG (p = 0.01) and SG (p<0.001) post-intervention. MRT increased trapezius muscle oxygenation after 6 weeks of intervention.
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Affiliation(s)
- Mayane dos Santos Amorim
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Larissa Sinhorim
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Iramar Baptistella do Nascimento
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Janaína Wagner
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Francisco de Paula Lemos
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Maria Elisa Duarte França
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Robert Schleip
- Associate Professorship of Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- DIPLOMA Hochschule Bad Sooden-Allendorf, Bad Sooden-Allendorf, Germany
| | - Anelise Sonza
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
| | - Gilmar Moraes Santos
- College of Health Sciences and Sports at Santa Catarina State University (UDESC), Posture and Balance Laboratory (LAPEQ), Florianópolis, State of Santa Catarina, Brazil
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Gabriel A, Konrad A, Herold N, Horstmann T, Schleip R, Paternoster FK. Testing the Posterior Chain: Diagnostic Accuracy of the Bunkie Test versus the Isokinetic Hamstrings/Quadriceps Measurement in Patients with Self-Reported Knee Pain and Healthy Controls. J Clin Med 2024; 13:1011. [PMID: 38398324 PMCID: PMC10889369 DOI: 10.3390/jcm13041011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The isokinetic measurement (IM) of the leg muscles is well established but costly, whereas the Bunkie Test (BT) is a rarely investigated but easy-to-conduct functional test to evaluate the total posterior chain. Although the tests differ in aim and test structures, both have their justification in the assessment process. Therefore, this study evaluated the diagnostic accuracy of the BT and the IM. (2) Methods: 21 participants (9 female, 12 male; age, 26.2 ± 5.26 years; weight 73.8 ± 14.6 kg; height 176.0 ± 9.91 cm) and 21 patients (9 female, 12 male; age, 26.5 ± 5.56 years; weight, 72.6 ± 16.9 kg; height 177.0 ± 10.1 cm) with self-reported pain in the knee performed the IM and the BT. For IM, we calculated the ratio of the knee mean flexor/extensor peak torque (H/Q ratio) for 60°/s and 120°/s, and BT performance was measured in seconds. We classified the IM (<0.6 H/Q ratio) and the BT (leg difference ≥4 s) as binary results according to the literature. We calculated the sensitivity and specificity, which we compared with the Chi-Square test, and the 95% confidence intervals (CI). A p-value of ≤0.05 is considered significant. (3) Results: The sensitivity for the BT was 0.89, 95% CI [0.67, 0.99], and the specificity was 0.52 [0.30, 0.74]. For the IM, the sensitivity was 0.14 [0.03, 0.36] for 60°/s and 0.05 [0.00, 0.24] for 120°/s, and the specificity was 0.70 [0.46, 0.88] for 60°/s and 0.90 [0.68, 0.99] for 120°/s. The results of the Chi-Square tests were significant for the BT (χ2 (1) = 6.17, p = 0.01) but not for the IM (60°/s: χ2 (1) = 0.70, p = 0.40; 120°/s: χ2 (1) = 0.00, p = 0.97). (4) Conclusions: Patients were more likely to obtain a positive test result for the BT but not for the IM.
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Affiliation(s)
- Anna Gabriel
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, 8010 Graz, Austria
| | - Nadine Herold
- Department Sport and Health Sciences, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany;
| | - Thomas Horstmann
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
| | - Robert Schleip
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
- Department of Medical Professions, Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Florian K. Paternoster
- Department of Biomechanics in Sports, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany;
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Slomka G, Schleip R, Frei P, Kurpiers N, Krämer M, Bauermeister K, Bauermeister W. The Influence of Mobility Training on the Myofascial Structures of the Back and Extremities. J Clin Med 2024; 13:329. [PMID: 38256463 PMCID: PMC10816048 DOI: 10.3390/jcm13020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The subject of the study was the effect of a multicomponent program (Mobility Routine) on muscular and fascial stiffness, flexibility, subjective well-being, and body perception. METHODS The assumption was that high physical stress affects myofascial structures and joint range of motion. The assessment of myofascial stiffness employed a Shear Wave Elastography. The joint flexibility, pressure pain threshold, and subjective experiences with regard to tension, pain, and general discomfort were documented. RESULTS In the CT group, a greater increase in stiffness was measured in fewer measurement areas compared to the MR group. MR demonstrated superior gains in flexibility compared to CT. Both groups experienced significant reductions in pain, tension, and discomfort. In conclusion, repetitive motion patterns akin to CT lead to increased myofascial stiffness, whereas MR yields more balanced stiffness development, compensates for asymmetries, and improves body awareness. CONCLUSIONS Hence, this study highlights the advantages of mobility training over Crosstrainer exercises and provides valuable insights for the recommendation of training regimens aiming at the enhancement of musculoskeletal functionality and overall well-being.
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Affiliation(s)
- Gunda Slomka
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allen, Germany
| | - Peter Frei
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Nicolas Kurpiers
- Institute of Sport Science, University of Hildesheim, Universitätsplatz 1, 31141 Hildesheim, Germany; (G.S.); (P.F.); (N.K.)
| | - Michael Krämer
- Institute for Materials Technology, Technical University Darmstadt, Grafenstrasse 2, 64283 Darmstadt, Germany;
| | - Katharina Bauermeister
- Conservative and Rehabilitative Orthopedics, Department Sport and Health Sciences, Technical University of Munich, Campus D, Georg-Bauchle-Ring 60/62, 80992 München, Germany;
| | - Wolfgang Bauermeister
- Department of Sports, Physical and Rehabilitative Medicine, Kharkiv National Medical University, 4 Nauky Avenue, 61022 Kharkiv, Ukraine;
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Nešporová K, Matonohová J, Husby J, Toropitsyn E, Stupecká LD, Husby A, Suchánková Kleplová T, Streďanská A, Šimek M, Nečas D, Vrbka M, Schleip R, Velebný V. Injecting hyaluronan in the thoracolumbar fascia: A model study. Int J Biol Macromol 2023; 253:126879. [PMID: 37709215 DOI: 10.1016/j.ijbiomac.2023.126879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Hyaluronan (HA) has been recently identified as a key component of the densification of thoracolumbar fascia (TLF), a potential contributor to non-specific lower back pain (LBP) currently treated with manual therapy and systemic or local delivery of anti-inflammatory drugs. The aim of this study was to establish a novel animal model suitable for studying ultrasound-guided intrafascial injection prepared from HA with low and high Mw. Effects of these preparations on the profibrotic switch and mechanical properties of TLF were measured by qPCR and rheology, respectively, while their lubricating properties were evaluated by tribology. Rabbit proved to be a suitable model of TLF physiology due to its manageable size enabling both TLF extraction and in situ intrafascial injection. Surprisingly, the tribology showed that low Mw HA was a better lubricant than the high Mw HA. It was also better suited for intrafascial injection due to its lower injection force and ability to freely spread between TLF layers. No profibrotic effects of either HA preparation in the TLF were observed. The intrafascial application of HA with lower MW into the TLF appears to be a promising way how to increase the gliding of the fascial layers and target the myofascial LBP.
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Affiliation(s)
| | - Jana Matonohová
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - Jarmila Husby
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | | | | | - Aaron Husby
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - Tereza Suchánková Kleplová
- Department of Dentistry, Charles University, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, 500 05 Hradec Kralové, Czech Republic
| | - Alexandra Streďanská
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Matěj Šimek
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
| | - David Nečas
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Martin Vrbka
- Biotribology Research Group, Faculty of Mechanical Engineering, Brno University of Technology, 616 69 Brno, Czech Republic
| | - Robert Schleip
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
| | - Vladimír Velebný
- Contipro a.s., Dolní Dobrouč 401, 561 02 Dolní Dobrouč, Czech Republic
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Wang TJ, Stecco A, Schleip R, Stecco C, Pirri C. Change in gliding properties of the iliotibial tract in hypermobile Ehlers-Danlos Syndrome. J Ultrasound 2023; 26:809-813. [PMID: 36802027 PMCID: PMC10632250 DOI: 10.1007/s40477-023-00775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Fascial changes in hypermobile Ehlers-Danlos syndrome (hEDS), a heritable connective tissue disorder, can be used visualized with sonoelastography. The purpose of this study was to explore the inter-fascial gliding characteristics in hEDS. METHODS In 9 subjects, the right iliotibial tract was examined with ultrasonography. Tissue displacements of the iliotibial tract were estimated from ultrasound data using cross-correlation techniques. RESULTS In hEDS subjects, shear strain was 46.2%, lower than those with lower limb pain without hEDS (89.5%) and in control subjects without hEDS and without pain (121.1%). CONCLUSION Extracellular matrix changes in hEDS may manifest as reduced inter-fascial plane gliding.
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Affiliation(s)
- Tina J Wang
- Department of Physical Medicine & Rehabilitation, Loma Linda University School of Medicine, Loma Linda, CA, USA.
- , 429 N Central Ave, Upland, CA, 91786, USA.
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Robert Schleip
- Department of Conservative and Rehabilitive Orthopaedics, Technical University of Munich, Munich, Germany
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
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Baroni F, Schleip R, Arcuri L, Consorti G, D’Alessandro G, Zegarra-Parodi R, Vitali AM, Tramontano M, Lunghi C. Functional Neuromyofascial Activity: Interprofessional Assessment to Inform Person-Centered Participative Care-An Osteopathic Perspective. Healthcare (Basel) 2023; 11:2886. [PMID: 37958030 PMCID: PMC10667998 DOI: 10.3390/healthcare11212886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Introduction: Health professionals and bodyworkers may be pivotal in promoting prevention programs, providing tailored advice and guidance to patients' adherence to self-care strategies, such as physical activity. Contemporary evidence encourages manual therapists to involve patients in decision-making and treatment procedures integrating passive and active approaches in treatment planning. This manuscript provides a definition and applications of neuromyofascial movement patterns, discusses the significance of functional assessment, and gives an example of clinical applications in the osteopathic field to highlight how this assessment can promote interdisciplinarity. Methods: The reporting framework used in the current manuscript followed guidelines for writing a commentary. Results: The manuscript highlights the crucial role that the neuromyofascial system plays in human movement and overall well-being and the importance of a functional neuromyofascial activity assessment in the context of person-centered participative care. Conclusions: Understanding individual neuromyofascial patterns could help healthcare practitioners, movement specialists, and bodyworkers in tailoring treatment plans, meeting patients' unique needs, and promoting a more effective personalized approach to care. The current perspective could spark debates within the professional community and provide a research roadmap for developing an evidence-informed interprofessional framework.
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Affiliation(s)
- Francesca Baroni
- BMS Formation, 75116 Paris, France; (F.B.); (C.L.)
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
| | - Robert Schleip
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, 80333 Munich, Germany;
| | - Lorenzo Arcuri
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
| | - Giacomo Consorti
- Education Department of Osteopathy, Istituto Superiore di Osteopatia, 20126 Milan, Italy
| | - Giandomenico D’Alessandro
- Clinical-Based Human Research Department, Foundation COME Collaboration, 65121 Pescara, Italy
- Centre pour l’Etude, la Recherche et la Diffusion Ostéopathiques “C.E.R.D.O.”, 00199 Rome, Italy
| | | | | | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40126 Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40126 Bologna, Italy
| | - Christian Lunghi
- BMS Formation, 75116 Paris, France; (F.B.); (C.L.)
- Osteopatia Lunghi-Baroni Private Practice, 00146 Rome, Italy
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11
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Sánchez Vera MA, Jaimes Fernández DA, Schleip R. Efficacy of myofascial induction compared with its simulation on joint amplitude in people with axial spondylarthritis: Protocol of a randomized controlled clinical trial. PLoS One 2023; 18:e0286885. [PMID: 37796870 PMCID: PMC10553292 DOI: 10.1371/journal.pone.0286885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Axial spondyloarthritis (AxSpA) produces structural changes that cause alterations in body functions. One tissue that seems to have a predictive role in the etiology and progression of the disease is the soft tissue, particularly the fascia. However, little is known about the use of myofascial induction in people with AxSpA, and clinical evidence from physiotherapy regarding potential strategies is limited. OBJECTIVE To evaluate the efficacy of myofascial induction compared with its simulation on joint amplitude in people with AxSpA. METHODS In this randomized controlled parallel superiority clinical trial, 84 people with an AxSpA diagnosis confirmed by a rheumatologist will be randomly assigned to groups: the experimental group or the control group. The experimental group will receive myofascial induction, and the control group will undergo a simulation of the technique. Both groups will receive an examination session and six intervention sessions twice per week for three weeks. A baseline follow-up will be performed immediately after the intervention and four weeks after treatment. CONCLUSION The results of this study may contribute to a better understanding of the efficacy of myofascial induction for joint mobility in people with AxSpA. The implications of these results have a potential transformative effect on the understanding, analysis, evaluation, and physiotherapeutic treatment of this health condition. TRIAL REGISTRATION ClinicalTrials.gov NCT04424589. Registered 11 June 2020.
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Affiliation(s)
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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12
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Seidel A, Brandl A, Egner C, Schleip R. Examination of Myofascial Stiffness and Elasticity in the Upper Trapezius Region in Patients with Unilateral Neck Pain: A Cross-Sectional Study. J Clin Med 2023; 12:6339. [PMID: 37834984 PMCID: PMC10573173 DOI: 10.3390/jcm12196339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. This study evaluated the stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS-33.76 ± 7.78, HS-29.75 ± 7.45, p < 0.001; indentometry: SS-59.73 ± 33.93, HS-4.18 ± 12.69, p = 0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter's elasticity (SS-0.101 ± 1.09, HS--0.006 ± 0.29, p = 0.416), cervical spine mobility (lateral flexion: SS-37.08 ± 8.15, HS-37.73 ± 7.61, p = 0.559; rotation: SS-73.55 ± 12.37, HS-72.85 ± 11.10, p = 0.660), and algometry (SS-36.41 ± 17.53, HS-37.22 ± 17.00, p = 0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.
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Affiliation(s)
- Anika Seidel
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
| | - Christoph Egner
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Robert Schleip
- Department of Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
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13
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Rabelo DB, Freire APCF, Brandão FCM, Melo SO, Ocarino JM, Dos Anjos MTS, Schleip R, Souza TR, Simoneau G, Pinto RZ. Erratum to "Myofascial stiffness of plantar fascia and Achilles tendon in individuals with plantar fasciopathy: An observational cross-sectional study" [Musculoskel. Sci. Pract. 66 (2023) 102781]. Musculoskelet Sci Pract 2023; 67:102821. [PMID: 37414672 DOI: 10.1016/j.msksp.2023.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Daniel Barreto Rabelo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Sabrina Oliveira Melo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana M Ocarino
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Germany
| | - Thales R Souza
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Guy Simoneau
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Rafael Zambelli Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
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14
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Brandl A, Wilke J, Egner C, Schmidt T, Schleip R. Effects of Maximal Eccentric Trunk Extensor Exercise on Lumbar Extramuscular Connective Tissue: A Matched-Pairs Ultrasound Study. J Sports Sci Med 2023; 22:447-454. [PMID: 37711713 PMCID: PMC10499134 DOI: 10.52082/jssm.2023.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
Recently, it has been shown that the extramuscular connective tissue (ECT) is likely involved in delayed onset muscle soreness (DOMS). Therefore, the aim of the present study was to investigate the effects of maximal trunk extension eccentric exercise (EE) on ECT thickness, self-reported DOMS, ECT stiffness, skin temperature, and possible correlations between these outcomes. Healthy adults (n = 16, 29.34 ± 9.87 years) performed fatiguing EE of the trunk. A group of highly active individuals (TR, n = 8, > 14 h of sport per week) was compared with a group of less active individuals (UTR, n = 8, < 2 h of sport per week). Ultrasound measurements of ECT thickness, stiffness with MyotonPro and IndentoPro, skin temperature with infrared thermography, and pain on palpation (100 mm visual analog scale, VAS) as a surrogate for DOMS were recorded before (t0), immediately (t1), 24 h (t24), and 48 h (t48) after EE. ECT thickness increased after EE from t0 to t24 (5.96 mm to 7.10 mm, p = 0.007) and from t0 to t48 (5.96 mm to 7.21 mm, p < 0.001). VAS also increased from t0 to t24 (15.6 mm to 23.8 mm, p < 0.001) and from t0 to t48 (15.6 mm to 22.8 mm, p < 0.001). Skin temperature increased from t1 to t24 (31.6° Celsius to 32.7° Celsius, p = 0.032) and t1 to t48 (31.6° Celsius to 32.9° Celsius, p = 0.003), while stiffness remained unchanged (p > 0.05). Correlation analysis revealed no linear relationship between the outcomes within the 48-hour measurement period. The results may confirm previous findings of possible ECT involvement in the genesis of DOMS in the extremities also for the paraspinal ECT of trunk extensors. Subsequent work should focus on possible interventions targeting the ECT to prevent or reduce DOMS after strenuous muscle EE.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Vienna School of Osteopathy, Vienna, Austria
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
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Barreto Rabelo D, Coelho Figueira Freire AP, Colen Milagres Brandão F, Oliveira Melo S, Ocarino JM, Saldanha Dos Anjos MT, Schleip R, Souza TR, Simoneau G, Zambelli Pinto R. Myofascial stiffness of plantar fascia and Achilles tendon in individuals with plantar fasciopathy: An observational cross-sectional study. Musculoskelet Sci Pract 2023; 66:102781. [PMID: 37290347 DOI: 10.1016/j.msksp.2023.102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Assessment of myofascial tissue stiffness have a role in identifying physical impairments in plantar fasciopathy (PF). It is still unclear which specific functional and tissue differences exist between individuals with PF. AIM To compare myofascial stiffness of plantar fascia, Achilles tendon, and triceps surae between symptomatic and asymptomatic limbs in individuals with PF and between individuals with and without PF. METHODS Thirty nine individuals diagnosed with PF and individuals with no history of PF were recruited. Myofascial stiffness of the plantar fascia, Achilles tendon, and triceps surae, range of motion, and clinical tests were performed. Mean difference (MD) and 95% confidence interval (CI) were calculated. RESULTS Individuals with PF showed lower mean stiffness in Achilles tendon insertion (MD = -1.00 N/mm; 95%CI: -1.80,-0.21) on the symptomatic limb compared to the corresponding symptomatic limb in control group, a lower mean stiffness in plantar fascia (MD = -0.16 N/mm; 95%CI: -0.30, -0.01) on the symptomatic limb compared to asymptomatic limb, and a lower mean stiffness in the region 3 cm above the Achilles tendon insertion (MD = -0.79; 95%CI: -1.59, -0.00) compared to control. Individuals with PF showed fewer repetitions in heel rise test (MD = -3.97 reps; 95%CI: -5.83, -2.12) and in the step-down test (MD = -5.23 reps; 95%CI: -7.02, -3.44) compared to control. CONCLUSIONS Individuals with PF present reduced stiffness in Achilles tendon insertion and plantar fascia. The reduced stiffness was more evident in Achilles tendon in individuals with PF compared to individuals without PF. Individuals with PF showed lower performance in clinical tests.
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Affiliation(s)
- Daniel Barreto Rabelo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | | | - Sabrina Oliveira Melo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Juliana M Ocarino
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Germany.
| | - Thales R Souza
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Guy Simoneau
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States.
| | - Rafael Zambelli Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
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16
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Brandl A, Wilke J, Egner C, Reer R, Schmidt T, Schleip R. Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain. Front Med (Lausanne) 2023; 10:1177146. [PMID: 37342497 PMCID: PMC10278943 DOI: 10.3389/fmed.2023.1177146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
Background Alterations in posture, lumbopelvic kinematics, and movement patterns are commonly seen in patients with low back pain. Therefore, strengthening the posterior muscle chain has been shown to result in significant improvement in pain and disability status. Recent studies suggest that thoracolumbar fascia (TLF) has a major impact on the maintenance of spinal stability and paraspinal muscle activity, and thus is likely to have an equal impact on deadlift performance. Objective Aim of the study was to evaluate the role of thoracolumbar fascia deformation (TFLD) during spinal movement in track and field athletes (TF) as well as individuals with and without acute low back pain (aLBP). Methods A case-control study was performed with n = 16 aLBP patients (cases) and two control groups: untrained healthy individuals (UH, n = 16) and TF (n = 16). Participants performed a trunk extension task (TET) and a deadlift, being assessed for erector spinae muscle thickness (EST) and TLFD using high-resolution ultrasound imaging. Mean deadlift velocity (VEL) and deviation of barbell path (DEV) were measured by means of a three-axis gyroscope. Group differences for TLFD during the TET were examined using ANOVA. Partial Spearman rank correlations were calculated between TLFD and VEL adjusting for baseline covariates, EST, and DEV. TLFD during deadlifting was compared between groups using ANCOVA adjusting for EST, DEV, and VEL. Results TLFD during the TET differed significantly between groups. TF had the largest TLFD (-37.6%), followed by UH (-26.4%), while aLBP patients had almost no TLFD (-2.7%). There was a strong negative correlation between TLFD and deadlift VEL in all groups (r = -0.65 to -0.89) which was highest for TF (r = -0.89). TLFD during deadlift, corrected for VEL, also differed significantly between groups. TF exhibited the smallest TLFD (-11.9%), followed by aLBP patients (-21.4%), and UH (-31.9%). Conclusion TFLD maybe a suitable parameter to distinguish LBP patients and healthy individuals during lifting tasks. The cause-effect triangle between spinal movement, TFLD and movement velocity needs to be further clarified. Clinical trial registration https://drks.de/register/de/trial/DRKS00027074/, German Clinical Trials Register DRKS00027074.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt, Austria
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg (MSH), Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, Bad Sooden-Allendorf, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
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17
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Brandl A, Egner C, Schwarze M, Reer R, Schmidt T, Schleip R. Immediate Effects of Instrument-Assisted Soft Tissue Mobilization on Hydration Content in Lumbar Myofascial Tissues: A Quasi-Experiment. J Clin Med 2023; 12:jcm12031009. [PMID: 36769657 PMCID: PMC9917932 DOI: 10.3390/jcm12031009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/14/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Instrument-assisted soft tissue mobilization (IASTM) is thought to alter fluid dynamics in human soft tissue. The aim of this study was to investigate the influence of IASTM on the thoracolumbar fascia (TLF) on the water content of the lumbar myofascial tissue. METHODS In total, 21 healthy volunteers were treated with IASTM. Before and after the procedure and 5 and 10 min later, lumbar bioimpedance was measured by bioimpedance analysis (BIA) and TLF stiffness was measured by indentometry. Tissue temperature was recorded at the measurement time points using an infrared thermometer. RESULTS Bioimpedance increased significantly from 58.3 to 60.4 Ω (p < 0.001) at 10-min follow-up after the treatment. Temperature increased significantly from 36.3 to 36.6 °C from 5 to 10 min after treatment (p = 0.029), while lumbar myofascial stiffness did not change significantly (p = 0.84). CONCLUSIONS After the IASTM intervention, there was a significant increase in bioimpedance, which was likely due to a decrease in water content in myofascial lumbar tissue. Further studies in a randomized control trial design are needed to extrapolate the results in healthy subjects to a symptomatic population as well and to confirm the reliability of BIA in myofascial tissue.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Monique Schwarze
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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Brandl A, Egner C, Reisser U, Lingenfelder C, Schleip R. Influence of high-energy laser therapy to the patellar tendon on its ligamentous microcirculation: An experimental intervention study. PLoS One 2023; 18:e0275883. [PMID: 36972259 PMCID: PMC10042339 DOI: 10.1371/journal.pone.0275883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Laser therapeutic applications, such as the use of high energy lasers (HILT), are widely used in physical therapy, but basic studies on the mechanisms of action of HILT on tendinous/ligamentous tissue are largely lacking. The aim of this study was to investigate microcirculatory changes of the patellar tendon by HILT. 21 healthy volunteers were included in the present investigation. Before and after HILT, as well as 10 minutes later, the microcirculation was measured by noninvasive laser Doppler and white light spectroscopy (O2C device). Tissue temperature was recorded at the measurement time points using thermography. Blood flow increased significantly by 86.38 arbitrary units (AU; p < 0.001) after the intervention and by 25.76 AU (p < 0.001) at follow-up. Oxygen saturation increased by 20.14% (p < 0.001) and 13.48%, respectively (p < 0.001), whereas relative hemoglobin decreased by 6.67 AU and 7.90 AU, respectively. Tendon temperature increased by 9.45° and 1.94° Celsius, respectively. Acceleration of blood flow by improving the flow properties of erythrocytes and platelets may have caused the results. HILT could be a therapeutic perspective for tendon pathologies with impaired microcirculation, although further studies are needed to validate the experimental results.
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Affiliation(s)
- Andreas Brandl
- Faculty for Psychology and Human Movement Science, Department of Sports Medicine, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
- DIPLOMA Hochschule, Bad Sooden-Allendorf, Germany
| | | | | | | | - Robert Schleip
- DIPLOMA Hochschule, Bad Sooden-Allendorf, Germany
- Department of Sport and Health Sciences, Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany
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19
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Weber P, Klingler W, Schleip R, Weber N, Joisten C. The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial. J Clin Med 2022; 11:jcm11237110. [PMID: 36498690 PMCID: PMC9736370 DOI: 10.3390/jcm11237110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/26/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Instrument-assisted manual therapy (IAMT) is indicated to improve flexibility, reduce pain, and induce hyperaemia locally and along myofascial chains. The underlying effects are largely unclear. This randomised, placebo-controlled pilot study aimed to gain first insights into these effects, primarily on the structural level, through ultrasonography. Methods: 67 healthy female soccer players aged 20.9 (±3.9) years were examined after right lumbar intervention (IAMT: intervention group (IG), heat application: comparison group (CG), pressure-less placebo: placebo group (PG)). Ultrasonography (absolute movement and shear motion), flexibility tests (passive straight leg raise test (PSLR), lumbar and thoracic double inclinometry), and superficial skin temperature were recorded before (t0), immediately (t1) and 45 min after the intervention (t2). Results: IAMT decreased the absolute mobility of the superficial lamina and its shear motion to the superficial fascia compared with the PG (t1; p < 0.05). PSLR improved in the IG compared with the CG (t2) and PG (t1, t2; p < 0.05). The temperature increased in the IG and CG compared with the PG (t1, t2) and in the CG compared with the IG (t1; p < 0.05). Conclusion: IAMT of the lumbar back briefly reduces absolute mobility of the superficial lamina and its shear motion to the superficial fascia, improves flexibility, and increases the temperature.
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Affiliation(s)
- Patrick Weber
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
- Correspondence:
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, 72488 Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, 89081 Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany
- Department for Medical Professions, Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Nadine Weber
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
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Brandl A, Egner C, Reer R, Schmidt T, Schleip R. Associations between Deformation of the Thoracolumbar Fascia and Activation of the Erector Spinae and Multifidus Muscle in Patients with Acute Low Back Pain and Healthy Controls: A Matched Pair Case-Control Study. Life (Basel) 2022; 12:life12111735. [PMID: 36362889 PMCID: PMC9697365 DOI: 10.3390/life12111735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae and multifidus muscle (ESM) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality (GC) were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). GC showed a direct effect of TLF deformation on ESM activation only in the aLBP group (p < 0.03). Conclusions: The results suggest that in aLBP, ESM activity is significantly affected by TLF, whereas this relationship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Christoph Egner
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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21
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Brandl A, Bartsch K, James H, Miller ME, Schleip R. Influence of Rolfing Structural Integration on Active Range of Motion: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11195878. [PMID: 36233746 PMCID: PMC9570915 DOI: 10.3390/jcm11195878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Recent work has investigated significant force transmission between the components of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause−effect pathology, comprehensive neuromusculoskeletal therapy such as the Rolf Method of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retrospectively screened from the medical records of an SI practice over a 23-year period. A total of 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flexion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001) but were not affected by age. Conclusions: An SI intervention could produce multiple changes in the components of myofascial chains that could help maintain upright posture in humans and reduce inadequate compensatory patterns. SI may also affect differently the outcome of some AROM parameters in women and men.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Katja Bartsch
- Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Helen James
- Department of Physical Therapy, California State University, Fresno, CA 93740, USA
| | - Marilyn E. Miller
- Department of Physical Therapy, University of St. Augustine for Health Sciences at San Diego, San Diego, CA 92069, USA
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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22
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Brandl A, Egner C, Schleip R. Practical Measurement of Changes in Leg Length Discrepancy After a Myofascial Release on the Thoracolumbar Fascia in Patients With Acute Low Back Pain: A Pilot Study. Cureus 2022; 14:e29084. [PMID: 36258943 PMCID: PMC9558767 DOI: 10.7759/cureus.29084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/26/2022] Open
Abstract
Background Recent work has examined an association between leg length discrepancy (LLD) and low back pain (LBP). Myofascial release (MFR) techniques are thought to be frequently applied in the treatment of chronic and acute LBP. The purpose of this study was to evaluate a practical measure of LLD and the feasibility of an MFR technique in a randomised controlled trial (RCT). Methods In 12 subjects (seven women and five men) with acute LBP and LLD greater than 3 mm, an MFR technique was performed on the thoracolumbar fascia. At the baseline, after the intervention, and at follow-up, LLD was measured using a cross-line laser and finger-to-floor distance, and the pain was measured with a visual analogue scale (VAS). Patients completed a questionnaire after follow-up to assess the acceptability of the study procedure. The therapist evaluated the methods in terms of their feasibility. Results LLD measurement and MFR treatment required little time and few resources. Participants agreed to the study procedure with moderate to high acceptance. The LLD decreased by 5 mm after treatment and by 4 mm at follow-up. The VAS showed a reduction in pain of 17.50 mm at follow-up but not immediately after treatment. Conclusion The measurement of LLD is applicable in daily osteopathic practice, but it cannot be assumed to be a valid method for an RCT. Validated methods such as video raster stereography are, therefore, recommended. Comprehensive RCTs to study the effects of MFR intervention on leg length are feasible.
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23
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Fede C, Petrelli L, Pirri C, Neuhuber W, Tiengo C, Biz C, De Caro R, Schleip R, Stecco C. Innervation of human superficial fascia. Front Neuroanat 2022; 16:981426. [PMID: 36106154 PMCID: PMC9464976 DOI: 10.3389/fnana.2022.981426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
The superficial fascia has only recently been recognized as a specific anatomical structure. Furthermore, whereas it is actually recognized that the innervation of the deep/muscular fascia plays a key role in proprioception and nociception, there are very few studies that have analyzed these characteristics in the superficial fascia. In this work, our group analyzed two different anatomical districts (abdomen and thigh), from volunteer patients, undergoing surgery procedures. Each sample was processed for histological analysis by Hematoxylin&Eosin, and by immunohistochemistry stainings (in 5-micron-paraffin embedded section and in cryosectioned free floating samples), with antibodies specific for nerve fibers: S100 antibody for myelinating and non-myelinating Schwann cells, PGP9.5 antibody as pan-neuronal marker, tyrosine hydroxylase for autonomic innervation. The results revealed a huge innervation: the nervous structures were found above all around blood vessels and close to adipocytes, but they penetrated also in the connective tissue itself and are found in the midst of fibro-adipose tissue. The tissue is pervaded by both thin (mean diameter of 4.8 ± 2.6 μm) and large nerve fiber bundles of greater diameter (21.1 ± 12.2 μm). The ratio S100/TH positivity was equal to 2.96, with a relative percentage of autonomic innervation with of 33.82%. In the light of these findings is evident that the superficial fasciae have a clear and distinct anatomical identity and a specific innervation, which should be considered to better understand their role in thermoregulation, exteroception and pain perception. The knowledge of the superficial fascia may improve grading and developing of different manual approach for treatments of fascial dysfunctions, and the understanding of how some factors like temperature or manual therapies can have an impact on sensitivity of the fascia.
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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
- *Correspondence: Caterina Fede
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Winfried Neuhuber
- Institute of Anatomy and Cell Biology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Cesare Tiengo
- Plastic and Reconstructive Surgery Unit University of Padua, Padua, Italy
| | - Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
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24
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Brandl A, Egner C, Schleip R. Reply to Kudus, A.L. Comment on "Brandl et al. Immediate Effects of Myofascial Release on the Thoracolumbar Fascia and Osteopathic Treatment for Acute Low Back Pain on Spine Shape Parameters: A Randomized, Placebo-Controlled Trial. Life 2021, 11, 845". Life (Basel) 2022; 12:life12060868. [PMID: 35743899 PMCID: PMC9225237 DOI: 10.3390/life12060868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas Brandl
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Christoph Egner
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Robert Schleip
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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25
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Gabriel A, Konrad A, Roidl A, Queisser J, Schleip R, Horstmann T, Pohl T. Myofascial Treatment Techniques on the Plantar Surface Influence Functional Performance in the Dorsal Kinetic Chain. J Sports Sci Med 2022; 21:13-22. [PMID: 35250329 PMCID: PMC8851122 DOI: 10.52082/jssm.2022.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/30/2022]
Abstract
Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.
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Affiliation(s)
- Anna Gabriel
- Technical University of Munich, Munich, Germany, Associate Professorship for Conservative and Rehabilitative Orthopedics, Technical University of Munich, Georg Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Austria
| | - Anna Roidl
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | | | - Robert Schleip
- Technical University of Munich, Munich, Germany,Diploma University of Applied Sciences, Germany, Department of Sports Medicine and Health Promotion, Friedrich Schiller University, Germany
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26
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dos Santos Amorim M, Sinhorim L, Wagner J, de Paula Lemos F, Schleip R, Sonza A, Santos GM. Acute effects of myofascial reorganization on trapezius muscle oxygenation in individuals with nonspecific neck pain. J Bodyw Mov Ther 2022; 29:286-290. [DOI: 10.1016/j.jbmt.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/17/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022]
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27
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Sinhorim L, Amorim MDS, Ortiz ME, Bittencourt EB, Bianco G, da Silva FC, Horewicz VV, Schleip R, Reed WR, Mazzardo-Martins L, Martins DF. Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies. J Clin Med 2021; 10:jcm10194342. [PMID: 34640360 PMCID: PMC8509394 DOI: 10.3390/jcm10194342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.
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Affiliation(s)
- Larissa Sinhorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Mayane dos Santos Amorim
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Human Movement Sciences Graduate Program, College of Health and Sport Science at Santa Catarina State University, Florianópolis 88080-350, Brazil
| | - Maria Eugênia Ortiz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Edsel Balduino Bittencourt
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Coastal Health Institute, Jacksonville, FL 32224, USA
| | - Gianluca Bianco
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, 00147 Rome, Italy
- Istituto di Formazione in Agopuntura e Neuromodulazione IFAN, 00147 Roma, Italy
| | | | - Verônica Vargas Horewicz
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, 80799 Munich, Germany
- Department for Medical Professions, DIPLOMA University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
- Correspondence: ; Tel.: +49-89-346016
| | - William R. Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Rehabilitation Science Program, Departments of Physical and Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Leidiane Mazzardo-Martins
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil;
| | - Daniel F. Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina, Palhoça 88137-272, Brazil; (L.S.); (M.d.S.A.); (M.E.O.); (E.B.B.); (G.B.); (V.V.H.); (D.F.M.)
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça 88137-272, Brazil
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28
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Yoshimura A, Inami T, Schleip R, Mineta S, Shudo K, Hirose N. Effects of Self-myofascial Release Using a Foam Roller on Range of Motion and Morphological Changes in Muscle: A Crossover Study. J Strength Cond Res 2021; 35:2444-2450. [PMID: 31136541 DOI: 10.1519/jsc.0000000000003196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
ABSTRACT Yoshimura, A, Inami, T, Schleip, R, Mineta, S, Shudo, K, and Hirose, N. Effects of self-myofascial release using a foam roller on range of motion and morphological changes in muscle: a crossover study. J Strength Cond Res 35(9): 2444-2450, 2021-Self-myofascial release using a foam roller (FR) is effective in improving range of motion (ROM) in at least some conditions. However, its mechanism is still unclear. Therefore, this study investigated potential acute muscle morphological changes after the FR intervention and aimed to clarify the mechanism of increases in ROM by the FR intervention. We hypothesized that the FR intervention may increase ROM because of changes in fascicle length (FL) and aponeurosis displacement. This crossover study, involving 22 male university students (21.5 ± 1.3 years, 170.6 ± 4.0 cm, and 64.1 ± 8.9 kg; mean ± SD), compared the FR intervention targeting the gastrocnemius muscle with the control trial. The outcome measures were maximum passive ankle ROM, morphology of the gastrocnemius muscle (FL and aponeurosis displacement) during passive ankle plantar flexor movement, degree of pain during the FR intervention, and sensation of the triceps surae muscle. Although ROM of both dorsiflexion and plantar flexion increased significantly after the FR intervention (p < 0.01), no significant differences were found in FL and aponeurosis displacement before and after the FR intervention. The mean perception of pain during the FR intervention was rated as "slightly uncomfortable," corresponding to a 2.3 ± 2.4-cm on a 9.5-cm visual analog scale. We found that the FR intervention did not influence the morphology of muscle. It is necessary to investigate other factors related to ROM as the next step of this study.
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Affiliation(s)
- Akane Yoshimura
- Graduate School of Sport Sciences, Waseda University, Nishitokyo, Japan
| | - Takayuki Inami
- Institute of Physical Education, Keio University, Yokohama, Japan
| | - Robert Schleip
- Fascia Research Group, Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany
| | - Shinshiro Mineta
- Graduate School of Sport Sciences, Waseda University, Nishitokyo, Japan
| | - Kohei Shudo
- Sinior High School, Waseda University, Nerimaku, Japan ; and
| | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, Nishitokyo, Japan
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29
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Brandl A, Egner C, Schleip R. Immediate Effects of Myofascial Release on the Thoracolumbar Fascia and Osteopathic Treatment for Acute Low Back Pain on Spine Shape Parameters: A Randomized, Placebo-Controlled Trial. Life (Basel) 2021; 11:845. [PMID: 34440589 PMCID: PMC8399614 DOI: 10.3390/life11080845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spine shape parameters, such as leg length and kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pathologies. This study examined the immediate effects of a myofascial release (MFR) technique on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in patients with acute low back pain (aLBP). METHODS This study was a single-blind randomized placebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blindedly assigned to three groups to be treated with MFR, OMT, or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, and lordotic angle) were measured before and after the intervention using video raster stereography. RESULTS Within the MFR group, fLLD reduced by 5.2 mm, p < 0.001 and kyphotic angle by 8.2 degrees, p < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, p < 0.001, and kyphotic angle by 8.4°, p = 0.007. CONCLUSION MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.
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Affiliation(s)
- Andreas Brandl
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Christoph Egner
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
| | - Robert Schleip
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany; (A.B.); (C.E.)
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80333 Munich, Germany
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30
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Freiwald J, Magni A, Fanlo-Mazas P, Paulino E, Sequeira de Medeiros L, Moretti B, Schleip R, Solarino G. A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review. Life (Basel) 2021; 11:780. [PMID: 34440524 PMCID: PMC8401625 DOI: 10.3390/life11080780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/29/2022] Open
Abstract
Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient's quality of life, limits their daily living activities, and reduces their work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of superficial heat therapy in the management of non-specific mild-to-moderate LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LBP), and finally review the published evidence regarding the impact of superficial heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is relevant for the management of non-specific mild or moderate low back pain in current clinical practice.
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Affiliation(s)
- Jürgen Freiwald
- Department of Movement and Training Science, Bergische University Wuppertal, 42119 Wuppertal, Germany;
| | - Alberto Magni
- S.I.M.G. Società Italiana di Medicina Generale, 50242 Florence, Italy;
| | - Pablo Fanlo-Mazas
- Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Ema Paulino
- Farmácia Nuno Álvares, 2800-179 Almada, Portugal;
| | - Luís Sequeira de Medeiros
- Nova Medical School, Nova University Lisbon, 1099-085 Lisbon, Portugal;
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de Lisboa Central, 1150-199 Lisbon, Portugal
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (B.M.); (G.S.)
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, 80992 Munich, Germany
- Department for Medical Professions, Diploma University of Applied Sciences Bad Sooden-Allendorf, 37242 Bad Sooden-Allendorf, Germany
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (B.M.); (G.S.)
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31
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Weinrich L, Paraskevaidis M, Schleip R, Agres AN, Tsitsilonis S. Does the Calcaneus Serve as Hypomochlion within the Lower Limb by a Myofascial Connection?-A Systematic Review. Life (Basel) 2021; 11:life11080745. [PMID: 34440492 PMCID: PMC8398293 DOI: 10.3390/life11080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Clinical approaches have depicted interconnectivity between the Achilles tendon and the plantar fascia. This concept has been applied in rehabilitation, prevention, and in conservative management plans, yet potential anatomical and histological connection is not fully understood. (2) Objective: To explore the possible explanation that the calcaneus acts as a hypomochlion. (3) Methods: 2 databases (Pubmed and Livivo) were searched and studies, including those that examined the relationship of the calcaneus to the Achilles tendon and plantar fascia and its biomechanical role. The included studies highlighted either the anatomical, histological, or biomechanical aspect of the lower limb. (4) Results: Seventeen studies were included. Some studies depicted an anatomical connection that slowly declines with age. Others mention a histological similarity and continuity via the paratenon, while a few papers have brought forward mechanical reasoning. (5) Conclusion: The concept of the calcaneus acting as a fulcrum in the lower limb can partially be supported by anatomical, histological, and biomechanical concepts. Despite the plethora of research, a comprehensive understanding is yet to be investigated. Further research exploring the precise interaction is necessary.
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Affiliation(s)
- Luise Weinrich
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Melissa Paraskevaidis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Robert Schleip
- Technische Universität München, 80333 München, Germany;
- Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Alison N. Agres
- Julius Wolff Institute, Berlin Institute of Health and Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
- Correspondence:
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Zullo A, Mancini FP, Schleip R, Wearing S, Klingler W. Fibrosis: Sirtuins at the checkpoints of myofibroblast differentiation and profibrotic activity. Wound Repair Regen 2021; 29:650-666. [PMID: 34077595 DOI: 10.1111/wrr.12943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022]
Abstract
Fibrotic diseases are still a serious concern for public health, due to their high prevalence, complex etiology and lack of successful treatments. Fibrosis consists of excessive accumulation of extracellular matrix components. As a result, the structure and function of tissues are impaired, thus potentially leading to organ failure and death in several chronic diseases. Myofibroblasts represent the principal cellular mediators of fibrosis, due to their extracellular matrix producing activity, and originate from different types of precursor cells, such as mesenchymal cells, epithelial cells and fibroblasts. Profibrotic activation of myofibroblasts can be triggered by a variety of mechanisms, including the transforming growth factor-β signalling pathway, which is a major factor driving fibrosis. Interestingly, preclinical and clinical studies showed that fibrotic degeneration can stop and even reverse by using specific antifibrotic treatments. Increasing scientific evidence is being accumulated about the role of sirtuins in modulating the molecular pathways responsible for the onset and development of fibrotic diseases. Sirtuins are NAD+ -dependent protein deacetylases that play a crucial role in several molecular pathways within the cells, many of which at the crossroad between health and disease. In this context, we will report the current knowledge supporting the role of sirtuins in the balance between healthy and diseased myofibroblast activity. In particular, we will address the signalling pathways and the molecular targets that trigger the differentiation and profibrotic activation of myofibroblasts and can be modulated by sirtuins.
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Affiliation(s)
- Alberto Zullo
- Department of Sciences and Technologies, Benevento, Italy.,CEINGE Advanced Biotechnologies s.c.a.r.l. Naples, Italy
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Germany.,Fascia Research Group, Department of Neurosurgery, Ulm University, Germany.,Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany
| | - Scott Wearing
- Department of Sport and Health Sciences, Technical University Munich, Germany.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Werner Klingler
- Department of Sport and Health Sciences, Technical University Munich, Germany.,Fascia Research Group, Department of Neurosurgery, Ulm University, Germany.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Anaesthesiology, SRH Hospital Sigmaringen, Germany
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Magerl W, Thalacker E, Vogel S, Schleip R, Klein T, Treede RD, Schilder A. Tenderness of the Skin after Chemical Stimulation of Underlying Temporal and Thoracolumbar Fasciae Reveals Somatosensory Crosstalk between Superficial and Deep Tissues. Life (Basel) 2021; 11:life11050370. [PMID: 33919303 PMCID: PMC8143345 DOI: 10.3390/life11050370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 01/14/2023] Open
Abstract
Musculoskeletal pain is often associated with pain referred to adjacent areas or skin. So far, no study has analyzed the somatosensory changes of the skin after the stimulation of different underlying fasciae. The current study aimed to investigate heterotopic somatosensory crosstalk between deep tissue (muscle or fascia) and superficial tissue (skin) using two established models of deep tissue pain (namely focal high frequency electrical stimulation (HFS) (100 pulses of constant current electrical stimulation at 10× detection threshold) or the injection of hypertonic saline in stimulus locations as verified using ultrasound). In a methodological pilot experiment in the TLF, different injection volumes of hypertonic saline (50–800 µL) revealed that small injection volumes were most suitable, as they elicited sufficient pain but avoided the complication of the numbing pinprick sensitivity encountered after the injection of a very large volume (800 µL), particularly following muscle injections. The testing of fascia at different body sites revealed that 100 µL of hypertonic saline in the temporal fascia and TLF elicited significant pinprick hyperalgesia in the overlying skin (–26.2% and –23.5% adjusted threshold reduction, p < 0.001 and p < 0.05, respectively), but not the trapezius fascia or iliotibial band. Notably, both estimates of hyperalgesia were significantly correlated (r = 0.61, p < 0.005). Comprehensive somatosensory testing (DFNS standard) revealed that no test parameter was changed significantly following electrical HFS. The experiments demonstrated that fascia stimulation at a sufficient stimulus intensity elicited significant across-tissue facilitation to pinprick stimulation (referred hyperalgesia), a hallmark sign of nociceptive central sensitization.
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Affiliation(s)
- Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Emanuela Thalacker
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Simon Vogel
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Robert Schleip
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Health Sciences, Technical University of Munich, 80333 Munich, Germany;
- DIPLOMA Hochschule, 37242 Bad Sooden-Allendorf, Germany
| | - Thomas Klein
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
| | - Andreas Schilder
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (W.M.); (E.T.); (S.V.); (T.K.); (R.-D.T.)
- Correspondence: ; Tel.: +49-621-383-71400; Fax: +49-621-383-71401
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Yoshimura A, Sekine Y, Schleip R, Furusyo A, Yamazaki K, Inami T, Murayama M, Hirose N. The acute mechanism of the self-massage-induced effects of using a foam roller. J Bodyw Mov Ther 2021; 27:103-112. [PMID: 34391221 DOI: 10.1016/j.jbmt.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maintaining flexibility, often defined as range of motion (ROM), is important. Recently, self-massage using a foam roller (FR) has been used in clinical and/or sports settings to effectively and immediately improve ROM. Many studies have found significant increases in ROM following the FR intervention; however, the mechanism of the effect is unclear. We aimed to clarify this mechanism regarding the ROM effects following the FR intervention by evaluating local tissue and autonomic nervous system responses. METHOD The study employed a crossover design that included a comparison between non-intervention (CON trial: left leg) and intervention (FR trial: right leg) groups. Fourteen volunteers participated. Nine outcomes (passive maximum ankle ROM [ROM with a specified and non-specified passive strength], tissue hardness, skin temperature, water contents, circumference, blood flow velocity, pressure pain threshold, autonomic nervous system, and heart rate) were investigated before (PRE) and 0 min (POST0), 20 min (POST20), 40 min (POST40), and 60 min (POST60) post intervention. RESULTS Skin temperature, impedance, and circumference changed significantly following the intervention, and increased ROM with non-specified strength was observed. DISCUSSION Although we found that the FR intervention influenced skin temperature, impedance, circumference, and ROM, adaptability to the intervention may differ depending on an individual's characteristics. Females and/or individuals with a high body water content could obtain greater positive ROM effects than males and/or individuals with a low body water content. CONCLUSION These findings suggest that the FR intervention may be an effective method to improve ROM, with alterations of skin temperature, impedance, and circumference.
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Affiliation(s)
- Akane Yoshimura
- Graduate School of Sport Sciences, Waseda University, Japan.
| | - Yuta Sekine
- Faculty of Modern Life, Teikyo Heisei University, Japan.
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Germany.
| | - Atsuya Furusyo
- Graduate School of Sport Sciences, Waseda University, Japan.
| | - Kazuya Yamazaki
- Graduate School of Sport Sciences, Waseda University, Japan.
| | - Takayuki Inami
- Institute of Physical Education, Keio University, Japan.
| | | | - Norikazu Hirose
- Faculty of Sport Sciences, Waseda University, 3-4-1, Higashifushimi, Nishitokyo City, Tokyo, 2020021, Japan.
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Kasper-Jędrzejewska M, Jędrzejewski G, Ptaszkowska L, Ptaszkowski K, Schleip R, Halski T. The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study. J Clin Med 2020; 9:jcm9123981. [PMID: 33316903 PMCID: PMC7764274 DOI: 10.3390/jcm9123981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during “pre-baseline rest” (p < 0.014) and that during “rest after tonic contraction” (p = 0.021) in the supine position, as were significant increases in “phasic contraction” in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention “phasic contraction” (p = 0.037) and “pre-baseline rest” (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.
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Affiliation(s)
- Martyna Kasper-Jędrzejewska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
- Correspondence:
| | - Grzegorz Jędrzejewski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Lucyna Ptaszkowska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland;
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, 80992 München, Germany;
- Diploma University of Applied Sciences, Am Hegeberg 2, 37242 Bad Sooden-Allendorf, Germany
| | - Tomasz Halski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020. [DOI: 10.58737310.3389/fphys.2020.587373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020; 11:587373. [PMID: 33424619 PMCID: PMC7793886 DOI: 10.3389/fphys.2020.587373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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Affiliation(s)
- Maria Elisa Duarte França
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Larissa Sinhorim
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil.,Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Daniel Fernandes Martins
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany.,Department for Medical Professions, DIPLOMA Hochschule Bad Sooden-Allendorf, Bad Sooden-Allendorf, Germany
| | - Nicolas A M M Machado-Pereira
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Gabriel Melo de Souza
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Verônica Vargas Horewicz
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Gilmar Moraes Santos
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
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Jędrzejewski G, Kasper-Jędrzejewska M, Dolibog P, Szyguła R, Schleip R, Halski T. The Rolf Method of Structural Integration on Fascial Tissue Stiffness, Elasticity, and Superficial Blood Perfusion in Healthy Individuals: The Prospective, Interventional Study. Front Physiol 2020; 11:1062. [PMID: 33041843 PMCID: PMC7522439 DOI: 10.3389/fphys.2020.01062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/31/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: There are multiple theories surrounding the physiological impact of structural integration (SI) with little evidence or research corroborating any of these. The aim of the study was to assess the effectiveness of 10 sessions of SI on fascial tissue (FT) superficial blood perfusion, stiffness, and elasticity in 13 healthy women. Methods: This was a prospective, interventional study. The primary outcome measures were FTs’ superficial blood perfusion, stiffness, and elasticity of bilateral selected FT points on the body. Data were collected before and after 10 sessions of SI intervention. Statistical analysis was performed using the non-parametric Wilcoxon test (intragroup comparison). Results: The superficial blood perfusion increased significantly in the most selected FT points on the body (p < 0.05). SI interventions produced significant decreases in selected points (brachioradialis, biceps brachii, and trapezius; p < 0.05) of FT stiffness and significant increases in elasticity (brachioradialis, biceps brachii, triceps surae, and trapezius; p < 0.05), especially in the FT of the right (dominant) upper limb. Conclusion: A 10-session of SI demonstrated positive effects on increasing superficial blood perfusion contributed to a decrease in FT stiffness and an increase in elasticity properties in the dominant upper limb. Data collection for this study is currently underway, and the trial is registered at ISRCTN.com with the identifier: ISRCTN46707309.
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Affiliation(s)
| | | | - Paweł Dolibog
- Faculty of Health Sciences, University of Opole, Opole, Poland
| | - Renata Szyguła
- Faculty of Health Sciences, University of Opole, Opole, Poland
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.,Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany
| | - Tomasz Halski
- Faculty of Health Sciences, University of Opole, Opole, Poland
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Bartsch KM, Schleip R, Zullo A, Hoppe K, Klingler W. The Stiffness Comparison Test: A pilot study to determine inter-individual differences in palpatory skill related to gender, age, and occupation-related experience. J Bodyw Mov Ther 2020; 24:1-6. [PMID: 33218495 DOI: 10.1016/j.jbmt.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Manual palpation is a core skill in physical examination. Assessing elastic properties such as tissue stiffness has the potential for being an important diagnostics tool in the detection of cancer and other diseases. OBJECTIVE The study describes the newly developed Stiffness Comparison Test (SCT). The aim of our study was to test the SCT as a tool to detect interindividual differences in palpation skill related to gender, age and occupational experience. METHODS We used eight pairs of polyuterhane gel pads with the stiffness difference decreasing from the first to the last pair. Test subjects were asked to palpate each pair and determine stiffness differences. PARTICIPANTS We recruited 25 osteopaths, 48 other manual therapists and 50 participants from other non-manual professions. RESULTS As hypothesized there was no significant difference in SCT performance between the sexes (t(121) = 0.288, p = .774). To investigate if an age-related decline would have an effect on palpation skill, we carried out a linear regression. As hypothesized, the model did not predict any significant associations (F(1, 121) = 2.733, b = -0.149, p = .101, R2 = 0.022). To compare the effect of occupational groups on SCT performance a one-way ANOVA was conducted. There were no statistically significant differences between group means (F(2, 120) = 0.598, p = .552). CONCLUSIONS The SCT can be used as simple and affordable tool for assessment, teaching and training in all disciplines of manual medicine. Further refinements of the tool are suggested to advance its discrimination power.
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Affiliation(s)
- Katja Martina Bartsch
- Verein zur Förderung der Faszienforschung e.V., Munich, Germany; Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, Germany.
| | - Robert Schleip
- Experimental Anaesthesiology, Ulm University, Ulm, Germany; Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany; Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany; Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, Germany.
| | - Alberto Zullo
- Department of Sciences and Technologies, University of Sannio, Benevento, Italy.
| | - Kerstin Hoppe
- Department of Anaesthesia, Critical Care Medicine and Pain Therapy, University of Frankfurt, Frankfurt, Germany.
| | - Werner Klingler
- Experimental Anaesthesiology, Ulm University, Ulm, Germany; SRH Hospital, Sigmaringen, Germany; Queensland University of Technology, Brisbane, Australia; Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, Germany.
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Abraham A, Franklin E, Stecco C, Schleip R. Integrating mental imagery and fascial tissue: A conceptualization for research into movement and cognition. Complement Ther Clin Pract 2020; 40:101193. [PMID: 32891273 DOI: 10.1016/j.ctcp.2020.101193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 12/28/2022]
Abstract
Mental imagery (MI) research has mainly focused to date on mechanisms of effect and performance gains associated with muscle and neural tissues. MI's potential to affect fascia has rarely been considered. This paper conceptualizes ways in which MI might mutually interact with fascial tissue to support performance and cognitive functions. Such ways acknowledge, among others, MI's positive effect on proprioception, body schema, and pain. Drawing on cellular, physiological, and functional similarities and associations between muscle and fascial tissues, we propose that MI has the potential to affect and be affected by fascial tissue. We suggest that fascia-targeted MI (fascial mental imagery; FMI) can therefore be a useful approach for scientific as well as clinical purposes. We use the example of fascial dynamic neuro-cognitive imagery (FDNI) as a codified FMI method available for scientific and therapeutic explorations into rehabilitation and prevention of fascia-related disabling conditions.
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Affiliation(s)
- Amit Abraham
- Department of Kinesiology, College of Education, The University of Georgia, Athens, GA, USA. 330 River Road, Athens, 30602, GA, USA; Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Eric Franklin
- The International Institute for Franklin Method, Hitnauerstrasse 40 CH-8623 Wetzikon, Zurich, Switzerland.
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Giustiniani, 5 - 35128, Padova, Italy.
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Germany. Georg-Brauchle-Ring 60/62, 80802, Muenchen, Germany; Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany; Fascia Research Group, Ulm University, Experimental Anesthesiology, Ulm, Germany.
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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: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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42
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Weber P, Graf C, Klingler W, Weber N, Schleip R. The feasibility and impact of instrument-assisted manual therapy (IAMT) for the lower back on the structural and functional properties of the lumbar area in female soccer players: a randomised, placebo-controlled pilot study design. Pilot Feasibility Stud 2020; 6:47. [PMID: 32322406 PMCID: PMC7164264 DOI: 10.1186/s40814-020-00592-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myofascial (self-)treatments, such as foam rollers to therapeutic instruments in manual therapy, are utilized increasingly in prevention and therapy in healthy people, athletes, and patients suffering from chronic back pain. However, there is limited knowledge about the effectiveness of treatment and the underlying mechanisms of myofascial therapies, especially for instrument-assisted manual therapy (IAMT). Therefore, this pilot study will investigate the feasibility and impact of IAMT for the lumbar area compared with heat application and placebo treatment as a basis for calculating the sample size for further full studies. The primary outcomes will be a critical analysis of the feasibility of the measurement protocol in terms of time economy and expressiveness and of the short- and long-term effects on shear motion of the single tissue layers of the lower back obtained through ultrasound imaging. Secondary outcomes will include thickness and compressibility of the lumbar structures and flexibility of the dorsal structures, indentometry, and superficial skin temperature. METHODS A minimum of 60 healthy, competitive 15-35-year-old female soccer players will be recruited and randomised into three groups. Short-term effects of IAMT on thoracolumbar structures will be compared with heat application and pressure-less placebo treatment. Long-term effects in the IAMT group will be tested after nine further interventions over a 5-week period (2×/week) and compared with the placebo group, which will not receive further treatments but will serve as a control. Intermediate and final testing of both groups will occur in weeks three and five. DISCUSSION This pilot study will assess the feasibility and the impact of IAMT for the lower back particularly by examining the structural and functional properties of myofascial tissue using diagnostic ultrasound. These outcomes could evaluate the feasibility of the measurements used, shall build a basis for sample size calculation of further full studies, and might generate a greater understanding of myofascial therapies, especially IAMT, for the lower back and its benefits. If this approach proves to be practicable, next steps will be further full studies with soccer players, other sports, and patients with low back pain. TRIAL REGISTRATION German Clinical Trials Register (DRKS00012252) 20.06.2018; retrospectively registered.
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Affiliation(s)
- Patrick Weber
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Christine Graf
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, Germany, Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Nadine Weber
- Department Cardiology, Aachen University, Aachen, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Sports Medicine and Health Promotion, Friedrich-Schiller University Jena, Jena, Germany
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Schleip R, Hedley G, Yucesoy CA. Fascial nomenclature: Update on related consensus process. Clin Anat 2019; 32:929-933. [PMID: 31183880 PMCID: PMC6852276 DOI: 10.1002/ca.23423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 01/14/2023]
Abstract
The term fascia is increasingly used not only by anatomists but also by other professionals and authors in different health‐oriented fields. This goes along with an inconsistent usage of the term, in which many different tissues are included by different authors causing an increasing amount of confusion. The Fascia Research Society acted to address this issue by establishing a Fascia Nomenclature Committee (FNC) with the purpose of clarifying the terminology relating to fascia. This committee conducted an elaborate Delphi process to foster a structured consensus debate among different experts in the field. This process led to two distinct terminology recommendations from the FNC, defining the terms “a fascia” and “the fascial system.” This article reports on the process behind this proposed terminology as well as the implications for inclusion and exclusion of different tissue types to these definitions. Clin. Anat. 32:929–933, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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Affiliation(s)
- Robert Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany.,Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany.,Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Gil Hedley
- Integral Anatomy Productions LLC, Melbourne, Florida
| | - Can A Yucesoy
- Biomedical Engineering, Bogazici University, Istanbul, Turkey
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Abstract
The ubiquitous network of fascial tissues in the human body is usually regarded as a passive contributor to musculoskeletal dynamics. This review aims to highlight the current understanding of fascial stiffness regulation. Notably the ability for active cellular contraction which may augment the stiffness of fascial tissues and thereby contribute to musculoskeletal dynamics. A related narrative literature search via PubMed and Google Scholar reveals a multitude of studies indicating that the intrafascial presence of myofibroblasts may enable these tissues to alter their stiffness. This contractile tissue behavior occurs not only in several pathological fibrotic contractures but has also been documented in normal fasciae. When viewed at time frames of seconds and minutes the force of such tissue contractions is not sufficient for exerting a significant effect on mechanical joint stability. However, when viewed in a time-window of several minutes and longer, such cellular contractions can impact motoneuronal coordination. In addition, over a time frame of days to months, this cellular activity can induce long-term and severe tissue contractures. These findings tend to question the common clear distinction between active tissues and passive tissues in musculoskeletal dynamics. Clin. Anat. 32:891-895, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany.,Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany.,Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Werner Klingler
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany.,Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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45
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Schleip R, Gabbiani G, Wilke J, Naylor I, Hinz B, Zorn A, Jäger H, Breul R, Schreiner S, Klingler W. Fascia Is Able to Actively Contract and May Thereby Influence Musculoskeletal Dynamics: A Histochemical and Mechanographic Investigation. Front Physiol 2019; 10:336. [PMID: 31001134 PMCID: PMC6455047 DOI: 10.3389/fphys.2019.00336] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Fascial tissues form a ubiquitous network throughout the whole body, which is usually regarded as a passive contributor to biomechanical behavior. We aimed to answer the question, whether fascia may possess the capacity for cellular contraction which, in turn, could play an active role in musculoskeletal mechanics. Human and rat fascial specimens from different body sites were investigated for the presence of myofibroblasts using immunohistochemical staining for α-smooth muscle actin (n = 31 donors, n = 20 animals). In addition, mechanographic force registrations were performed on isolated rat fascial tissues (n = 8 to n = 18), which had been exposed to pharmacological stimulants. The density of myofibroblasts was increased in the human lumbar fascia in comparison to fasciae from the two other regions examined in this study: fascia lata and plantar fascia [H(2) = 14.0, p < 0.01]. Mechanographic force measurements revealed contractions in response to stimulation by fetal bovine serum, the thromboxane A2 analog U46619, TGF-β1, and mepyramine, while challenge by botulinum toxin type C3–used as a Rho kinase inhibitor– provoked relaxation (p < 0.05). In contrast, fascial tissues were insensitive to angiotensin II and caffeine (p < 0.05). A positive correlation between myofibroblast density and contractile response was found (rs = 0.83, p < 0.001). The hypothetical application of the registered forces to human lumbar tissues predicts a potential impact below the threshold for mechanical spinal stability but strong enough to possibly alter motoneuronal coordination in the lumbar region. It is concluded that tension of myofascial tissue is actively regulated by myofibroblasts with the potential to impact active musculoskeletal dynamics.
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Affiliation(s)
- Robert Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Günzburg, Germany.,Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany.,Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Giulio Gabbiani
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jan Wilke
- Department of Sports Medicine, Institute of Sport Science, Goethe University Frankfurt, Frankfurt, Germany
| | - Ian Naylor
- School of Pharmacy, University of Bradford, Bradford, United Kingdom
| | - Boris Hinz
- Laboratory of Tissue Repair and Regeneration, Matrix Dynamics Group, University of Toronto, Toronto, ON, Canada
| | - Adjo Zorn
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Heike Jäger
- Division of Neurophysiology, Ulm University, Ulm, Germany
| | - Rainer Breul
- Anatomische Anstalt, Ludwig-Maximilians-Universität, München, Germany
| | | | - Werner Klingler
- Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany.,Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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46
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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: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Fleckenstein J, Schleip R, Sachs C, Driscoll M, Shockett S, Findley T, Klingler W. Faszienforschung: Quo vadis? Manuelle Medizin 2018. [DOI: 10.1007/s00337-018-0475-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Schleip R, Zorn A, Wilke J, Klingler W. Contractility of human and rat lumbar fascia. J Bodyw Mov Ther 2018. [DOI: 10.1016/j.jbmt.2018.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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49
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Avila Gonzalez CA, Driscoll M, Schleip R, Wearing S, Jacobson E, Findley T, Klingler W. Frontiers in fascia research. J Bodyw Mov Ther 2018; 22:873-880. [PMID: 30368329 DOI: 10.1016/j.jbmt.2018.09.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/06/2018] [Indexed: 01/07/2023]
Abstract
Basic sciences are the backbone of every clear understanding of how the body is composed and how different structures and functions are connected with each other. It is obvious that there is a huge variability in human beings - not only in terms of the outer appearance such as measurements of height, weight, muscle mass and other physical properties, but also with respect to metabolic and functional parameters. This article highlights recent developments of research activities in the field of fascia sciences with a special emphasis on assessment strategies as the basis of further studies. Anatomical and histological studies show that fascial tissue is highly variable in terms of density, stiffness, and other parameters such as metabolic and humoral activity. Moreover, it encompasses nerves and harbours a system of micro-channels, also known as the primo vascular system. As ultrasound is a widely available method, its use is appealing not only for imaging of fascial structures, but also for thorough scientific analysis. Unlike most other imaging technologies, US has the advantage of real-time analysis of active or passive movements. In addition, other assessment methods for fascial tissue are discussed. In conclusion, fascial tissue plays an important role not only in functional anatomy, but also in evolutionary and molecular biology, sport, and exercise science as well as in numerous therapeutic approaches. A high density of nerves is found in fascial tissue. Knowledge of individual characteristics, especially by visualizing with ultrasound, leads to personalized therapeutic approaches, such as in pain therapy.
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Affiliation(s)
- Carla Alessandra Avila Gonzalez
- Department of Anaesthesiology, Intensive Care, Palliative Care, and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr University Bochum, Germany; Department of Anaesthesiology and Intensive Care Medicine, Hessing Foundation, Augsburg, Germany.
| | - Mark Driscoll
- Department of Mechanical Engineering, McGill University, Canada
| | - Robert Schleip
- Fascia Research Group, Department of Experimental Anaesthesiology, Ulm University, Germany
| | - Scott Wearing
- Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Eric Jacobson
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, USA; Motion Analysis Laboratory, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, USA
| | - Tom Findley
- Rutgers New Jersey Medical School, State University of New Jersey, USA
| | - Werner Klingler
- Fascia Research Group, Department of Experimental Anaesthesiology, Ulm University, Germany; Faculty of Health School - Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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50
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Schleip R, Wilke J, Schreiner S, Wetterslev M, Klingler W. Needle biopsy-derived myofascial tissue samples are sufficient for quantification of myofibroblast density. Clin Anat 2018; 31:368-372. [PMID: 29314236 DOI: 10.1002/ca.23040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 01/02/2023]
Abstract
Quantification of myofibroblasts is a promising method for assessing tissue properties in the field of fascia research. This is commonly performed by immunohistochemistry for α-smooth muscle actin. However, usually larger tissue samples sizes are required for quantification. The aim of this investigation was to explore whether a microscopic quantification of myofibroblasts can be conducted with fascial tissue samples derived via percutaneous needle biopsy. Fascial tissues were derived via percutaneous needle biopsy from the fascia lata of 11 persons (aged 19-40 years). Following immunohistochemistry, selected fields for photomicroscopic analysis were chosen by a Monte Carlo method based randomization procedure. On these fields, a digital quantification for the relative density of α-smooth muscle actin was attempted. The newly developed quantification method could successfully be applied in all tissue samples. The median α-smooth muscle actin density in the selected tissue samples ranged between 0% and 1.7% (median 0%, IQR 0%-0.001%). The applied protocol proved to be workable for the purpose of an estimation of the α-smooth muscle actin density in fascial tissue samples derived via percutaneous needle biopsy. Since this type of biopsy is less invasive than the commonly performed open muscle biopsy, this offers a new and useful perspective for future histological investigations of fascial tissue properties in living patients. Clin. Anat. 31:368-372, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- R Schleip
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany
| | - J Wilke
- Department of Sports Medicine, Institute of Sport Science, Goethe University Frankfurt, Germany
| | - S Schreiner
- Division of Neurophysiology, Ulm University, Ulm, Germany
| | - M Wetterslev
- Department of Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - W Klingler
- Department of Neuroanesthesiology, Neurosurgical Clinic, Ulm University, Guenzburg, Germany
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