Article

Fascial plasticity - A new neurobiological explanation. Part 2

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Abstract

Part 1 of this two part article showed that immediate fascial responsiveness to manipulation cannot be explained by its mechanical properties alone. Fascia is densely innervated by mechanoreceptors which are responsive to myofascial manipulation. They are intimately connected with the central nervous system and specially with the autonomic nervous system. Part 2 of the article shows how stimulation of these receptors can trigger viscosity changes in the ground substance. The discovery and implications of the existence of fascial smooth muscle cells are of special interest in relation to fibromyalgia, amongst other conditions. An attitudinal shift is suggested, from a mechanical body concept towards a cybernetic model, in which the practitioner's intervention are seen as stimulation for self-regulatory processes within the client's organism. Practical implications of this approach in myofascial manipulation will be explored.

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... De nombreuses recherches sur le fascia (Findley, Chaudhry, Stecco, Roman, 2012 ;Willard, Vleeming, Schuenke, Danneels, Schleip, 2003, 2003a) ont par ailleurs confirmé la plupart des intuitions de D. Bois qui a été l'un des premiers à diffuser et à modéliser en France la fasciathérapie, thérapie manuelle ciblée sur le fascia. Dans ses premiers ouvrages (1984,1985,1995), D. Bois soulignait l'unité dynamique de fonction de ce tissu particulier : « Ainsi, l'être humain est une unité dynamique de fonction dont chaque partie est intégrée aux autres par cette membrane vivante qu'est le fascia ; ce dernier apparaît comme étant l'outil essentiel capable de transformer les individualités anatomiques en une unité fonctionnelle. ...
... » 1990. Aujourd'hui les chercheurs évoquent l'existence d'une contractilité fasciale faisant du fascia un tissu vivant, actif et interconnecté avec le système nerveux (Schleip, 2003(Schleip, , 2003a. La présence de cellules contractiles (myofibroblastes) dans les tissus fasciaux sains et pathologiques (Findley, Schleip, 2007, Schleip, 2003, Schleip et al, 2005 (Bois, 1984, 1985, Quéré, 2004. ...
... La présence de cellules contractiles (myofibroblastes) dans les tissus fasciaux sains et pathologiques (Findley, Schleip, 2007, Schleip, 2003, Schleip et al, 2005 (Bois, 1984, 1985, Quéré, 2004. Nous trouvons également un apport scientifique sur le lien qui existerait entre le tonus du fascia et le tonus psychique (dénommé psychotonus Bois, 2006, Courraud, 2004, 2007a, Quéré, 2010 Schleip (2003Schleip ( , 2003a. Selon cet auteur, la forme du fascia ne peut être modifiée par une action manuelle mais la main peut entraîner une auto-régulation locale et générale par activation du système nerveux central expliquant les sensations de relâchement perçues par le praticien : ...
Thesis
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The study of the professional identity which is developed in this thesis addresses the themes of profession, professionalization and professional identity, which are all current issues in the present background of modernization and job mobility. This research is taking place in the the field of French physiotherapy, a profession which has undergone different phases of transformations and identity changes. The other field carried out by this research is fasciatherapy Danis Bois Method, a manual therapy originated in osteopathy which has long been part of the physiotherapy environment. The research question was formulated in order to address this cross section between physiotherapy and fasciatherapy: « How and in what ways do physiotherapists who practice fasciatherapy are led to reconfigure their professional identity ? » In view of bringing answers to such questioning, a quantitative survey was conducted using a self-administered questionnaire on 446 physiotherapists practicing fasciatherapy. This survey brought numerous results and information which allow a better understanding of the identity of the investigated physiotherapists, with regards to their reference profession. It reveals the existence of three identity profiles amongst physiotherapists practicing fasciatherapy, and also documents identity reconfiguring processes depending on the profile. This piece of work forms a scientific basis for further characterization and assessment of fasciatherapy specificities with regards to its professional and institutional acknowledgement.
... The plasticity of fascial tissue can be explained by various theories such as thixotropy and piezoelectricity. However, it is currently postulated that the short-term effects of myofascial interventions are instead the product of complex neuromuscular responses modulated by the central and autonomic nervous system (Kalichman & Ben David, 2017;Schleip, 2003aSchleip, , 2003bTozzi, 2015). Fascia oriented work may have beneficial effects when activating various receptors in the connective tissues obtaining various neuromuscular reflexes (Schleip, 2003a). ...
... However, it is currently postulated that the short-term effects of myofascial interventions are instead the product of complex neuromuscular responses modulated by the central and autonomic nervous system (Kalichman & Ben David, 2017;Schleip, 2003aSchleip, , 2003bTozzi, 2015). Fascia oriented work may have beneficial effects when activating various receptors in the connective tissues obtaining various neuromuscular reflexes (Schleip, 2003a). The response of the central nervous system to such localized pressure includes a decreased tone of the related striated muscle fibers, which then contributes to the release felt through MFR application (Kalichman & Ben David, 2017;Schleip, 2003a). ...
... Fascia oriented work may have beneficial effects when activating various receptors in the connective tissues obtaining various neuromuscular reflexes (Schleip, 2003a). The response of the central nervous system to such localized pressure includes a decreased tone of the related striated muscle fibers, which then contributes to the release felt through MFR application (Kalichman & Ben David, 2017;Schleip, 2003a). As the muscle spindle detects a muscle stretch, the neural pathways transmit efferent signals to that muscle, resulting in a contraction that resists overstretching. ...
Article
Currently, greater background is required about the effectiveness of myofascial release (MFR) on muscle flexibility. Objective Our goal was to determine the immediate effect of a direct MFR technique on hip and cervical flexibility in inactive females with hamstring shortening. Method The sample group included 68 female university students, randomly divided into a control group (n = 34) and an experimental group (n = 34). A placebo technique was used with the control group, and direct MFR on the posterior thigh region was used with the experimental group. Results The mixed factorial ANOVA did not show significant intergroup differences (p>0.05). In the experimental group, Bonferroni post hoc test showed significant intragroup differences between pre-test and post-test 1, as well as between pre-test and post-test 2 for the three ischiotibial muscle flexibility tests (p<0.001). Cervical flexion range of motion showed significant differences between pre-test and post-test 1 (p<0.001). Conclusions We conclude that the protocol based on a single direct MFR intervention was no more effective than the placebo in improving flexibility both locally at the hamstring level and remotely at the level of the cervical extensor muscles. Future research should consider different MFR techniques on the immediate increase in muscle flexibility and the long-term effect of MFR, as well as consider different intervention groups.
... In effetti, la fascia è stata definita da Schleip come tessuto connettivo denso irregolare che circonda e collega ogni muscolo, fino alla più piccola fibra muscolare e ogni singolo organo del corpo, formando una continuità nel corpo. [7][8][9] Successivamente, Schleip ha ampliato la sua definizione di fibra come "il componente dei tessuti I n top-level football, the prevention of muscular injuries, the reduction in the frequency of re-injury and the determination of the best time to return to the field represent the major challenges of sports medicine. 1,2 For the prevention of muscular injuries, the study and evaluation of the anatomical network and of the reciprocal relationships between the various structures of the body in movement represent the substrate on which we must research. ...
... Indeed, the fascia was defined by Schleip as "irregular dense connective tissue that surrounds and connects every muscle, down to the smallest muscle fiber and every single organ of the body, forming a continuity in the body." [7][8][9] Successively, Schleip has expanded its fibra in termini di tempo lontano dai campi da gioco, hanno spinto i ricercatori di più campi (medici sportivi, ortopedici, fisioterapisti, scienziati sportivi e fisiologi) a trovare cause riguardanti lesioni muscolari e articolari e possibili strategie di prevenzione. Molti ricercatori hanno dimostrato la causa del danno in ambito anatomico: nel singolo muscolo, nel fascio muscolare e dal fascicolo alla singola miofibrilla, perdendo il sistema generale, studiando la singola funzione e la struttura muscolare e non la vera fisiologia del movimento e la complessa connettività della rete anatomica. ...
... [41][42][43] By examining a flap of fascia lata (the aponeurotic fascia that covers the Vol. 73 7,8,29 Questa funzione della fascia consente di trasmettere simultaneamente la forza meccanica prodotta dalla contrazione muscolare in più direzioni e tra più strutture muscolari e articolari. 37,49,50 Ad esempio "le strutture che sono normalmente descritte come i muscoli dell'anca, del bacino e della gamba interagiscono con i muscoli della colonna vertebrale e del braccio attraverso la fascia toraco-lombare, che consente un efficace trasferimento del carico tra la colonna, il bacino e gli arti, che costituiscono un sistema integrato". ...
Article
Accident prevention is certainly the topic of greatest interest in the football medical field. Data literature reported that the risk of injuries is approximately 1000 times greater in professional football than in other occupations; for these reasons, it is very important the prevention. The costs of an accident, both in economic terms and in terms of time away from the playing fields, have pushed researchers from more fields (sports doctors, orthopedists, physiotherapists, sports scientists and physiologists) to find causes regarding muscle and joint injuries and to prevent them. Many researchers have tried the cause of the damage in the anatomic setting: in the single muscle, in the muscular bundle and from the fasciculus to the single myofibril, losing the general system, studying the single function and muscular structure, and not the real physiology movement and the complex connectivity of the anatomical network. For these reasons, we think that the anatomical network and the relationships between the various structures of the body in motion represent the substrate on which we must research. For many years the anatomists have divided the body, while in recent decades it is understood the importance of the elements that unite the body, and in particular to the mechanical connection element: the fascia.
... Some hypotheses explain hands-on or exercise-based approaches' selection with fascial mechanoreceptors [43,[82][83][84][85][86][87] (Table 2). The mentioned hypotheses need to be verified by research [82,83]. ...
... Some hypotheses explain hands-on or exercise-based approaches' selection with fascial mechanoreceptors [43,[82][83][84][85][86][87] (Table 2). The mentioned hypotheses need to be verified by research [82,83]. In light of the Schleip's hypothesis a patient's responsiveness to a rapid compressive touch could be due to tissue changes in the internal layer of the joint capsule, affecting, among others, Pacini mechanoreceptors [82,83]. ...
... The mentioned hypotheses need to be verified by research [82,83]. In light of the Schleip's hypothesis a patient's responsiveness to a rapid compressive touch could be due to tissue changes in the internal layer of the joint capsule, affecting, among others, Pacini mechanoreceptors [82,83]. In this case osteopathic techniques such as High-Velocity Low Amplitude techniques, Recoil techniques or Harmonic techniques, as well as the active patient approaches with rapid stimulation and vibratory tools exercise, could be selected [82,83]. ...
Article
Introduction Osteopathy relies on a touch-based approach to promote health. This narrative review aims to analyze the role of touch in clinical osteopathic practice. Methods A database search was conducted using MEDLINE, EMBASE, PEDro and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included. Results 47 articles met the inclusion criteria and were used to elucidate two main themes: Biological and psychological effects of touch; Touch in the context of osteopathic clinical reasoning. Discussion Touch is one of the tools to achieve a collaborative interaction with the patient, to substantiate clinical information, and to detect somatic dysfunctions: neuro-myofascial active areas that might act as an osteopath-patient interface to transmit the biological and physiological effects of touch. Conclusion The findings of the review support a shared decision-making process, in which touch is one of the osteopath-patient dyad 's leading communication tools to develop a tailor-made osteopathic approach.
... We hypothesize that OCM may affect pain and cervical spine aROM by the manual stimulation of mechanoreceptors contained inside the fascial system, leading to tonus changes in the motor unit that are mechanically linked to the tissue under the practitioner's hand. 20 We propose that cranial techniques could induce physiological movement of the spine and decreased pain, interacting with the central nervous system via the fascial tissue. 20 Cervicogenic headache following whiplash injury may be referred pain from the cervical spine. ...
... 20 We propose that cranial techniques could induce physiological movement of the spine and decreased pain, interacting with the central nervous system via the fascial tissue. 20 Cervicogenic headache following whiplash injury may be referred pain from the cervical spine. 21 Physiologically, cervicogenic pain is analogous to shoulder, chest wall, buttock, or lower limb pain referred from spinal sources. ...
... 21 Physiologically, cervicogenic pain is analogous to shoulder, chest wall, buttock, or lower limb pain referred from spinal sources. 20 The hypothesized mechanism underlying the pain involves convergence between the cervical and trigeminal afferents in the trigeminocervical nucleus. In this nucleus, nociceptive afferents from C1-C2 and C3 spinal nerves converge onto second-order neurons that also receive afferents from adjacent cervical nerves and from the first division of the trigeminal nerve via the trigeminal nerve spinal tract. ...
Article
Objective The purpose of this case report is to describe the immediate effects of osteopathic cranial manipulation on pain and cervical motion in a patient with whiplash-associated disorder. Clinical Features A 74-year-old man reported daily cervicogenic headaches after a whiplash injury caused by a traffic accident 3 months prior. Physical examination and osteopathic assessment identified tissue texture alteration, positional asymmetry, limited range of motion, and tenderness. The resulting diagnosis was somatic dysfunction of the head and the cervical region. Intervention and Outcome Osteopathic manipulative treatment was administered to the occipital area. The patient reported an immediate improvement in pain. Accessory movement of the cervical spine was improved. Conclusion This patient responded favorable to osteopathic cranial manipulation with improved symptoms and ranges of motion.
... SMR not only stretches muscles and scar tissue, but also provides benefits similar to those of stretching and massage [12]. SMR is well known to increase flexibility, either acutely or chronically [14,15]. ...
... In this study, trunk and shoulder flexibility significantly improved after performing one bout of foam rolling in both young and middle-aged women groups. Previous studies suggested that SMR increases flexibility by increasing blood flow and soft tissue circulation [14,21]. During SMR, when pressure increases, mechanical receptors (i.e., Golgi tendon organs, the Ruffini and Pacinian corpuscles) stimulate the nervous system, resulting in decreases in muscle tone and increases in flexibility [13,15]. ...
Article
PURPOSE: Arterial stiffness is an independent risk factor for cardiovascular disease and inversely associated with flexibility. Self-myofascial release (SMR) using a foam roller is a popular intervention to improve flexibility, restore the muscles, fascia, tendons, and ligaments, and regain soft-tissue extensibility. This study aimed to investigate whether a single bout of SMR has a beneficial effect on arterial stiffness and the function of the autonomic nervous system and the relationships among these variables in young and middle-aged women by age.METHODS: Ten healthy young (23.20±0.59 years) and 10 middle-aged women (44.50±0.91 years) completed an instructed SMR using a foam roller. Brachial-ankle pulse wave velocity (baPWV), augmentation index (AIx), trunk flexibility, shoulder flexibility, heart rate variability, including standard deviation of normal R-R intervals (SDNN), and the root mean square of the standard deviation of the time between heartbeats (RMSSD) were measured before and after one 30-minutes bout of SMR.RESULTS: After one bout of SMR, trunk and shoulder flexibility increased in both groups of women, while AIx decreased significantly (from 6.9±2.9 to -1.9±4.6%, p=.0072, young women group; from 22.1±3.4 to 14.7±1.7%, p=.0049, middle-aged women group). However, the baPWV, RMSSD, and SDNN did not change. In the analysis of correlations between all measured variables, changes in AIx showed negative correlations with flexibility and SDNN.CONCLUSIONS: This study suggests that one bout of SMR using a foam roller positively affected arterial stiffness in women by reducing AIx and improving flexibility.
... Whilst there is scant evidence to detect how sensory cells adjust to mechanical stimuli [62], recent research [63] proposes that the investing visceral fascia that closely relates to organs and supports them, may be richly innervated by fibres from the autonomic nervous system, and thereby affect metabolic behaviour. Further studies have supported this view of manual manipulation of fascia globally affecting the autonomic nervous system [64,65]. ...
... One of the founding osteopathic principles identified by A.T. Still in 1910 is the "rule of the artery is supreme", such that any obstruction of blood supply may lead to disease. Osteopathic manipulation can affect blood flow via the autonomic nervous system, and by a reduction in tension via the fascia [64,65,73]. Arteries and veins pass through the fascia [74] and may be compromised by fascial restrictions. ...
Article
Full-text available
Reflexology is a complementary therapy focusing mainly on the application of pressure on the feet, hands and ears. A small but growing evidence base suggests that positive outcomes can be gained in the management and improvement of symptoms across a range of conditions. Biological plausibility is a key concept in the determination of the usefulness of therapies. Research which tests for safety and efficacy alongside the underpinning mechanism of action are therefore important. This paper explores the potential mechanism of action for the outcomes associated with reflexology treatment as reflected in the current evidence. The influences of therapeutic touch, relaxation, placebo effects and the similarities with other therapeutic methods of structural manipulation are considered. The lack of clarity around the precise definition of reflexology and the challenges of researching the therapy as a treatment tailored to individual need are discussed. A deeper understanding of the mechanism of action for reflexology may help to further develop research into safety and efficacy. Such an understanding may lead to the integration of knowledge which may provide both symptomatic support and longer term preventative health benefits.
... The objectives of each session are listed in Table 1. In addition to restoring fascial gliding, the intervention applied by the therapist aims to alter skin receptors and also mechanoreceptors in fascial tissue under the skin (e.g., in the epi/peri/endomysium, fascia profunda, tendons, and joint capsules) [17][18][19]. Jacobson et al. [16] also described an intense psycho-emotional effect of SI. Weinberg et Hunt [20] showed that SI is able to reduce state-trait anxiety. ...
... Here, SI treatment may have altered mechanoreceptors in fascial tissue (e.g., in the epi/peri/endomysium, fascia profunda, tendons, and joint capsules). These may have triggered changes in muscle tone, hydration, and neurological effects, which was likely achieved by the interventions in this study [17,19]. ...
Article
Full-text available
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.
... Physiological structures impacted by SMFR involve the skin, the muscles and their corresponding fascia. These organs contain mechanoreceptors such as the Golgi tendon organ involved in tonus regulations, and the corpuscles of Pacini, Meissner, and Ruffini which enable proprioception by detecting subtle changes in pressures, tangential forces and fine touch [6][7][8]. Myofascial manipulations also impact type III and IV interstitial receptors, which have an additional role in vasodilation and pain perception [6][7][8]. ...
... These organs contain mechanoreceptors such as the Golgi tendon organ involved in tonus regulations, and the corpuscles of Pacini, Meissner, and Ruffini which enable proprioception by detecting subtle changes in pressures, tangential forces and fine touch [6][7][8]. Myofascial manipulations also impact type III and IV interstitial receptors, which have an additional role in vasodilation and pain perception [6][7][8]. ...
Article
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Background Self-myofascial release is an emerging technique in strength and conditioning. Yet, there is no consensus regarding optimal practice guidelines. Here, we investigated the acute effects of various foam rolling interventions targeting quadriceps muscles, with or without sliding pressures. Methods We conducted a blinded randomized control pilot trial in 42 healthy weightlifting athletes over 4 weeks. Participants were randomly allocated to one of the four intervention (120 s massage routine) groups: foam rolling, roller massager, foam rolling with axial sliding pressures, foam rolling with transverse sliding pressures. Knee range of motion, skin temperature and subjective scores of the perceived heat, range of motion, muscle pain and relaxation were the dependent variables. Measurements were carried on before, after and up to 15 min (follow-up) after the massage intervention. Results The range of motion increased immediately after the various foam rolling interventions (+ 10.72%, 95% CI 9.51 to 11.95, p < 0.001), but progressively returned back to the pre-intervention baseline along within the 15 min post-intervention. Foam rolling was the most effective intervention to increase skin temperature from thermographic measures (+ 14.06%, 95% CI 10.97 to 17.10, p < 0.001), while the increase in perceived heat was comparable in all experimental groups (107%, 95% CI 91.08 to 122.61, p < 0.001). Conclusions Subjective indexes of heat, range of motion, muscle pain and relaxation improved immediately after the intervention, but also gradually returned to the pre-intervention baseline. Overall, combining foam rolling with sliding pressures did not yield additional benefits from objective measures.
... This technique can solve muscle contracture or weakness, and it can reduce localized oedema by stimulating rhythmic muscle movements [28]. MET decreases sympathetic tone through fascial stimulation and localized vasodilatation [29]. Then, the patient can perform an isometric contraction and, consequently, a post-isometric relaxation of the muscle contracted. ...
Article
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Background: Non-specific neck pain (NNP) affects 30-50% of the general population, and it often leads to severe disability. Several manual therapy techniques are available to reduce pain and disability and to improve cervical range of motion and functional activities. Muscle Energy Technique (MET) showed more evidence for treating such a disorder. The aim of this current scientific literature analysis was to compare the clinical effects of MET with the other manual or rehabilitative treatments for non-specific acute and chronic neck pain. Methods: The literature search was conducted using the following databases: PubMed, Medline, PEDro, Cochrane Database, and Google Scholar from 2010 to January 2020. Clinical trials about MET were included. The quality of the trials was assessed according to the PEDro scale. Results: Twenty-one papers according to inclusion and exclusion criteria were selected: 15 studies about non-specific acute neck pain and 6 studies about non-specific chronic neck pain. Conclusions: This analysis suggests that the MET approach has a good clinical effect on reducing neck pain in patients with acute neck pain and improves cervical range of motion in patients with chronic neck pain, and is better if combined with a traditional rehabilitative approach. This review's findings should be considered with caution for physiotherapy practice because of the studies' methodologic limitations. On the basis of the current available and limited evidence, clinicians could combine MET with traditional physiotherapy and other manual techniques when treating people with non-specific neck pain.
... Although FR and MM groups exhibited distinct patterns profiles of resting-state activity, both interventions promoted brain states of relaxation, characterized by alpha and beta synchronizations in the frontal and parietal region, respectively [19,28,[87][88][89]. Conversely, a desynchronization was observed after autogenic training. Similar to others before us, we suggest that the effects of MM and FR may involve autonomic nervous system regulations as a result of the bottom-up stimulation of proprioceptive organs as a result of mechanical pressures [12,13]. From a practical standpoint, present results seem to support the hypothesis that MM and FR are relevant to promote recovery in athletic populations [6,90,91]. ...
Article
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The present double-blinded, randomized controlled study sought to compare the effects of a full-body manual massage (MM) and a foam rolling (FR) intervention on subjective and objective indexes of performance and well-being. A total of 65 healthy individuals were randomly allocated to an FR, MM, or a control group who received a cognitively oriented relaxation routine. Self-report ratings of perceived anxiety, muscle relaxation, and muscle pain were used to index changes in affect and physical sensations. The sit-and-reach and toe-touch tests, as well as a mental calculation task, were used to index motor and cognitive performances, respectively. We also conducted resting-state electroencephalography and continuous skin conductance recordings before and after the experimental intervention. Both FR and MM groups exhibited neural synchronization of alpha and beta oscillations during the posttest. Skin conductance increased from the pretest to the posttest in the relaxation group, but decreased in the FR group. All interventions improved range of motion, although only the MM group outperformed the relaxation group for the toe-touch performance. MM was associated with reduced muscle pain and increased muscle relaxation. Reduced perceived anxiety after the intervention was observed in the FR group only. Overall, MM and FR both improved objective and subjective indexes of performance and well-being. Differences between the two massage interventions are discussed in relation to the effects of pressure stimulation on autonomic regulations and the proactive vs. retroactive nature of FR, compared to MM.
... The slow deep pressure would induce a decrease in the tone of related skeletal motor units by stimulating mechanoreceptors. This chain reaction would elicit a parasympathetic-dominant neurophysiological state, thus eliciting a greater relaxation (Schleip, 2003b). Mechanical pressure applied during FR would elicit similar effect. ...
Article
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Manual massage and foam rolling are commonly used by athletes for warm-up and recovery, as well as by healthy individuals for well-being. Manual massage is an ancient practice requiring the intervention of an experienced physiotherapist, while foam rolling is a more recent self-administered technique. These two topics have been largely studied in isolation from each other. In the present review, we first provide a deep quantitative literature analysis to gather the beneficial effects of each technique through an integrative account, as well as their psychometric and neurophysiological evaluations. We then conceptually consider the motor control strategies induced by each type of massage. During manual massage, the person remains passive, lying on the massage table, and receives unanticipated manual pressure by the physiotherapist, hence resulting in a retroactive mode of action control with an ongoing central integration of proprioceptive feedback. In contrast, while performing foam rolling, the person directly exerts pressures through voluntary actions to manipulate the massaging tool, therefore through a predominant proactive mode of action control, where operations of forward and inverse modeling do not require sensory feedback. While these opposite modes of action do not seem to offer any compromise, we then discuss whether technological advances and collaborative robots might reconcile proactive and retroactive modes of action control during a massage, and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human-machine interactions.
... 19,33 On the other hand, through myofascial release techniques, the connective tissue could be indirectly stretched after a static load because of its innate viscoelastic properties, causing a modification of the nociceptive sensation and possible reflex changes. 34 Diaphragmatic myofascial release techniques have obtained benefits in both muscle and joint mobility in different studies. 19,35 No significant differences have been found between both types of techniques applied at the diaphragm level in the benefits obtained in terms of rib mobility. ...
Article
Objectives To analyze the effects at the musculoskeletal level of manual treatment of the diaphragm muscle in adults. Data Sources Systematic review using four databases: PubMed, Science Direct, Web of Science and Scopus. Study selection and data extraction Two independent reviewers applied the selection criteria and assessed the quality of the studies using the Physiotherapy Evidence Database (PEDro) scale for experimental studies. A third reviewer intervened in cases where a consensus had not been reached. A total of 9 studies were included in the review. Results Manual therapy directed to the diaphragm has been shown to be effective in terms of the immediate increase in diaphragmatic mobility and thoracoabdominal expansion. The immediate improvement in the posterior muscle chain flexibility test is another of the most frequently found findings in the evaluated studies. Limited studies show improvements at the lumbar and cervical level in the range of motion and in pain. Conclusion Manual diaphragm therapy has shown an immediate significant effect on parameters related to costal, spinal and posterior muscle chain mobility. Further studies are needed, not only to demonstrate the effectiveness of manual diaphragm therapy in the long term and in symptomatic populations, but also to investigate the specific neurophysiological mechanisms involved in this type of therapy.
... MTs may induce local effects, through the activation of mechanobiological pathways that can change the cells' behavior (106), and lead to systemic responses involving the circulatory, immune, endocrine, and nervous systems, and the mental state (6,7,9,(107)(108)(109)(110). These systemic responses could influence the brain processes and, thus, interact with the VR and AR experience. ...
Article
Full-text available
Virtual reality (VR) and augmented reality (AR) have been combined with physical rehabilitation and psychological treatments to improve patients' emotional reactions, body image, and physical function. Nonetheless, no detailed investigation assessed the relationship between VR or AR manual therapies (MTs), which are touch-based approaches that involve the manipulation of tissues for relieving pain and improving balance, postural stability and well-being in several pathological conditions. The present review attempts to explore whether and how VR and AR might be integrated with MTs to improve patient care, with particular attention to balance and to fields like chronic pain that need an approach that engages both mind and body. MTs rely essentially on touch to induce tactile, proprioceptive, and interoceptive stimulations, whereas VR and AR rely mainly on visual, auditory, and proprioceptive stimulations. MTs might increase patients' overall immersion in the virtual experience by inducing parasympathetic tone and relaxing the mind, thus enhancing VR and AR effects. VR and AR could help manual therapists overcome patients' negative beliefs about pain, address pain-related emotional issues, and educate them about functional posture and movements. VR and AR could also engage and change the sensorimotor neural maps that the brain uses to cope with environmental stressors. Hence, combining MTs with VR and AR could define a whole mind-body intervention that uses psychological, interoceptive, and exteroceptive stimulations for rebalancing sensorimotor integration, distorted perceptions, including visual, and body images. Regarding the technology needed to integrate VR and AR with MTs, head-mounted displays could be the most suitable devices due to being low-cost, also allowing patients to follow VR therapy at home. There is enough evidence to argue that integrating MTs with VR and AR could help manual therapists offer patients better and comprehensive treatments. However, therapists need valid tools to identify which patients would benefit from VR and AR to avoid potential adverse effects, and both therapists and patients have to be involved in the development of VR and AR applications to define truly patient-centered therapies. Furthermore, future studies should assess whether the integration between MTs and VR or AR is practically feasible, safe, and clinically useful.
... In contrast, the much lighter touch of the PLC treatment is likely to act only on cutaneous receptors. Fascial mechanoreceptors could trigger changes in muscle tone, fluid hydration, as well as neurological effects, which was likely achieved through the interventions in this study [35,36]. ...
Preprint
Background: Spine shape parameters, such as leg length, kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pa-thologies. This study examined the immediate effects of a myofascial release technique (MFR) on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in pa-tients with acute low back pain (aLBP). Methods: This study was a single-blind randomized pla-cebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blinded assigned to three groups to be treated with MFR, OMT or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, lordotic an-gle) 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.
... The fascia and connective tissue systems communicates much faster than the CNS using chemo-mechano-transduction to initiate a biochemical response. It is estimated that mechanical vibrations travelling the myofascial network move three times faster than the signals sent by the CNS [39]. ...
Experiment Findings
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Foundational Stability, Support, Strength, Symmetry and Balance of the Foot and Lower Extremity is the Predictable Primary Starting Platform for All Closed Chain Stance and Movement
... La liberación miofascial manual es una intervención que intenta estirar de forma indirecta las fibras musculares diafragmáticas para reducir la tensión generada por los PGM, normalizar la longitud de sus fibras, y promover una mayor efectividad de la contracción muscular, consiguiendo un incremento de la movilidad de la parrilla costal (152,153). El comúnmente usado terminó "relajación o liberación tisular", en relación al resultado del tratamiento de los desequilibrios musculares, es típicamente razonado desde una perspectiva estructural y mecánica (154). El tejido conectivo es conocido por estirarse tras una carga estática debido a sus propiedades viscoelásticas innatas; sin embargo, este efecto es transitorio y dependiente de la duración y el modo de estiramiento (155). ...
Thesis
Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries. Introduction: The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. In the case of nervous system, according to several studies the phrenic nerve has communicating branches to the brachial plexus with connections to shoulder key nerves including the suprascapular, lateral pectoral, musculocutaneous, and axillary nerves, besides, the vagal innervation that receives the diaphragm and their connections with the sympathetic system could make this muscle treatment a remarkable way of pain modulation in patients with rotator cuff pathology. To these should be added a possible common embryological origin in some type of vertebrates. Considering the connection through myofascial system, the improving of chest wall mobility via diaphragm manual therapy could achieve a better function of shoulder girdle muscles with insertion or origin at ribs and those that are influenced by the fascia such as the pectoralis major muscle, latissimus dorsi and subscapularis. Objectives: • Main objective: To compare the immediate effect of diaphragm physical therapy in the symptoms of patients with rotator cuff pathology regarding a manual treatment over shoulder muscles. • Specific objectives: 1. To evaluate the immediate effectiveness of each of the three groups in shoulder pain using a numerical pain rating scale (NPRS) and compare between them. 27 2. To evaluate the immediate effectiveness of each of the three groups in shoulder range of motion (ROM) using an inclinometer and compare between them. 3. To evaluate the immediate effectiveness of each of the three groups in pressure pain threshold (PPT) using an algometer and compare between them. Material and method: A prospective, randomized, controlled, single-blind (assessor) trial with a previous pilot study in which a final sample size of 45 subjects was determined to people diagnosed with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (15 subjects per group): 1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group). 2. Diaphragm manual therapy techniques (diaphragm group). 3. Active diaphragm mobilization by hipopressive gymnastic (hipopressive group). The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NPRS of pain in shoulder movements and algometry. The data obtained were analyzed by an independent (blinded) statistician, who compared the effects of each one of the treatments using the Student’s t-test for paired samples or the Wilcoxon signed rank test, and calculated the post -intervention percentage of change in every variable. An analysis of variance (ANOVA) followed by the post-hoc test or a non-parametric Kruskal-Wallis test for non-parametric multiple-groups comparisons were performed to compare pre- to post-intervention outcomes between groups. Effect-size estimates of each intervention and between groups were calculated to allow interpretation of results in a more functional and meaningful way. Results: Both the control group and diaphragm group showed a statistically (p< 0.005) and clinically significant improvement, as well as a significant effect size (moderate to strong), on the NPRS in shoulder flexion and abduction movements. Regarding NPRS in shoulder external rotation, only the control group obtained a significant effect size. There was a significant increase in shoulder abduction and external rotation ROM (p< Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en sujetos con patología del manguito rotador. 28 0.001) with a significant effect size in the control group. The PPT at the xiphoid process of the sternum showed a statistically (p< 0.001) and clinically significant improvement in the diaphragm group. The hipopressive gymnastic treatment was found to be no clinically effective in the shoulder pain and mobility, and showed a less efficacy than the other two groups. Conclusion: Both the shoulder non-direct treatment by a protocol of diaphragm manual therapy techniques and the rotator cuff MTP intervention showed been clinically effective in reducing pain (NPRS) immediately in shoulder flexion and abduction movements. The ROM assessment improvements obtained post- intervention by the diaphragm group have not been enough to consider them as clinically significant. The control group has obtained a significant effect size in shoulder abduction and external rotation ROM improvement. Both the control group and the diaphragm group treatments have been more effective in improving shoulder pain and mobility than the hipopressive group. The control group intervention has been the most effective in improving shoulder external rotation pain and mobility. The diaphragm group intervention was more effective in improving PPT at the xiphoid process than the other groups. Neither the effect size nor clinical significance proves the short-term benefit of the hipopressive gymnastic treatment in shoulder pain and mobility. Future studies are necessary to show the effectiveness of the diaphragm manual therapy applied in several sessions to determine its long-term effects in shoulder pain and mobility.
... In contrast, the much lighter touch of the PLC treatment is likely to act only on cutaneous receptors. Fascial mechanoreceptors could trigger changes in muscle tone, fluid hydration, as well as neurological effects, which was likely achieved through the interventions in this study [35,36]. ...
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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.
... The aforementioned role of sympathetic stimulation on non-local ROM can originate not only from cortical efferents but also from peripheral afferents. Thus, another mechanism that might impact changes in non-local ROM are myofascial and skin sensory receptors [84,85] that are sensitive to skin stimulation, tangential forces and lateral stretch [86]. These exteroceptive (E-) reflexes possess multi-synaptic innervations to motoneurons [87,88] that inhibit sympathetic excitation (decrease muscle tone) [89]. ...
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Background Stretching a muscle not only increases the extensibility or range of motion (ROM) of the stretched muscle or joint but there is growing evidence of increased ROM of contralateral and other non-local muscles and joints. Objective The objective of this meta-analysis was to quantify crossover or non-local changes in passive ROM following an acute bout of unilateral stretching and to examine potential dose–response relations. Methods Eleven studies involving 14 independent measures met the inclusion criteria. The meta-analysis included moderating variables such as sex, trained state, stretching intensity and duration. Results The analysis revealed that unilateral passive static stretching induced moderate magnitude (standard mean difference within studies: SMD: 0.86) increases in passive ROM with non-local, non-stretched joints. Moderating variables such as sex, trained state, stretching intensity, and duration did not moderate the results. Although stretching duration did not present statistically significant differences, greater than 240-s of stretching (SMD: 1.24) exhibited large magnitude increases in non-local ROM compared to moderate magnitude improvements with shorter (< 120-s: SMD: 0.72) durations of stretching. Conclusion Passive static stretching of one muscle group can induce moderate magnitude, global increases in ROM. Stretching durations greater than 240 s may have larger effects compared with shorter stretching durations.
... This type of dynamic exercise may favour ROM through a positive effect on the stretch-shortening cycle[35]. On the other hand, the improvements in the ROM with the SMFR technique could be explained by altered tissue stiffness, change in the thixotropic property of the fascia and the analgesic effects of the technique by mediating pain-modulatory systems[36,37]. Specifically, SMFR involves small undulations back and forth over a mild-density foam roller which places direct and sweeping pressure on the soft tissue to stretch it and generate friction between the soft tissue of the body and the foam, resulting in higher flexibil-up and the use of self-myofascial release with foam rolling may be equally effective to increase hip ROM in high-performance tennis players, and perhaps they may be useful for workouts focused on enhancing muscle flexibility. ...
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To date, there is a lack of information about the optimal conditions of the warm-up to lead to a better performance in elite tennis players. The aim of this study was to compare the effects of two different warm-up protocols (dynamic vs. self-myofascial release with foam rolling) on neuromuscular variables associated with physical determinants of tennis performance. Using a crossover randomised experimental design, eleven professional men tennis players (20.6 ± 3.5 years) performed either a dynamic warm-up (DWU) or a selfmyofascial release with foam rolling (SMFR) protocol. DWU consisted of 8 min of dynamic exercises at increasing intensity and SMFR consisted of 8 min of rolling on each lower extremity unilaterally. Just before (baseline) and after completing warm-up protocols, players performed a countermovement jump (CMJ), the 5-0-5 agility test, a 10-m sprint test and the Straight Leg Raise and Thomas tests to assess range of motion. Compared to baseline, the DWU was more effective to reduce the time in the 5-0-5 test than SMFR (-2.23 vs. 0.44%, respectively, (p = 0.042, ηp2 = 0.19). However, both warm-up protocols similarly affected CMJ (2.32 vs. 0.61%, p = 0.373, ηp2 = 0.04) and 10-m sprint time changes (-1.26 vs. 1.03%, p = 0.124, ηp2 = 0.11). Changes in range of motion tests were also similar with both protocols (p = 0.448–1.000, ηp2 = 0.00–0.02). Overall, both DWU and SMFR were effective to prepare well-trained tennis players for highly demanding neuromuscular actions. However, DWU offered a better preparation for performing change of direction and sprint actions, and hence, in high-performance tennis players, the warm-up should include dynamic exercises.
... As a result, It's a type of manual therapy for articulations of any kind with a limited range of motion. By inducing repetitive muscular movements, this procedure can ease muscle restriction or weakness, as well as lessen local oedema [25].Through deep tissue stimulation and localised vasodilation, MET suppresses sympathetic tone [26]. After that, the patient can perform an isometric contraction and a postisometric relaxation on the contracted muscle. ...
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Introduction: Chronic neck pain might lead to a change in muscle tissue fibres. Neck discomfort is a serious and prevalent sickness. It is common in the general population, and it frequently results in severe impairment. These alterations have an impact on the cervical spine's capacity to govern 3-D movement efficiently. A range of manual therapy approaches are available to assist relieve pain and impairment while also cervical spine range of motion enhancement and everyday mobility. More evidence for Muscle Energy Technique (MET) in treating such a condition was found. This case report describes muscular energy technique's effect on a patient who has been suffering from neck pain for a long time. Case Presentation: At the previous three months, a 27-year-old female accountant in a hospital with extended periods of sitting while working on a computer presented to our facility with neck pain. Increase in pain with looking up. Discussion: The therapy was well embraced through this patient to muscle energy technique resulting in a high degree of flexibility in the cervical spine, reduce pain and improves flexibility and strength. Conclusion: Physiotherapy has a significant effect Pain, strength, and range of motion are all factors to consider. The findings of this case study indicate that a specific muscle energy technique It's possible that a routine will help to alleviate the problem of neck pain, improves strength and functional ability. Case Study Jain et al.; JPRI, 33(59A): 124-129, 2021; Article no.JPRI.78427 125
... Muscle tissue consists of 40% to 50% of body weight and almost 85% of people in their lifetime will complain of muscle aches (Amanolahi Asadollah, 2009). Myofascial pain syndrome is the most common cause of skeletal muscle pain, with trigger points originating from one or more connective tissues about 30-70% of the time, as reported in various studies (Schleip, 2003). Trigger points can be referred to as pain in a special point of skeletal muscle or fascia muscle which is sensitive to touch such that exertion of pressure on that point can lead to sensitivity or reflective pain (Hou et al., 2002). ...
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Background: The purpose of this research was studying the impact of 8 weeks selected corrective exercises on neck pain, range of motion in the shoulder and neck of lifesaver women who suffering from forward head posture and myofascial pain syndrome. Methods: The method of research is semi-experimental. The population consists of 30 lifesaver women who suffering from forward head posture and myofascial pain syndrome who they placed randomly in two groups of experimental (33±2.2) and control (33±2.5). Research plan was as the pre-test and post-test with control group. The exercise protocol was carried out by experimental groups for 8 weeks, 3 sessions per week, each session lasting 45 minutes. Studied variables include myofascial pain in the neck, shoulder and neck range of motion. The mean and standard deviation were used as descriptive statistics and in the section of inferential statistics analysis of covariance was used. Results: Results of research indicated that, the protocol on the reform exercise of neck pain (P=0.001), range of motion of shoulder joint (P=0.001) and neck range of motion (P=0.001) has significant difference. Conclusion: Therefore, lifesavers women can benefit from it as a training program to improve and prevent damage caused by head forward and myofascial pain syndrome.
... Manual therapies are thought to influence myofascial tissues such as the TLF through stretch and manual pressure, by disrupting adhesions, improving or stimulating lymphatic and vascular circulation, and reducing abnormally high muscle tone [19][20][21]. Hyaluronan, a glycosoaminoglycan polymer, which normally functions as a lubricant between fascial layers, is compromised with immobility, inflammation, and tissue injury [22][23][24]. Manual therapies temporarily alter intercellular fluid pressures [25], promoting redistributed hyaluronan within and between fascial layers [23,26,27], and potentially serving as a mechanical catalyst for self-resolving inflammation [28]. ...
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Background Thoracolumbar fascia mobility observed with ultrasound imaging and calculated as shear strain is lower in persons with chronic low back pain. This pilot and feasibility trial assessed thoracolumbar shear strain in persons with chronic low back pain following spinal manipulation and over an 8-week course of multimodal chiropractic care. Methods Adults self-reporting chronic low back pain ≥ 1 year participated between September 2019 and April 2021 in a trial using ultrasound imaging to measure thoracolumbar shear strain. Ultrasound imaging occurred 2–3 cm lateral to L2-3 while participants relaxed prone on an automated table moving the lower extremities downward 15 degrees, for 5 cycles at 0.5 Hz. Pain intensity on an 11-point numerical rating scale, disability, pain interference, and global improvement were also collected. Participants received 8-weeks of twice-weekly chiropractic care including spinal manipulation, education, exercise, self-management advice and myofascial therapies. Shear strain was computed using 2 methods. The highest shear strain from movement cycles 2, 3, or 4 was averaged over right and left sides for each participant. Alternately, the highest shear strain from movement cycle 3 was used. All data were analyzed over time using mixed-effects models. Estimated mean changes are reported. Results Of 20 participants completing 8-weeks of chiropractic care (female n = 11), mean (SD) age was 41 years (12.6); mean BMI was 28.5 (6.2). All clinical outcomes improved at 8-weeks. Mean (95% confidence interval) pain intensity decreased 2.7 points (− 4.1 to − 1.4) for females and 2.1 points (− 3.7 to 0.4) for males. Mean Roland–Morris disability score decreased by 5 points (− 7.2 to − 2.8) for females, 2.3 points (− 4.9 to 0.2) for males. Mean PROMIS pain interference T-score decreased by 8.7 points (− 11.8 to − 5.5) for females, 5.6 points (− 9.5 to − 1.6) for males. Mean shear strain at 8-weeks increased in females 5.4% (− 9.9 to 20.8) or 15% (− 0.5 to 30.6), decreasing in males 6.0% (− 24.2 to 12.2) or 2% (− 21.0 to 16.8) depending on computational method. Conclusion Spinal manipulation does not likely disrupt adhesions or relax paraspinal muscles enough to immediately affect shear strain. Clinical outcomes improved in both groups, however, shear strain only increased in females following 8-weeks of multimodal chiropractic care. Trial registration ClinicalTrials.gov registration is NCT03916705.
... Fascia is densely innervated with mechanoreceptors and nociceptors (Langevin, 2006, Schleip, 2003a, Schleip, 2003b. The mechanoreceptors, such as Pacini corpucles, Ruffini organs and free-nerve endings, maintain muscular coordination via the constant feedback from ligaments. ...
Article
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Postural disorders are common among preschool and school-age children. In regard to gen�der and age distribution, children are characterized by different indicators of body posture. Posture for different professionals has different importance, and from a standpoint of one physiatrist it rep�resents a measure of the efficiency of muscular balance and neuromuscular coordination. Bad pos�ture represents a functional deviation from normal posture status without structural changes to the spine or lower extremities. Evaluation and treatment of postural disorders requires knowledge of basic principles related to the conduct of individual body segments, joints and muscles. The com�bined physical training programmes that include strength and muscle stretching exercises, particu�larly with regard to the postural antigravity muscles, should help in the prevention of health prob�lems that could occur later in life. Future research on the impact of early school-based back pos�ture promotion in relation to the integration of back posture principles according to biomechanical favourable lifestyle and back pain prevalence later in life is essential. Keywords: posture, assessment, exercise, scoliosis
... The decrease in PFM bioelectric activity observed after SI intervention can be explained by its influence on the central and autonomic nervous systems. In its assumptions, SI is based on the mobilization of the fascia, which, according to Schleip [38,39], is strongly connected with the nervous system thanks to the presence of mechanoreceptors sensitive to touch. In response to their stimulation, through the central nervous system, it causes changes in the tone of some related striated muscle fibers. ...
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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.
... It can be concluded the fascial release technique may provide a decrease in HA viscosity and facilitates the gliding movements of the fascial layers and thus increases the ROM. It has been reported in the literature that mechanoreceptors in the fascia are stimulated by the manual techniques to regulate the autonomic nervous system and thus leading to an increase in local fluid flow, a decrease in local vasodilatation, and tissue viscosity, in general muscle tone and the tone of muscle cells in the fascia [39]. It is thought that these effects may be created with the fascial release technique. ...
Article
Background Fascial release technique is used for releasing fascial tissue to decrease pain, to increase range of motion, and to improve functional level. Objective To investigate the acute effects of fascial release technique on pain, range of motion, upper extremity functional level, and fear of movement in individuals with arthroscopic rotator cuff repair. Methods Thirty volunteers with an arthroscopic rotator cuff repair were included in the study. The individuals were randomly divided into two groups. One group received only conventional physiotherapy including hot pack, interferential current, and exercise program, while the fascial release technique was applied to the other group in addition to the conventional physiotherapy program for 2 weeks with 2 sessions per week. Individuals were assessed for pain intensity, range of motion, functional level, fear of movement before and after treatment, and satisfaction level after treatment. Results Demographic and clinical characteristics of the groups were similar (p > 0.05). Both groups showed improvement in pain, range of motion, and upper extremity functions (p < 0.05). Improvements in the treatment group were better than the conventional physiotherapy group (p < 0.05). Fear of movement was significantly decreased in the treatment group (p < 0.05). Both groups were similar in terms of satisfaction level (p > 0.05). Conclusion Fascial release technique is acutely effective on the pain, joint range of motion and upper extremity functions in the treatment of individuals with arthroscopic rotator cuff repair and more successful results can be obtained by including it in the early rehabilitation program after arthroscopic rotator cuff surgery.
... As a result of the mechanical tension placed on the fascia, the ROM of the ankle joint increases. Mechanical pressure activates mechanoreceptors, which alter the information sent to the central nervous system, resulting in a change in tissue tension [26]. ...
Article
Aim: The purpose of this study was to evaluate and compare the effects of Instrument-Assisted Soft-Tissue Mobilisation (IASTM) and Therapeutic Ultrasound in patients with heel pain in terms of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. This was undertaken as even though Ultrasound is regularly used, heel pain still remains resistant to treatment in some patients. Hence, the need to compare a relatively newer technique with it. Study Design : Experimental study Place and Duration: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe) , Wardha , duration of 12 months. Methods: Seventy people (n=70) with heel discomfort (lasting 6 weeks to 1 year) were chosen at random and placed into two groups, each getting eight therapy sessions. IASTM and Home Exercise Program was given to Group A, whereas Therapeutic Ultrasound and Home Exercise Program was given to Group Calf muscle stretches and Plantar fascia stretches were incorporated in the Home Exercise Programme. Outcome measures were recorded both at the beginning of treatment and after final treatment. The patients were assessed for Numerical Pain Rating Scale with first step in morning and at the beginning of first session and after end of last session and for Foot and Ankle Ability Measure scale at the beginning of first session and after end of last session. A follow up period of 90 days (after last session) was taken, the measurements of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale were taken again to see the long-term effects. Results: Group A which received IASTM + Home exercises showed great improvements than Ultrasound and Home exercise group, from baseline to week 4 after the pain intensity and foot function were assessed using Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. Statistically significant differences were found in both the groups. i.e. P=0.0001. But 7 people in Ultrasound group complained of pain and functional ability at follow-up session. Conclusion: In this study, it can be concluded that combining both the IASTM and Home Exercise Program have got beneficial effects in decreasing the pain intensity thus improving the foot and ankle function in patients with heel pain.
... When mechanical stress is applied to the muscle fascia, intrafascial mechanoreceptors are stimulated. This change changes the proprioceptive input to the central nervous system, which in turn changes the tension in the tissue-related motor units (Schleip 2003). The IASTM method has been reported to be effective in the treatment of MTrPs (Gulick 2018). ...
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Purpose To compare the ischaemic compression (IC) and instrument-assisted soft tissue mobilization (IASTM) in the treatment of MTrPs in addition to standard rehabilitation program in patients with rotator cuff tears. Methods Participants with rotator cuff tears were included the study (n = 46). Patients were randomly divided into two groups; which were Group 1 (IC + standard rehabilitation program (n = 23)), and Group 2 (IASTM + standard rehabilitation program (n = 23)) groups. Pain were assessed by visual analog scale (VAS). Range of motion (ROM) was assessed by a universal goniometer. Active MTrPs were assessed according to the Travel and Simons criteria. Pressure pain threshold (PPT) were assessed by a digital algometer. Function were evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and American Shoulder and Elbow Surgeons Standardised Shoulder Assessment (ASES) Form. Anxiety and depression were evaluated by the Hospital Anxiety and Depression (HAD) scale. Satisfaction was assessed by the Global Rating of Change scale after 6 weeks treatment. Results After the treatment, pain, ROM and the DASH, ASES, HAD scores improved in both groups (p < 0.05). The active MTrPs of 2 muscles, PPT of 4 muscles and DASH in Group 1 significantly improved compared to Group 2 (p < 0.05). Conclusion Although patients with low functionality accumulated in the IC group, the IC is more effective than the IASTM in increasing the PPT and functional improvement according to the results of the DASH score.
... Studies have been demonstrated the positive effects of manual therapy on the fascia, [13][14][15][16] it is believed that MVT could attenuate visceral fascia densification, favoring bladder compliance. Additionally, since the endopelvic fascia connects the visceral system with the pelvic floor muscles (PFM), 17 MVT could increase the functionality of these muscles. ...
Article
Aims To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM). Methods A double-blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire – Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry. Results Fifty-two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference −1.5 cmH₂0 [95% confidence interval [CI] −4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH₂0 [25%–75% interquartile range 0.0–5.6; p = 0.12]) after the intervention period. Conclusions Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.
... Another explanation may be provided by the theory of mechanical force transmission via connective tissue. Several studies have shown that fascial structures transfer strain to neighboring skeletal muscles [7][8][9] . Based on that theory, it can be assumed that the treatment of specific points located in the upper part of the DFL can affect a more significant portion of the DFL and, therefore, lead to more significant adaptations than the treatment of the lower part of the DFL. ...
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[Purpose] This study aimed to investigate the effects of Ergon® instrument-assisted softtissue mobilization of the upper and lower midpoints of the Deep Front Line (DFL) on hip abduction range of motion (ROM). [Participants and Methods] Forty healthy adults (29.3 ± 6.3 years; height: 175.8 ± 7.4 cm; weight: 77.2 ± 9.2 kg) were randomly divided into two groups and received a single 15-minute Ergon treatment in the upper midpoint (scalene muscles) and the lower midpoint of the DFL (hip adductors) on their dominant side. The non-dominant hip served as a control. Pre-and post-therapy active and passive hip abduction ROM at 0° and 90° flexion was examined using a goniometer. [Results] In both experimental groups, active and passive hip abduction ROM on the treated side improved significantly compared to the control side. Scalene treatment led to significantly greater improvement in active hip abduction ROM at 0° and 90° and in passive ROM at 90° compared to local hip adductor treatment. [Conclusion] The application of the Ergon technique on remote parts of the DFL may lead to a significant increase in hip abduction ROM compared to local hip adductors treatment.
Chapter
Chronic urogenital pain (CUP) disorders pose a unique challenge to healthcare providers. Two of the most common disorders are vulvodynia (Vd) and bladder pain syndrome (BPS). These syndromes are comorbid with each other and a range of other disorders that occur in the absence of identifiable pathology. Most traditional interventions are deemed ineffective and often lack evidence and mechanism-based models to rationalize their use. Responding to this deficit, the discussion considers recent evidence from pain mapping and the role of peripheral mechanisms in chronic pain. A pain mapping assessment protocol localises the source of the pain and identifies the common generators. Chronic pain, organ-related symptoms and muscle dysfunction form the most common features of CUP syndromes. The most likely mechanism linking these variables is the body-wide fascial system. Based on this premise, a new model of CUP is proposed. In this model, the non-relaxing pelvic muscles are seen as the primary generators of tension. Surface electromyography assists in the functional assessment of pelvic muscles. The tension generated by muscles is transmitted via the three-dimensional fascial network. Changes in the tensioning of fascia directly impacts the ganglia that regulate the peristalsis of pelvic organs. In time, the progressive loss of fascial elasticity results in chronic organ symptoms. On the basis of this model, management of CUP syndromes needs to focus on the dynamic properties of fascia—its malleability and plasticity—and on the rehabilitation of non-relaxing muscles. The research presented and literature discussed support the plausibility of a myofascial model of CUP.
Article
This article is offered in the spirit of supporting students studying at home during the COVID-19 lockdown. It is offered as a study aid for those who may not be able to return to the studio for months but want to continue with their life-giving somatic studies at home. The article shares the properties of fascia and biotensegrity. I reflect on why somatic movement dance education and therapy is an effective approach in the world of fascial therapies. The first areas covered are sensory nerve endings found in fascia that respond to different types of movement and pressure, such as Golgi organs, Ruffini receptors, Pacini corpuscles and interstitial receptors. Other movement concepts covered are omnidirectional volume, pressure, time, stretch, gravity, ground reaction, floating bones, and chirality and counter-chirality. The article serves as an introduction to biotensegrity and why fascia innervates the parsympathetics. Of note, the article is pedagogical, primarily aimed at supporting students who are training in somatic movement dance education and therapy. Throughout the article Karin Rugman and Maisie Beth James offer experiential sensory images applying key ideas about fascia in the studio.
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This study investigated how different manual therapies applied to the posterior thigh muscles affect the ten-repetitions maximum performance test (10 RM) and hip flexion range-of-motion among young soccer players. Seventeen non-professional male soccer players performed the 10RM and range of motion pre-testing, and, in separate laboratory visits, they underwent three different experimental activities presented to each participant in a randomized order: (a) rest control activity with no intervention, (b) manual massage, and (c) muscle energy. Comparing pre-testing performances to repeated tests after each intervention condition, participants increased their maximum load lift on the 10-repeitions maximum test following manual massage and muscle energy interventions (p<0.05), but not following the control condition. They also increased their hip range-of-motion on flexibility testing following manual massage and muscle energy (p<0.05), but not following the control condition. Thus, both manual massage and muscle energy therapies applied to the posterior thigh were beneficial to performance. This finding has clear implications when preparing athletes for competition.
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[Purpose] The purpose of this pilot study was to investigate the effectiveness of instrument-assisted soft tissue mobilization (IASTM), foam rolling, and athletic elastic taping on improving elite volleyball players’ shoulder range of motion (ROM) and throwing performance. [Participants and Methods] Fifteen elite male volleyball players (mean age: 24 ± 4.54 years; mean height: 177 ± 0.08 cm; mean weight: 81 ± 7.71 kg) received shoulder Ergon IASTM, foam rolling, and elastic taping treatment in random order on both upper extremities once a week for three weeks. Pre-and post-treatment assessments of their shoulders’ ROM and functional throwing performance were performed. [Results] Ergon IASTM technique resulted in significantly higher shoulder flexion ROM values than foam rolling and elastic taping. Foam rolling, in turn, showed better results than athletic elastic taping. Moreover, the Ergon IASTM technique resulted in significantly higher OSP values than athletic elastic taping. No significant differences were observed between the therapeutic interventions in terms of FTPI. [Conclusion] This pilot study on elite athletes provides evidence that both IASTM and foam rolling techniques may improve their passive shoulder ROM compared to elastic athletic taping while Ergon IASTM can also enhance their shoulder throwing performance.
Article
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PURPOSE: Self-myofascial release (SMR) using a foam roller is a popular intervention used to improve flexibility and restore skeletal muscles, fascia, tendons, ligaments and soft-tissue extensibility. However, the mechanism about the effects of SMR on flexibility, delayed onset of muscle soreness and arterial stiffness has not been elucidated. The purpose of this review is to provide basic knowledge for the mechanism about the effects of SMR from a functional and anatomical perspective.METHODS: In this review, we summarized previous studies investigating the effects of SMR which were associated with the human fascial system on flexibility, delayed onset of muscle soreness, arterial stiffness and autonomic nervous system (ANS).RESULTS: SMR with a foam roller can improve flexibility by increasing blood flow and circulation to the soft tissues. Foam rollingrelated mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial afferent nerves that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. In addition, SMR with a foam roller may improve arterial stiffness, which was associated with increased circulating level of nitric oxide induced by elevated shear stress on the walls of the blood vessel.CONCLUSIONS: SMR using a foam roller improves flexibility by relaxing tension in skeletal muscles or fascia and may help to improve arterial stiffness and the function of the ANS. We suggest that SMR using a foam roller may help to reduce the risks of cardiovascular disease as a new alternative method.
Article
Zusammenfassung Ziel Ziel dieser Literaturübersicht ist es das fasziale Netzwerk im Zusammenhang mit der Entstehung von Rückenschmerzen zu betrachten, mögliche Einflussfaktoren zu analysieren und diagnostische Möglichkeiten aufzuzeigen, mit denen Veränderungen in faszialen Strukturen bei Rückenschmerzpatienten verdeutlicht werden können. Methode Es wurde eine Literaturrecherche mit den Schlagworten Faszien, Sensomotorik, unspezifischer Rückenschmerz, creep, Schmerz und Diagnostik durchgeführt. Von etwa 400 Artikeln wurden die Abstracts gesichtet, etwa 150 wurden gelesen und ausgewertet. Am Ende flossen 86 Artikel in die Erstellung dieses narrativen Reviews ein. Ergebnis Faszien können sich aufgrund der enthaltenen Fasern gut an eine Zugbelastung anpassen. Ab einer Dehnung der Fasern zwischen 3–8% kommt es zu ersten irreversiblen Gewebeveränderungen, die einen Beitrag zu unspezifischen Rückenschmerzen leisten können (creep-Effekt). Durch Mikroverletzungen können die in den Faszien enthaltenen Fibroblasten aktiviert werden und die Steifigkeit der Faszien erhöhen, was den möglichen Bewegungsradius einschränken kann und die Faszienvorspannung erhöht. Somit sinkt die Toleranz auf eine angelegte Zugspannung. Durch die Ultraschallelastografie ist die reduzierte Beweglichkeit in den Faserschichten der Faszien zu erkennen. Außerdem spielen Faszien durch ihre starke Innervation bei der Propriozeption, Exterozeption, Interozeption und Nozizeption eine maßgebliche Rolle. Schlussfolgerung Ob das fasziale Netzwerk mit der Entstehung von unspezifischen Rückenschmerzen in Verbindung steht, kann aufgrund der derzeit immer noch lückenhaften Erkenntnisse über die funktionellen Zusammenhänge noch nicht geklärt werden. Außerdem stehen noch keine diagnostischen Mittel zur Verfügung, die die Funktionalität der Faszien sicher bewerten können. Dennoch sollten die Faszien als sensomotorisches Netzwerk verstanden werden, das in seiner Komplexität mit allen Strukturen des menschlichen Körpers wechselwirkt und somit einen Einfluss auf Rückenschmerzen haben kann.
Thesis
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Традиционните медицински практики от различни части на света и в частност акупунктурата имат своето място в медицинската практика и са включени в закона за здравето като алтернативни методи за подобряване на здравето. Тяхното използване никога не е прекъсвало, а в съвремието са в подем. Китайската традиционна медицина има няколко основни направления едно от което е акупунктурата. Акупунктурата на езика като вид манипулация представлява интерес за нашето проучване с морфологичните й аспекти. Морфологичните изменения, които настъпват в тъканите след иглоубождането, може да бъдат установени и документирани с помощта на обективни, съвременни хистологични методи. Количественото измерване е улеснено от компютърни програми за хистоморфометрични методи. Езикът е плътен мускулест орган разположен в устната кухина свързан със съществени функции в живия организъм. От тази гледна точка той винаги е представлявал интересен обект за изучаване, както от морфологията, така и от клиниката. Близкото му разположение до централната нервна система (ЦНС) и богатата му инервация го прави област за рефлексологични манипулации. Манипулациите върху него са бързи, лесни и същевременно ефективни. Напредъкът в хранително-вкусовата и фармацевтични индустрии също насочва интереса към езика като място за прилагане на нови вещества, като стимуланти за вкусовия анализатор или сублингвални системи за пренос на лекарства. Един от първите органи в досег с антигените на околната среда е езика, което засилва неговата роля за имунната реакция на организма и може да се проучва във връзка със съответните клинични проявления като имунна реакция и автоимунни заболявания. Нашият интерес към него в това проучване е фокусиран върху морфологичните промени, които настъпват в езикът в резултат на акупунктура, както и към нормалната му морфология.
Article
Objective The purpose of this study was to compare the flexibility of the thoracolumbar fascia (TLF) in individuals with and without subacromial impingement syndrome (SAIS). A secondary purpose was to demonstrate a new method for measuring TLF flexibility. Methods A total of 60 participants—30 diagnosed with SAIS and 30 asymptomatic—were included. In both groups, trunk flexibility was assessed by the modified Schober test, TLF flexibility by rotational measurement on a goniometric platform, and shoulder posterior capsule tightness by tape measurement. The data obtained were compared using t tests for independent variables. Results No statistically significant difference was observed for any parameter between participants with SAIS and healthy controls (P > .05). Conclusion For the participants we studied, the flexibility of the TLF was not associated with SAIS. The goniometric evaluation method used in this study was affordable and feasible. The validity and reliability of this measurement method should be assessed further in future studies.
Article
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# Background Mechanical percussion devices have become popular among sports medicine professionals. These devices provide a similar effect as manual percussion or tapotement used in therapeutic massage. To date, there are few published studies or evidence-based guidelines for these devices. There is a need to understand what professionals believe about this technology and how they use these devices in clinical practice. # Purpose To survey and document the knowledge, clinical application methods, and use of mechanical percussion devices among healthcare professionals in the United States. # Design Cross-sectional survey study. # Methods A 25 question online survey was emailed to members of the National Athletic Trainers Association, Academy of Orthopedic Physical Therapy, and American Academy of Sports Physical Therapy. # Results Four hundred twenty-five professionals completed the survey. Most professionals (92%, n=391) used devices from two manufacturers: Hyperice® and Theragun®. Seventy-seven percent directed clients to manufacturer and generic websites (n=329) to purchase devices. Most respondents used a medium and low device speed setting for pre- and post-exercise (62%, n=185), pain modulation (59%, n=253), and myofascial mobility (52%, n=222). A large proportion of respondents preferred a total treatment time between 30 seconds and three minutes (36-48%, n=153-204) or three to five minutes (18-22%, n=76-93). Most respondents (54-69%, n=229-293) believed that mechanical percussion increases local blood flow, modulates pain, enhances myofascial mobility, and reduces myofascial restrictions. Most respondents (72%, n=305) were influenced by other colleagues to use these devices. Sixty-six percent used patient reported outcomes (n=280) to document treatment efficacy. Live instruction was the most common mode of education (79%, n=334). # Conclusion These results are a starting point for future research and provide insight into how professionals use mechanical percussion devices. This survey also highlights the existing gap between research and practice. Future research should examine the efficacy of this technology and determine consensus-based guidelines. # Level of Evidence 3
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Inflammatory processes in the thoracolumbar fascia lead to thickening, compaction, and fibrosis and are thought to contribute to the development of nonspecific low back pain (nLBP). The blood circulation of fascial tissue may play a critical role in this process, as it may promote hypoxia-induced inflammation. This study examined the influence of thoracolumbar fascia morphology (TLFM), sports activity (SA), body mass index (BMI), pain, and a set of myofascial release (MFR) techniques on blood flow data (BFD) of lumbar myofascial tissue. This study was a single-blind, randomized, placebo-controlled trial. Thirty pain-free subjects (40.5 ± 14.1 years) were randomly assigned to two groups treated with MFR or a placebo intervention. Correlations between pain, SA, BMI, and TLFM were calculated at baseline. The effects of TFLM and MFR on BFD were determined. There were strong correlations between pain (r = -0.648), SA (d = 0.681), BMI (r = -0.798), and TLFM. Blood flow was significantly different between disorganized and organized TLFM (p < 0.0001). The MFR group had a significant increase in blood flow after treatment (31.6%) and at follow-up (48.7%) compared with the placebo group. Circulatory restrictions caused by disorganized TFLM could lead to hypoxia-induced inflammation, which likely results in pain and impaired proprioceptive function and contributes to the development of nLBP. The deformation and altered morphology associated with dysfunction of blood vessels and free nerve endings could be positively affected by the intervention in this study.
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Objectives: myofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height. Methods: a prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention. Results: significant improvements were found by DN on ankle dorsiflexion at 24 hours post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions. Conclusions: Both SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness.
Article
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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.
Article
This article is a report of the somatic practice, Bones for Life®, as both a therapeutic tool for self-healing and as a simple and readily accessible tool to increase students’ somatic awareness in the voice studio. The author’s experience with a congenital defect of the left temporomandibular joint (TMJ), and the access to relief that this somatic modality has afforded her, is articulated. Four of the ninety processes are explored—specifically focused on improved alignment and ease of movement in the upper shoulder area—as presented in Workshop format at the 2021 Virtually PAVA Symposium. Finally, some thoughts on why these processes work to create changes in vocalization are offered.
Article
Introduction Self-massage using a foam roller (foam rolling) has been used to improve joint range of motion (ROM). However, the effect of foam rolling on the morphology of a targeted muscle, tendon, and muscle-tendon unit (MTU) has not been fully clarified. This study aimed to investigate extensibility changes in the gastrocnemius muscle (GM), MTU, and the Achilles tendon (AT) in terms of maximum ankle dorsiflexion (max-DF) following a foam rolling intervention. This was an interventional study with no controls. Methods Study participants comprised 10 male and female students (mean [standard deviation]: 22.7 [2.5] years; height, 164.2 [6.7] cm; weight, 57.9 [7.9] kg). The foam rolling intervention was performed on the right leg plantar flexor muscles for 3 min. The outcomes were max-DF with specified resistance values (ROM-SR) and non-specified resistance values (ROM-NSR) and GM, MTU, and AT extensibility. An ultrasound device was used to determine the rate of change by subtracting the value in a neutral ankle joint position (0°) from the ankle max-DF to identify GM, MTU, and AT extensibility. All outcomes were measured pre- and post-intervention. Results The range of ankle joint dorsiflexion increased significantly following the foam rolling intervention (Δ: ROM-SR, +4.35 [5.79]; ROM-NSR, +4.18 [4.43]), whereas GM extensibility increased 4.0 mm, although no significant difference was observed pre- and post-intervention. Conclusion Foam rolling was effective in increasing ankle joint dorsiflexion ROM. Moreover, it was suggested that the GM morphology might be affected by the intervention.
Article
This is a five-part article that shares the compassionate artistry and science behind self-regulation and co-regulation. Each section explores the concept of self-regulation and how Somatic Movement Dance Therapy supports health through self-regulatory and co-regulatory processes. Part 1 offers general reflections on self-regulation and how the field differs from bodywork modalities and mechanistic health regimes. Part 2 shares polyvagal theory and how practice supports a deep parasympathetic state (immobilization without fear). Part 3 enacts a research process where polyvagal theory is evident and applied in practice. Part 4 shares processes of co-regulation and the transpersonal heart-field. Part 5 details somatic touch combined with sense perception of the heart-field. I share photographic images of my students throughout where they are applying theory to practice and, additionally, empirically investigating how theory might support or illuminate their practice. The article shares how parasympathetic ease-and-release is an essential physiological state that underlies self-regulatory health. I also apply research by Doc Childre and Stephen Porges, attending to polyvagal theory and HeartMath; I share how this science shapes my practice and my training course in Somatic Movement Dance Therapy. The article is redacted from my new book, Somatic Movement Dance Therapy : The Healing Art of Self-Regulation and Co-Regulation . Across the pages I share sensory-perceptual pathways into a physiological state of consciousness (a transpersonal field of breath and heart) that supports ease and healing.
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Whereas a variety of pre-exercise activities have been incorporated as part of a “warm-up” prior to work, combat, and athletic activities for millennia, the inclusion of static stretching (SS) within a warm-up has lost favor in the last 25 years. Research emphasized the possibility of SS-induced impairments in subsequent performance following prolonged stretching without proper dynamic warm-up activities. Proposed mechanisms underlying stretch-induced deficits include both neural (i.e., decreased voluntary activation, persistent inward current effects on motoneuron excitability) and morphological (i.e., changes in the force–length relationship, decreased Ca²⁺ sensitivity, alterations in parallel elastic component) factors. Psychological influences such as a mental energy deficit and nocebo effects could also adversely affect performance. However, significant practical limitations exist within published studies, e.g., long-stretching durations, stretching exercises with little task specificity, lack of warm-up before/after stretching, testing performed immediately after stretch completion, and risk of investigator and participant bias. Recent research indicates that appropriate durations of static stretching performed within a full warm-up (i.e., aerobic activities before and task-specific dynamic stretching and intense physical activities after SS) have trivial effects on subsequent performance with some evidence of improved force output at longer muscle lengths. For conditions in which muscular force production is compromised by stretching, knowledge of the underlying mechanisms would aid development of mitigation strategies. However, these mechanisms are yet to be perfectly defined. More information is needed to better understand both the warm-up components and mechanisms that contribute to performance enhancements or impairments when SS is incorporated within a pre-activity warm-up.
Chapter
The integumentary surfaces are derived from ectoderm and consist of a variety of general and specialized regions of stratified epithelium with a superficial keratinized layer of varying thickness. The sensory function of the skin and its appendages (e.g., hairs and claws, which serve as mechanical levers) is achieved by means of a wide diversity of sense organs specialized for several distinct sensory modalities. Mechanical sensibility appears to be dominant, and sensations of touch, pressure, vibration, tickle, itch, with perhaps a contribution from position and movement (kinesthetic) sense, can be correlated with the properties of a variety of sensitive mechanoreceptors. Thermal sensations are conveyed by distinct populations sensitive to either warming or cooling. In many regions, the most numerous innervation consists of the thinnest fibers subserving sensory reports of pain or related noxious and aversive qualities.
Article
In a sample of 24 subjects with healthy veins, the collagen fibrils in the superficial layer of the crural fascia were arranged strictly in bundles running in various directions in space. Our EM pictures confirmed the concept, derived from light microscopy, of the texture of the collagen fibres of the fascia recalling the struts of a concertina barrier. This arrangement makes it possible for the fascia to adapt without tension to every state of contraction of the underlying muscles. In patients with chronic venous insufficiency, on the other hand, this normal arrangement of the collagen within the fascia is completely lost. In place of the scissor-like configuration of the texture, there is a tight disorderly network of fibrils, which are themselves sometimes abnormal in appearance. We describe this situation as 'fascial insufficiency'. The ultrastructural basis of fascial insufficiency accounts for the clinical picture of the chronic compartment syndrome, with its complication of treatment-resistant crural ulcers.
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The structure and function of breathing. Patterns of breathing dysfunction in hyperventilation syndrome. Biochemical influences on breathing. Biomechanical influences on breathing. Interaction of psychological and emotional effects with breathing dysfunction. Osteopathic assessment and treatment of thoracic and respiratory dysfunction. Physiotherapy breathing rehabilitation strategies. Self-regulation of breathing. Other breathing issues. Self-help approaches: reducing shoulder movement during breathing.
Article
The muscles of the human body may be divided into two groups, postural and phasic. The postural muscles are those involved primarily in maintenance of upright posture while the phasic muscles are those primarily involved in movement. These two groups of muscles react in distinct ways to musculoskeletal injury and even to the ordinary stresses of daily life. The postural muscles tend to become short and tight while the phasic muscles tend to become weak and inhibited. Tightness of postural muscles is extremely common and can initiate a cascade of changes in locomotor system function which often lead to pain. In our desire to provide thorough and effective care to our patients, we may wish to include examination and treatment for loss of normal muscle length in our treatment protocol. A standardized, step-by-step procedure for length assessment of key postural muscles is presented, as developed by Professor Vladimir Janda, of the Department of Rehabilitation Medicine, Charles University Hospital in Prague.
Article
The purpose of this study is to provide better understanding of the mechanical response of the lumbodorsal fascia to dynamic and static traction loadings. Since the fascia shows a viscoelastic behaviour, tests in which time is a variable were used, namely hysteresis and stress relaxation. Load-strain and load-time curves obtained from the hysteresis and stress-relaxation tests point out three different phenomena. First, an increase in stiffness is noticed when ligaments are successively stretched, i.e. strains produced by successive and identical loads decrease. Second, if a sufficient resting period is allowed between loadings, stiffening is reversed and strains tend to recover initial values. The third phenomenon, observed in stress-relaxation tests as time progresses, is ligament contraction in stretched and isometrically held samples. This third phenomenon may be explained by the possibility that muscle fibres capable of contracting spontaneously could be present in lumbodorsal fascia ligaments.
Article
A randomized, double-blind, controlled, multicenter trial was conducted. To assess the efficacy of neuroreflexotherapy in the management of low back pain. Neuroreflexotherapy consists of temporary implantation of epidermal devices in trigger points in the back and referred tender points in the ear. The rheumatology and rehabilitation departments of three teaching hospitals in Madrid recruited 78 patients with chronic low back pain. These patients were randomly assigned to the control group (37 patients) or to the treatment group (41 patients). Patients in the treatment group underwent one neuroreflexotherapeutic intervention. The control group received sham treatment consisting of placement of the same number of epidermal devices within a 5-cm radius of the target zones. Patients from both groups were allowed to continue drug treatment as previously prescribed. The use of medications during the trial was recorded. Patients underwent clinical evaluations on three occasions: within 5 minutes before intervention, within 5 minutes after intervention, and 45 days later. The preintervention assessment was carried out by the physician from each hospital department who included the patient in the study. Each of the two follow-up assessments were carried out independently by two of three physicians who had no connection with the research team. Patients in the treatment group showed immediate lessening of pain compared with the results in patients in the control group. The pain relief was clinically relevant and statistically significant, and it persisted up to the end of the trial. Neuroreflexotherapy intervention seems to be a simple and effective treatment for rapid amelioration of pain episodes in patients with chronic low back pain. At this time, the duration of pain relief beyond 45 days has not been evaluated.
Article
Electrical microstimulation was used to study primary motor and premotor cortex in monkeys. Each stimulation train was 500 ms in duration, approximating the time scale of normal reaching and grasping movements and the time scale of the neuronal activity that normally accompanies movement. This stimulation on a behaviorally relevant time scale evoked coordinated, complex postures that involved many joints. For example, stimulation of one site caused the mouth to open and also caused the hand to shape into a grip posture and move to the mouth. Stimulation of this site always drove the joints toward this final posture, regardless of the direction of movement required to reach the posture. Stimulation of other cortical sites evoked different postures. Postures that involved the arm were arranged across cortex to form a map of hand positions around the body. This stimulation-evoked map encompassed both primary motor and the adjacent premotor cortex. We suggest that these regions fit together into a single map of the workspace around the body.
Multidisciplinary Approaches to Breathing Pattern Disorders Osteopathic Manipulative Techniques for the Body
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Ligamentous Articular Strain: Osteopathic Manipulative Techniques for the Body
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