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Effectiveness of Myofascial Release Therapies on Physical Performance Measurements: A Systematic Review
... Fascia has been forgotten and devalued by the scientific community for many years due to its ubiquitous and apparently disordered nature and, mainly, to the lack of adequate assessment tools (Carla, Veronica, Andrea, Fabrice, & De Caro, 2011;Klinger, W., & Schleip, 2015). Recent evolution of histology and US imaging evaluation led to a considerable increase in fascia-related research (Chaitow, L., & Schleip, 2012), especially regarding its role in muscular force transmission , movement perception and coordination (Carla et al., 2011;Schleip et al., 2012;Turrina, Martínez-González, & Stecco, 2013), aetiology of pain (Wells et al., 2013), as well as the therapeutic modalities that aim to restore the normal functioning of the fascial system (Ajimsha, Al-Mudahka, & Al-Madzhar, 2015;Beardsley & Škarabot, 2015;Mauntel, Clark, & Padua, 2014;McKenney, Elder, Elder, & Hutchins, 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
... On this subject, several recently conducted systematic reviews report that myofascial techniques are emerging as solid evidence base strategies (Ajimsha et al., 2015) that increase range of motion (ROM) (Mauntel et al., 2014;Webb & Rajendran, 2016) and flexibility (Beardsley & Škarabot, 2015) without decreasing muscle function | 3 (Mauntel et al., 2014); decrease pain perception (Webb & Rajendran, 2016) and improve muscle performance (Webb et al., 2015) and recovery (Beardsley & Škarabot, 2015), which results in increased movement efficiency and reduced risk of injury (Mauntel et al., 2014); these techniques may be used for athletes and the general population (Beardsley & Škarabot, 2015) before rehabilitation and physical activity (Webb et al., 2015). Although, great heterogeneity in quality, methods and results is highlighted among studies (Ajimsha et al., 2015;McKenney et al., 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
... On this subject, several recently conducted systematic reviews report that myofascial techniques are emerging as solid evidence base strategies (Ajimsha et al., 2015) that increase range of motion (ROM) (Mauntel et al., 2014;Webb & Rajendran, 2016) and flexibility (Beardsley & Škarabot, 2015) without decreasing muscle function | 3 (Mauntel et al., 2014); decrease pain perception (Webb & Rajendran, 2016) and improve muscle performance (Webb et al., 2015) and recovery (Beardsley & Škarabot, 2015), which results in increased movement efficiency and reduced risk of injury (Mauntel et al., 2014); these techniques may be used for athletes and the general population (Beardsley & Škarabot, 2015) before rehabilitation and physical activity (Webb et al., 2015). Although, great heterogeneity in quality, methods and results is highlighted among studies (Ajimsha et al., 2015;McKenney et al., 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
Background
Failure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.
Objectives
To identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.
Methods
A systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.
Results
From a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n=4), abdominal (n=7), femoral (n=4) and crural (n=3) regions. These studies addressed issues concerning either diagnosis (n=11) or treatment benefits (n=7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies. This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).
Conclusion
The US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.
... Fascia has been forgotten and devalued by the scientific community for many years due to its ubiquitous and apparently disordered nature and, mainly, to the lack of adequate assessment tools (Carla, Veronica, Andrea, Fabrice, & De Caro, 2011;Klinger, W., & Schleip, 2015). Recent evolution of histology and US imaging evaluation led to a considerable increase in fascia-related research (Chaitow, L., & Schleip, 2012), especially regarding its role in muscular force transmission , movement perception and coordination (Carla et al., 2011;Schleip et al., 2012;Turrina, Martínez-González, & Stecco, 2013), aetiology of pain (Wells et al., 2013), as well as the therapeutic modalities that aim to restore the normal functioning of the fascial system (Ajimsha, Al-Mudahka, & Al-Madzhar, 2015;Beardsley & Škarabot, 2015;Mauntel, Clark, & Padua, 2014;McKenney, Elder, Elder, & Hutchins, 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
... On this subject, several recently conducted systematic reviews report that myofascial techniques are emerging as solid evidence base strategies (Ajimsha et al., 2015) that increase range of motion (ROM) (Mauntel et al., 2014;Webb & Rajendran, 2016) and flexibility (Beardsley & Škarabot, 2015) without decreasing muscle function | 3 (Mauntel et al., 2014); decrease pain perception (Webb & Rajendran, 2016) and improve muscle performance (Webb et al., 2015) and recovery (Beardsley & Škarabot, 2015), which results in increased movement efficiency and reduced risk of injury (Mauntel et al., 2014); these techniques may be used for athletes and the general population (Beardsley & Škarabot, 2015) before rehabilitation and physical activity (Webb et al., 2015). Although, great heterogeneity in quality, methods and results is highlighted among studies (Ajimsha et al., 2015;McKenney et al., 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
... On this subject, several recently conducted systematic reviews report that myofascial techniques are emerging as solid evidence base strategies (Ajimsha et al., 2015) that increase range of motion (ROM) (Mauntel et al., 2014;Webb & Rajendran, 2016) and flexibility (Beardsley & Škarabot, 2015) without decreasing muscle function | 3 (Mauntel et al., 2014); decrease pain perception (Webb & Rajendran, 2016) and improve muscle performance (Webb et al., 2015) and recovery (Beardsley & Škarabot, 2015), which results in increased movement efficiency and reduced risk of injury (Mauntel et al., 2014); these techniques may be used for athletes and the general population (Beardsley & Škarabot, 2015) before rehabilitation and physical activity (Webb et al., 2015). Although, great heterogeneity in quality, methods and results is highlighted among studies (Ajimsha et al., 2015;McKenney et al., 2013;Webb et al., 2015;Webb & Rajendran, 2016). ...
Background
Failure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated.
Objectives
To identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans.
Methods
A systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study.
Results
From a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n=4), abdominal (n=7), femoral (n=4) and crural (n=3) regions. These studies addressed issues concerning either diagnosis (n=11) or treatment benefits (n=7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies.
This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2).
Conclusion
The US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.
... This myofascial tightness develops over time as a result of muscular microtrauma or after acute injury, both of which lead to scarring or thickening of fascia. Scarring in turn, contributes to reduced range of movement (ROM); neuromuscular dysfunction; joint, nerve and vascular compression; reductions in strength; and pain and injury -all of which negatively affect physical performance (Healey et al., 2014;Barnes, 1997;Schroeder and Best, 2015;Curran et al., 2008;Mauntel et al., 2014). ...
... Manual therapy has become increasingly popular amongst sports medicine practitioners, strength and conditioning coaches and athletes all over the world. The aim is to promote efficient movement by improving ROM and muscular function, as better movement efficiency is associated with a lower risk of injury (Mauntel et al., 2014). More and more athletes and coaches are using manual therapy in the form of SMR or foam rolling as an easy and cost-effective way to achieve this aim (Schroder and Best, 2015). ...
... However, there are also studies detailing no beneficial effects on ROM (Couture et al., 2015;Peacock et al., 2014;Skarabot et al., 2015). Mauntel et al. (2014) published a systematic review that looked at the effectiveness of multiple myofascial release techniques on joint ROM, muscle force, and muscle activation. They included active release technique (ART), trigger point therapy, SMR, and positional release therapy, and the authors found that collectively, these therapies resulted in a significant improvement in ROM but no significant improvements in muscle function after application. ...
Self-myofascial release (SMR) with tools like the foam roller has become increasingly popular amongst active populations to self-treat areas of myofascial restriction and positively affect sporting performance. SMR achieves its effect through various mechanisms, such as altered connective tissue properties, improved neuromuscular and arterial function, autonomic nervous system stimulation, increased hydration and altered fascial piezoelectric function. In recent years, multiple studies have demonstrated that the effects of SMR include improved range of movement (ROM), increased muscle performance, enhanced recovery after exercise, and reduced stress. However, there is great heterogeneity amongst current research, which makes it difficult to reach a consensus regarding the protocols and parameters to follow in order to achieve beneficial results. Larger longer-term studies which repeat current protocols would significantly add to the current body of literature. This study reviews the literature on the effects of SMR on ROM, muscle performance, post-exercise recovery, balance and stress.
... 2,3 Tightened or stiffened fascial tissue or its reduced sliding ability (due to either repeated micro-trauma or acute injury) is thought to be a source of tension to the rest of the body leading to pain and to the loss of functional capacity. [2][3][4][5] It is believed that by stretching restricted fascia, myofascial release therapy is able to normalize the length and the sliding properties of myofascial tissues releasing also pressure from the pain-sensitive structures and restoring the mobility of the joints. 2,3,6 The descriptive characteristics and main results of previous narrative reviews on the effectiveness of myofascial release therapy are presented in detail in Supplementary Table 1. ...
... No review has yet summarized the evidence on the effectiveness of myofascial release in chronic musculoskeletal pain patients based on randomized controlled studies alone. [4][5][6][7][8][9][10] In previous reviews, there are no effect sizes to support the reported encouraging conclusions on myofascial release. Based on the reviews of lowquality studies, the evidence of myofascial release can at most be considered vague. ...
... In turn, the indirect release technique stretches myofascial complex by lower load and longer duration. 2,4,6 Also, direct myofascial release by patients themselves called "self-myofascial release" was included. This kind of self-myofascial release uses various types of roller massagers and provides tools for pain sufferers, athletes, and fitness trainers. ...
Objective:
To evaluate the evidence on the effectiveness of myofascial release therapy to relieve chronic musculoskeletal pain and to improve joint mobility, functioning level, and quality of life in pain sufferers. Data sources and review: Randomized controlled trials were systematically gathered from CENTRAL, Medline, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration's domain-based framework. In addition, the effect sizes of main outcomes were calculated based on reported means and variances at baseline and in follow-up.
Results:
Of 513 identified records, 8 were relevant. Two trials focused on lateral epicondylitis ( N = 95), two on fibromyalgia ( N = 145), three on low back pain ( N = 152), and one on heel pain ( N = 65). The risk of bias was considered low in three and high in five trials. The duration of therapy was 30-90 minutes 4 to 24 times during 2-20 weeks. The effect sizes did not reach the minimal clinically important difference for pain and disability in the studies of low back pain or fibromyalgia. In another three studies with the high risk of bias, the level of minimal clinically important difference was reached up to two-month follow-up.
Conclusion:
Current evidence on myofascial release therapy is not sufficient to warrant this treatment in chronic musculoskeletal pain.
... The etiology of MPS is complex, involving the creation of trigger points, which are overly sensitive spots in the fascia that cause referred pain, leading to neck pain, stiffness, changed fascial movements, and decreased cervical ROM [2,12,13]. Issues like muscle overuse, injuries, stress, bad posture, and health problems affecting muscle health can lead to the development of these trigger points and the onset of MPS [14]. Persistent stress, anxiety, sleep problems, lack of proper nutrition, and medical conditions such as fibromyalgia, hypothyroidism, and diabetes can worsen MPS by increasing muscle tension and pain [14]. ...
... MPS is also a multifaceted disorder marked by myofascial trigger points associated with fascia adhesions. These abnormal attachments reduce mobility and elasticity, leading to myofascial restrictions, dysfunctional movement patterns, and limitation of motion (LOM) [11,12,15]. Healthy fascia displacement is essential for optimal ROM, flexibility, and coordination, but it can be hampered by injury, inflammation, stress, dehydration, or lack of movement. ...
Context
Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial flexibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM).
Objectives
This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of superficial fascial displacement during active cervical flexion with the clinical diagnosis of MPS.
Methods
A cross-sectional study selectively included MPS and non-MPS participants from different workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a sonographer recorded superficial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized.
Results
In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found significant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically significant (p>0.05). Also, the type of work, the direction of fascial displacement, and the difference in superficial fascial displacement during cervical flexion did not show a significant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a specificity of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS.
Conclusions
We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as significant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.
... Myofascial restrictions occur most commonly as a result of high resistance training volume, with resultant hypertrophy triggering connective tissue or fascia stiffness (92). This loss in elasticity causes myofascia to bind to the affected region, leading to fibrous adhesions most commonly known as myofascial trigger points (MTrPs) (104). ...
... There are a variety of tools available to assist individuals in managing MTrPs through self-massage (SM) (78). Self-massage techniques aim to promote movement efficiency and reduce injury risk by improving ROM and muscular function and reducing pain (92). These improved ROM and pain responses are a consequence of mechanisms that may include increased pain tolerance, thixotropic effects, and neural modulation in relation to the sympathetic and parasympathetic nervous systems and afferent excitability (e.g., H-reflex) (10,11). ...
Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD) and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility which contributes to abnormal muscle mechanics, reduced muscle length and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power which may lead
to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain including differing densities of foam rollers, roller massagers, tennis balls and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating
foam rollers eliciting an increased reduction to pain perception and tennis balls and soft massage balls shown to be efficacious in targeting smaller affected areas.
... Effects of MFR have been also studied on performance measures of power, force development or agility and static and dynamic balance, however, these usually result unaffected by the application of the techniques [29,[37][38][39]. Since MFR techniques have the potential to improve ROM without impairing performance or balance parameters as observed after SS, it has been speculated that MFR could lead to improved muscle efficiency [38] supporting its use in sporting and rehabilitation environments. ...
... Effects of MFR have been also studied on performance measures of power, force development or agility and static and dynamic balance, however, these usually result unaffected by the application of the techniques [29,[37][38][39]. Since MFR techniques have the potential to improve ROM without impairing performance or balance parameters as observed after SS, it has been speculated that MFR could lead to improved muscle efficiency [38] supporting its use in sporting and rehabilitation environments. ...
Background
The aim of this study was to compare the positional transversal release (PTR) technique to stretching and evaluate the acute effects on range of movement (ROM), performance and balance.
Methods
Thirty-two healthy individuals (25.3 ± 5.6 years; 68.8 ± 12.5 kg; 172.0 ± 8.8 cm) were tested on four occasions 1 week apart. ROM through a passive straight leg raise, jumping performance through a standing long jump (SLJ) and balance through the Y-balance test were measured. Each measure was assessed before (T0), immediately after (T1) and after 15 min (T2) of the provided intervention. On the first occasion, no intervention was administered (CG). The intervention order was randomized across participants and comprised static stretching (SS), proprioceptive neuromuscular facilitation (PNF) and the PTR technique. A repeated measure analysis of variance was used for comparisons.
Results
No differences across the T0 of the four testing sessions were observed. No differences between T0, T1 and T2 were present for the CG session. A significant time × group interaction for ROM in both legs from T0 to T1 (mean increase of 5.4° and 4.9° for right and left leg, respectively) was observed for SS, PNF and the PTR. No differences for all groups were present between T1 and T2. No differences in the SLJ and in measures of balance were observed across interventions.
Conclusions
The PTR is equally effective as SS and PNF in acutely increasing ROM of the lower limbs. However, the PTR results less time-consuming than SS and PNF. Performance and balance were unaffected by all the proposed interventions.
... [23] Timothy et al investigated the effects of myofascial release on physical performance and discovered that myofascial release interventions help restore normal resting muscle electrical activity. [32] They indicated that while the muscle is at rest, it is locally hyperactive, causing pain, which may prompt people to compensate by intentionally decreasing their ROM. [32] According to a study Table 1 Anthropometrical characteristics among the control and experimental groups. ...
... [32] They indicated that while the muscle is at rest, it is locally hyperactive, causing pain, which may prompt people to compensate by intentionally decreasing their ROM. [32] According to a study Table 1 Anthropometrical characteristics among the control and experimental groups. conducted by Akta et al on the short-term effect of myofascial release on calf muscle spasticity in patients with spastic cerebral palsy, myofascial release reduces spasticity by inhibiting motor neuron excitability through prolonged stretch and compression on muscle spindles, Golgi tendon organ, joint and cutaneous receptors. ...
Background:
Impaired motor function and upper extremity spasticity are common concerns in patients after stroke. It is essential to plan therapeutic techniques to recover from the stroke. The objective of this study was to investigate the effects of myofascial release with the tennis ball on spasticity and motor functions of the upper extremity in patients with chronic stroke.
Methods:
Twenty-two chronic stroke patients (male-16, female-6) were selected to conduct this study. Two groups were formed: the control group (n=11) which included conventional physiotherapy only and the experimental group (n=11) which included conventional physiotherapy along with tennis ball myofascial release - in both groups interventions were performed for 6 sessions (35 minutes/session) per week for a total of 4 weeks. The conventional physiotherapy program consisted of active and passive ROM exercises, positional stretch exercises, resistance strength training, postural control exercises, and exercises to improve lower limb functions. All patients were evaluated with a modified Ashworth scale for spasticity of upper limb muscles (biceps brachii, pronator teres, and the long finger flexors) and a Fugl-Meyer assessment scale for upper limb motor functions before and after 4 weeks. Nonparametric (Mann-Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data statistically. This study has been registered on clinicaltrial.gov (ID: NCT05242679).
Results:
A significant improvement (P < .05) was observed in the spasticity of all 3 muscles in both groups. For upper limb motor functions, significant improvement (P < .05) was observed in the experimental group only. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison to the control group for both spasticity of muscles and upper limb motor functions.
Conclusion:
Myofascial release performed with a tennis ball in conjunction with conventional physiotherapy has more beneficial effects on spasticity and motor functions of the upper extremity in patients with chronic stroke compared to conventional therapy alone.
... Some studies have shown that massage techniques can produce an improvement in grip strength [7], range of motion (ROM) [8,9] and delayed onset muscular soreness [10]. However, there is controversy as to whether pre-competitive massage produces improvements in specific athletic performance parameters [11]. Pre-competition massage is used in many sports competitions. ...
... Several techniques have tried to modify the NMF with the purpose of improving athletic performance [11]. Nonetheless, studies evaluating the effects of a massage in NMF have not been found. ...
Background: Pre-competition massage is usually used to improve athletic performance and
reduce risk of injury. Despite its usual use, the effects of pre-competition massage on neuromuscular function have barely been studied. The aim of this study is to evaluate the effects of the precompetition massage over the gastrocnemius neuromuscular function. Method: The study is a quasi-experimental clinical trial thirty healthy athletes were enrolled in the study. Subjects received an intervention in one leg (experimental), consisting of a massage, and no intervention in the opposite leg (control). From all values of neuromuscular function, the following were analyzed: contraction time (Tc) and maximal displacement (Dm) by tensiomyography, and stiffness and tone by myotonometry. Results: Main effects of pre-competition massage on neuromuscular function include a significant (p < 0.05) increase in Tc and Dm variables, as well as a reduction in stiffness and tone.
Conclusion: Data shows an increase in Tc and maximal radial displacement (Dm) variables, as well as a reduction in stiffness and tone. More quality studies are needed to draw clear conclusions about the effects of pre-competition massage.
... This viscoelastic connective tissue exists as one continuous 3D network throughout the body and i) gives the body structure, ii) houses and protects muscles, vessels and nerves, iii) assists in force transmission, iv) plays a role in proprioception, v) promotes efficient movement by reducing friction, and vi) contributes to shock absorption (Kumka and Bonar, 2012;Mirkin, 2008;Barnes, 1997). Owing to this fascial interconnectedness, local fascial restrictions can have far-reaching consequences elsewhere in the body leading to deficits in ROM and neuromuscular function, reduced strength and muscle performance, and an increase in pain (Healey et al., 2014;Mauntel, 2014;Barnes, 1997). ...
... In connection with fascia, there has also been much investigation into the effects of myofascial release (either manual or with devices such as the foam roller) to relieve fascial restrictions. These effects include increased ROM, improved muscle performance, and enhanced recovery after exercise (Cheathem et al., 2015;Mauntel et al., 2014;Schroder and Best, 2015). The mechanisms behind the proposed effects of myofascial release tend to center around changes in thixotrophic properties, increased blood supply, increased tissue hydration, altered piezoelectric function of fascia, improved neuromuscular function, and autonomic nervous system stimulation (Cole, 2018). ...
In recent years there has been an increase in the use of neurolymphatic reflex (NLR) stimulation (also known as Chapman's reflex stimulation) in the athletic world; however, most evidence remains anecdotal at best. As well as discussing the origins of this technique in Applied Kinesiology, this paper also draws from neighbouring literature in the realms of myofascial chains, proprioceptive neuromuscular facilitation, myofascial release, and trigger point therapy to a suggest proposed mechanisms behind the hypothesised effectiveness of NLR stimulation. A research strategy to address the gaps in the literature is also proposed.
... For example, this can include reduction of tissue flexibility (range of motion), myofascial trigger points (MTrPS), post-traumatic and post-surgical soft tissue dysfunction and any other disorders which stem from overstraining or compression [4,6]. DTM is commonly employed by sports medicine physiotherapists to improve athletes' physical capabilities and movement efficiency through an increased range of motion and muscular function [7]. ...
... When muscles and fascia are subjected to some kind of strain or compression, fascial restrictions may alter normal muscular function through the development of myofascial trigger points and increased soft tissue stiffness. As a result, the range of motion in a person's joints may similarly decrease, and may be accompanied by altered neuromuscular properties and decreased muscle strength [7][8][9]. Current research suggests that the skeletal muscles of the human body are directly linked by fascia through myofascial chains. Because the fascia run in different directions, they are able to move and change form in concert with their surrounding tissues. ...
... Self-myofascial release (SMR) is a collective term for manual therapy techniques based on the effects of applying mechanical force to soft body tissue [55]. Self-myofascial release is widely used by people who are physically active, is one of the tools used by physiotherapists in their work with patients, and is useful for athletes from all sporting disciplines at all levels of competition [14,42]. The main objective of adding SMR to a set of therapeutic techniques or to training aids is improvement in range of motion (ROM) and a reduction in post-training muscular pain [21,68]. ...
... This also applies to the forms of SMR which use rollers (FR -foam rolling). The rollers are used to lengthen and apply pressure to the fascia, which in turn stimulates histological tissue changes in the area being treated, which has undergone pathological changes through strain, traumatising movements, metabolic dysfunction and even psychological factors [32,42]. Self-treatment is supposed to lead to the elimination of symptoms known as fascial restrictions and adhesions, such as pain and decreased ROM [34,68]. ...
Self-myofascial release (SMR) is a well-known and popular therapy. Its growing popularity is based on high effectiveness and availability. However, there is a lack of agreement about which parameters should be used to optimize the effects of the therapy. The purpose of this review is to critically select and assess current literature and ascertain the values of the following parameters: (1) therapy duration, (2) volume of applied pressure, (3) speed and (4) frequency of roll, (5) type of roller, (6) the number of treatment applications during one session, (7) the duration of intervals between applications that yield the best results in terms of soft tissue.
The authors launched their research in May 2018. The search strategy included the electronic databases EBSCOhost and PubMed. The following inclusion criteria were assessed:
- English language, high quality manuscripts (evaluation in PEDro scale)
- at least one of the groups using the foam roller, tennis ball or the stick to fascial release
- basic parameters of therapy described.A total 55 articles met the inclusion criteria. Patients can usually withstand a maximum tolerable pressure for 30-120 seconds, repeated 1-3 times, separated by 30 seconds of rest. The intensity of a single rolling movement should be moderate, and the movement should last about 3 seconds. Keeping the roller on particularly sensitive areas is recommended to release tension and enhance blood perfusion.Currently, there is no consensus on an optimal FR programme. However, there is a tendency to use SMR tools with a physiology-based method to enhance therapeutic efficiency.
... For instance, MacDonald et al. [12] showed an 8-10 degree improvement in ROM following an acute bout of foam rolling without a concomitant effect on muscular performance or contractile force capacities. In other studies, improvements in ROM were observed following treatment durations of 1.5 to 3 min [24]. Although the current investigation lacked the appropriate assessments, an improvement in ROM may at least partly explain the preservation of jump kinematics under exercise-induced fatigue. ...
... Overall, an increase in ROM with no observed impairment of performance may be of practical or clinical value. Altogether, the evidence suggests that self-MFR therapies, when applied pre-exercise, fail to inhibit or improve subsequent performance; however, this conclusion is predicated on a limited pool of studies ranging from fair to high methodological quality, as previously stated in a systematic review [24]. ...
The purpose of this study was to examine the effects of self-myofascial release (MFR) via foam rolling immediately following strenuous activity on acute fatigue-related impairments of muscular performance. Healthy male (n = 16) and female (n = 9) subjects visited the laboratory three separate times. During visit 1, subjects were familiarized with performance testing procedures and the foam rolling and fatigue protocols. For visits 2 and 3, subjects were (T1) assessed for vertical jump height, velocity, and power and dynamic reaction time (DRT). Subjects then performed the exercise fatigue protocol, followed by either a foam rolling treatment (MFR) or seated rest (CON). Immediately after, subjects repeated the performance tests (T2). CON resulted in a greater percent decline from T1–T2 for average power (p = 0.03), average velocity (p = 0.02), and peak power (p = 0.03) than the MFR treatment. No between-treatment differences were detected for %∆ vertical jump height (p = 0.14) or DRT (p = 0.20). According to magnitude-based inference analysis, MFR is likely beneficial in attenuating fatigue-induced kinematic decrements (i.e., power and velocity). Based on magnitude-based inference analysis, MFR is “possibly beneficial” with respect to mitigating acute fatigue-related impairment of jump height and dynamic reaction time. Results demonstrate the plausible short-term benefits of foam rolling on muscular performance decrements associated with acute muscular fatigue from exercise.
... 12 Only two prior reviews have been published relating to myofascial therapies. Mauntel et al 13 conducted a systematic review assessing the effectiveness of the various myofascial therapies such as trigger point therapy, positional release therapy, active release technique, and selfmyofascial release on joint range of motion, muscle force, and muscle activation. The authors appraised 10 studies and found that myofascial therapies, as a group, significantly improved ROM but produced no significant changes in muscle function following treatment. ...
... The authors appraised 10 studies and found that myofascial therapies, as a group, significantly improved ROM but produced no significant changes in muscle function following treatment. 13 Schroder et al 14 conducted a literature review assessing the effectiveness self-myofascial release using a foam roll and roller massager for pre-exercise and recovery. Inclusion criteria was randomized controlled trials. ...
Background:
Self-myofascial release (SMR) is a popular intervention used to enhance a client's myofascial mobility. Common tools include the foam roll and roller massager. Often these tools are used as part of a comprehensive program and are often recommended to the client to purchase and use at home. Currently, there are no systematic reviews that have appraised the effects of these tools on joint range of motion, muscle recovery, and performance.
Purpose:
The purpose of this review was to critically appraise the current evidence and answer the following questions: (1) Does self-myofascial release with a foam roll or roller-massager improve joint range of motion (ROM) without effecting muscle performance? (2) After an intense bout of exercise, does self-myofascial release with a foam roller or roller-massager enhance post exercise muscle recovery and reduce delayed onset of muscle soreness (DOMS)? (3) Does self-myofascial release with a foam roll or roller-massager prior to activity affect muscle performance?
Methods:
A search strategy was conducted, prior to April 2015, which included electronic databases and known journals. Included studies met the following criteria: 1) Peer reviewed, english language publications 2) Investigations that measured the effects of SMR using a foam roll or roller massager on joint ROM, acute muscle soreness, DOMS, and muscle performance 3) Investigations that compared an intervention program using a foam roll or roller massager to a control group 4) Investigations that compared two intervention programs using a foam roll or roller massager. The quality of manuscripts was assessed using the PEDro scale.
Results:
A total of 14 articles met the inclusion criteria. SMR with a foam roll or roller massager appears to have short-term effects on increasing joint ROM without negatively affecting muscle performance and may help attenuate decrements in muscle performance and DOMS after intense exercise. Short bouts of SMR prior to exercise do not appear to effect muscle performance.
Conclusion:
The current literature measuring the effects of SMR is still emerging. The results of this analysis suggests that foam rolling and roller massage may be effective interventions for enhancing joint ROM and pre and post exercise muscle performance. However, due to the heterogeneity of methods among studies, there currently is no consensus on the optimal SMR program.
Level of evidence:
2c.
... However, considering the viscoelastic properties of biological tissues, which also depend on tissue hydration [53,54] a decrease in the water content would logically lead to a more rigid tissue. Therefore, we hypothesise that a concomitant decrease of extracellular fluids with an increase in intracellular fluids occurred, improving muscle efficiency [55] and therefore, ROM. The effect observed may open to possible new applications of the FR as a tool to locally reduce extracellular fluids in those conditions characterized by fluid accumulation. ...
Background
This study aimed to compare and examine the local and non-local effects of a foam rolling (FR) and static stretching (SS) intervention applied to the plantar flexor (PF).
Methods
Fourteen female participants were investigated. Each participant underwent three conditions in a random order at least 48h apart and at the same time of the day: Control (CC), SS, and FR. Each condition was performed unilaterally in the dominant PF for 4 sets (apart from CC). SS was performed for 30 s. The FR included 30 rolls (15 in each direction) over a period of 30 s. A rest of 30 s was provided between each set for all conditions. Outcome variables were ankle dorsiflexion range of movement (ROM), tissue hardness, localized bioimpedance analysis at 50 kHz (L-BIA), and pain pressure thresholds (PPT). Tissue hardness, L-BIA, and PPT were measured in the lower leg and thigh. Measures were assessed pre (T0), immediately post (T1), and 10-min after (T2) the intervention.
Results
No differences were found for time for the CC or between the T0 of each condition. Concerning the lower leg, ROM improved for SS and FR from T0 to T1 while returning to baseline in T2. A significant increase in PPT was observed only for SS in T1. L-BIA showed a significant increase for both phase angle and impedance only for FR in T1. Tissue hardness did not change for any group at any time-point. Concerning the thigh, no measure at any time point showed significant differences.
Conclusion
Both, FR and SS were able to acutely improve ankle ROM. The observed changes were probably caused by a change in viscoelastic properties and local pain perception, without any variation in tissue morphology. FR was the only intervention to improve the intracellular-to-extracellular ratio and decrease fluids. Non-local effects were not observed.
... Manual therapy can significantly improve EMG parameters following muscle fatigue (Daneau et al., 2019), promoting recovery and potentially minimizing injury risk (Avandi et al., 2024;Short et al., 2023). Manual therapy techniques, such as massage (Weerapong et al., 2005), myofascial release (Mauntel et al., 2014), or joint mobilization (Hanrahan et al., 2005), can enhance muscle function by reducing muscle tension, improving blood flow (Kaharina et al., 2024;Nugroho et al., 2024). These effects contribute to a quicker reduction in muscle fatigue (Weerapong et al., 2005). ...
The aim of this study was to analyze the effects of manual therapy on electromyography (EMG) measures of the primary muscles involved in archery, considering the differences between sexes. Twenty trained archery athletes (men: 14, age: 32.1±6.6 years; women: 6, age: 25.3±5.0 years) participated in this experimental study. The athletes were subjected to 100 archery shots, after which they received regenerative manual therapy. EMG measurements were taken from the middle deltoid, posterior deltoid, upper trapezius, middle trapezius, lower trapezius, and infraspinatus muscles before the shots, after the shots, and after the manual therapy. The outcomes measured included the mean and maximal amplitude of the EMG root mean square (EMGRMS) and the median frequency of the raw surface EMG signal power spectrum (EMGMED). Sex comparisons revealed a significantly higher EMGMED in the upper trapezius following manual therapy in women compared to men (F=5.096; p=0.037). No other significant differences were found between sexes (p>0.05). Repeated measures conducted at baseline, after 100 shots, and after manual therapy showed a significantly greater mean amplitude EMGRMS in the infraspinatus following manual therapy compared to after 100 shots (169.7 vs. 109.8 µV; p=0.008). Similar results were noted for maximal amplitude EMGRMS (372.7 vs. 209.5 µV; p=0.010). Additionally, a significantly lower maximal amplitude EMGRMS was observed at baseline compared to after manual therapy in low trapezius (312.6 vs. 551.2 µV; p=0.045). In summary, and overall, manual therapy did not play a significant role in restoring the EMG parameters in the primary muscles of archers after exposure to a fatigue condition. However, it showed efficacy in the case of the infraspinatus. Furthermore, apart from the upper trapezius, no significant effects were observed between genders, indicating similar effects in both. Keywords: archery; muscle fatigue; recovery; physical therapy modalities.
... This relaxes the fascia (Curran et al., 2008;Healey et al., 2014;Renan-Ordine et al., 2011). Self-myofascial release technique is a technique applied to restore the appropriate tension of tissues, increase their flexibility (Bradbury-Squires et al., 2015;Halperin et al., 2014;Macdonald et al., 2013;Mauntel et al., 2014), eliminate trigger points (Barnes, 1997;Schleip, 2003) and increase muscle recovery after exercise (Cheatham et al., 2015;MacDonald, et al., 2014;Weerapong et al., 2005). ...
Myofascial release techniques, particularly when applied using foam rollers, have gained prominence in sports science due to their potential benefits in enhancing athletic performance. This study delves into the impact of this technique on swimmers, a group where flexibility, jump capacity, and short-distance speed are paramount.The research engaged 12 male swimmers, all of whom had been active in the sport for a minimum of three years. Their average age stood at 19.58±.66 years, with an average height of 176.83±8.49 cm and body weight of 75.43±6.62 kg. Following a 5-minute low-intensity warm-up run, participants underwent 10 minutes of dynamic stretching exercises targeting major muscle groups involved in swimming. This was followed by a self-myofascial release (SMR) protocol using foam rollers, focusing on muscle areas most prone to tension and strain in swimmers. These protocols were applied consecutively at 48-hour intervals and at consistent times of the day to ensure uniformity.Post-protocol assessments revealed varying impacts on performance metrics. While the countermovement jump measurements remained statistically unchanged (p>0.05), significant improvements were observed in the 15 m swimming (t: 2,307, p: ,041), squat jump (t:,-2,541, p:,027), and flexibility (t:-2,491, p:,030) tests (p<0.05).These findings underscore the potential of integrating myofascial release techniques with foam rollers into swimmers' training regimens. Not only does this approach enhance specific performance parameters like squat jump and flexibility, but it also offers broader implications for the athletic community, emphasizing the importance of muscle relaxation and flexibility in achieving peak performance. Future research could delve deeper into the long-term impacts of such techniques and explore their efficacy across different athletic disciplines.
... It may also be used in the prevention of injuries. SMFR is a technique applied to restore proper tension of tissues, increasing their flexibility [16,[23][24][25], removing trigger points [8,26] and enhancing muscle recovery after exercise [14,27,28]. ...
During long-distance running, athletes are exposed to repetitive loads. Myofascial structures are liable to long-term work, which may cause cumulating tension within them. The aim of this study was to evaluate the acute effect of self-myofascial release on muscle flexibility in long-distance runners. The study comprised 62 long-distance, recreationally running participants between the age of 20 and 45 years. The runners were randomly divided into two groups: Group 1 (n = 32), in which subjects applied the self-myofascial release technique between baseline and the second measurement of muscle flexibility, and Group 2 (n = 30), without any intervention. The self-myofascial release technique was performed according to standardized foam rolling. Assessment of muscle flexibility was conducted according to Chaitow's proposal. After application of the self-myofascial release technique, higher values were noted for the measurements of the following muscles: piriformis, tensor fasciae latae muscles and adductor muscles. Within the iliopsoas and rectus femoris muscles, lower values were observed in the second measurement. These changes were statistically significant (p <0.05) within the majority of muscles. All these outcomes indicate improvement related to larger muscle flexibility and also, an increase in range of motion. In the control group (Group 2), significant improvement was observed only in measurements for the iliopsoas muscles. The single application of self-myofascial release techniques with foam rollers may significantly improve muscle flexibility in long-distance runners. Based on these results, the authors recommend the self-myofascial release technique with foam rollers be incorporated in the daily training routine of long-distance runners, as well as athletes of other sport disciplines.
... Análises recentes indicam que a SFM pode ocorrer espontaneamente por efeito cumulativo de estresse físico, psicológico e emocional que se dá ao longo da vida (Kwiatek, 2017 Vale destacar ainda que a liberação miofascial é uma terapia manual / massagem que pode incluir liberação do ponto gatilho miofascial que visa à restauração da função muscular, tratando "pontos gatilhos" musculares, ou seja, "nós" hiperirritáveis dentro de faixas tensas de músculos esqueléticos (Mauntel, Clark, & Padua, 2014). Implementação ou não da liberação do ponto gatilho miofascial na presente revisão de modo geral foi inespecífica. ...
Objetivo: Este estudo objetivou mapear as contribuições
disponíveis sobre o uso da liberação miofascial como estratégia
terapêutica auxiliar na fibromialgia. Métodos: Trata-se de uma scoping
review (revisão de escopo) da literatura científica indexada e não
indexada (área cinza) nas bases SciELO (Scientific Electronic Library
Online), LILACS (Literatura Latino-Americana e do Caribe em Ciências
da Saúde), PubMed e PEDro (Physiotherapy Evidence Database) e na
“área cinzenta da literatura” por meio do buscador Google Scholar, pela combinação de palavras-chave “myofascial release" AND
“fibromyalgia”, sem restrições de ano de publicação, idioma, ou
qualquer outra restrição. Resultados: O corpus totalizou oito artigos,
prevalentemente com ocorrência na PubMed, com delineamento de
ensaios clínicos realizados na Espanha, com diagnóstico da fibromialgia
pelos critérios de Wolfe et al. (1990), com desfecho relacionado à
“qualidade de vida” e à “dor”. Conclusão: Conclui-se que, em geral, os
trabalhos disponíveis sobre liberação miofascial como estratégia
terapêutica auxiliar na fibromialgia indicam resultados positivos para os
vários desfechos investigados, ainda que sejam poucos os estudos acerca
da temática, explicitando lacuna expressiva no contexto acadêmico-
científico nacional e internacional.
... The theory holds that myofascial is the main factor determining musculoskeletal function and plays a vital role in the dynamic characteristics of the human body (39). Fascial tissue hardening or increased tension and decreased sliding ability may be the cause of tension in other parts of the body, which in turn leads to increased pain and limited function (39)(40)(41)(42). ...
Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial.
Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP.
Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated.
Results: Eight RCTs ( n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = −0.37, 95% CI (−0.67, −0.08), I ² = 46%, P = 0.01] and physical function [SMD = −0.43, 95% CI (−0.75, −0.12), I ² = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (−0.38, 0.64), I ² = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (−0.49, 1.64), I ² = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (−0.75, 0.69), I ² = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (−0.09, 2.13), I ² = 92%, P = 0.07] and mental health [SMD = −0.06, 95% CI (−0.83, 0.71), I ² = 73%, P = 0.88].
Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.
... However, its authors concluded that due to the heterogeneity of methods there is no consensus regarding the optimal program for recovery and performance. Mauntel and Padua (2014) and Schroeder and Best (2015) conducted reviews assessing the effectiveness of myofascial techniques on joint range of motion, muscle force and activation, and postexercise and recovery, respectively. To our knowledge, this is the first study to use a self-administered program involving active myofascial release as a part of the intervention in patients with chronic neck pain. ...
Background:
While neck pain can be severely disabling and costly, treatment options have shown moderate evidence of effectiveness.
Objective:
The objective of this study was to explore the effects of a 4-week active program based on myofascial release and neurodynamics on trigger point (TrP) examination, pain, and functionality in patients with chronic neck pain.
Methods:
Randomized controlled trial. A total of 40 patients with chronic neck pain were randomly allocated to an experimental or a control group (n = 20). The primary outcome measure was TrP examination. Secondary outcomes were pain, assessed with the Brief Pain Inventory and a visual analogue scale, and functionality, evaluated with the Neck Outcome Score.
Results:
A between-group analysis showed significant differences (p < .05) in the percentage of active TrPs in the following muscles: suboccipital (50 vs. 92.4% in the right muscle and 37.5 vs. 89.6% in the left muscle), left scalene and levator scapulae. Significant differences (p < .05) were also found in pain severity, average pain, and functionality (i.e. symptoms, sleep, and participation).
Conclusions:
A 4-week self-administered program for patients with chronic neck pain was effective in reducing the presence of active TrPs. Pain severity, average pain, and some aspects of functionality also improved significantly after the intervention.
... Research investigating foam rollers, roller massagers, and other similar devices have generally reported increased range of motion (ROM), diminished perceived pain, accelerated recovery from exercise-induced muscle damage and augmented performance (5,17,48,62,67). Rolling can acutely increase ROM (6-13) by 3-23% (30,63) persisting for 20 minutes (37,41,52). ...
Behm, DG, Alizadeh, S, Hadjizadeh Anvar, S, Mahmoud, MMI, Ramsay, E, Hanlon, C, and Cheatham, S. Foam rolling prescription: a clinical commentary. J Strength Cond Res XX(X): 000-000, 2020-Although the foam rolling and roller massage literature generally reports acute increases in range of motion (ROM) with either trivial or small performance improvements, there is little information regarding appropriate rolling prescription. The objective of this literature review was to appraise the evidence and provide the best prescriptive recommendations for rolling to improve ROM and performance. The recommendations represent studies with the greatest magnitude effect size increases in ROM and performance. A systematic search of the rolling-related literature found in PubMed, ScienceDirect, Web of Science, and Google Scholar was conducted using related terms such as foam rolling, roller massage, ROM, flexibility, performance, and others. From the measures within articles that monitored ROM (25), strength (41), jump (41), fatigue (67), and sprint (62) variables; regression correlations and predictive quadratic equations were formulated for number of rolling sets, repetition frequency, set duration, and rolling intensity. The analysis revealed the following conclusions. To achieve the greatest ROM, the regression equations predicted rolling prescriptions involving 1-3 sets of 2-4-second repetition duration (time for a single roll in one direction over the length of a body part) with a total rolling duration of 30-120-second per set. Based on the fewer performance measures, there were generally trivial to small magnitude decreases in strength and jump measures. In addition, there was insufficient evidence to generalize on the effects of rolling on fatigue and sprint measures. In summary, relatively small volumes of rolling can improve ROM with generally trivial to small effects on strength and jump performance.
... Increment in muscular activation and force production succeeding myofascial release treatments would be ideal, as it could increase movement efficiency and athletic performance, but this does not appear to be as intended. However, myofascial release therapies do not decrease muscular activation or force production [24]. No changes were observed in peak power production. ...
Integrating warm-up and stretching prior to performing physical activities has been shown to enhance sporting performance prevent injuries. Foam rolling, also known as myofascial release is widely applied in sport settings as a warm-up. However, there is limited evidence on its effectiveness on lower body power and flexibility among ruggers. This study aimed to compare the effects of myofascial release using foam rolling (MFR) and resistance band assisted stretching (RB) on lower body power and flexibility among Malaysian rugby players. Fifteen elite Malaysian male rugby players were exposed to three warm-up routines consisted of a total body dynamic warm-up (DYN), a total-body dynamic warm-up with foam rolling session (MFR), and total-body dynamic warm-up with resistance band assisted stretching (RB). Following general warm-up in each condition, participants performed flexibility and power tests. Differences in test results between conditions (DYN vs. MFR vs. RB) were investigated using one-way ANOVA. Findings revealed no significant differences in test results for both variables, however MFR recorded a superior performance of power relative to others.
... THE MUSCULOSKELETAL SYSTEM combines multiple independent tissues all interconnecting and striving for one goal, efficient motion of the body. 1 A sedentary lifestyle, chronic inflammation, and/or injuries can cause the dense, tough fascia to develop adhesions and restrictions, impeding normal range of motion (ROM), which can impact sports performance, prevent normal muscle function, and cause pain. 2,3 Different techniques including instrument assisted soft tissue mobilization (IASTM), roller massage sticks, and tennis balls have been studied to release these adhesions, increase myofascial mobility, and restore normal ROM for injury prevention, athletic performance improvement, and therapeutic rehabilitation. ...
Purpose:
Fascial adhesions can reduce range of motion (ROM). Different techniques of varying costs have been studied to release these adhesions and restore normal ROM, but none have compared instrument-assisted soft tissue mobilization (IASTM) with a roller massage stick. The objective was to compare the acute and residual effects of IASTM and a roller massage stick on active and passive hamstring ROM after a single treatment.
Design:
Prospective cohort study in a university laboratory.
Methods:
Sixteen (8M, 8F) recreationally active individuals (age 23.38±2.45 yrs). IASTM using Graston instruments and a roller massage stick were randomly applied to the hamstrings of the dominant or non-dominant leg for 3.5 minutes. Active and passive ROM were measured pre-intervention, immediately post-intervention, and 48-hrs post-intervention.
Results:
There was a main effect for time showing a significant increase in active and passive ROM from pre-intervention to immediate post-intervention (p<0.05) and from pre-intervention to 48-hr post-intervention (p<0.05). However, no interaction effect between treatment and time was found in either active or passive ROM (p>0.05).
Conclusions:
IASTM and the roller massage stick were equally effective immediately and over time, but the roller massage stick is more affordable.
... On one hand, this result is consistent with previous studies that demonstrated a significant pain reduction in patients with MTrPs and, consequently, the efficiency of the IC technique [22,26,33]. On the other hand, the outcomes of the present study support other researches that tend to demonstrate that the manual therapy is not enough to fully improve the muscle contraction (i.e., muscle activation and strength production) [35] and the motor control. Two studies suggest that pain perception drop does not necessarily translate into a significant functional improvement in joint amplitude and quality of life [36,37]. ...
Objective
To analyse the effect of the manual ischemic compression (IC) on the upper limb motor performance (MP) in patients with LTrPs.
Materials and Methods
A quasiexperimental study was performed in twenty subjects allocated to either patients group with LTrPs (PG, n=10) or healthy group with no symptoms (HG, n=10). Subjective pain and linear MP (movement time and Fitts' Law) were assessed before and after a linear tapping task. Data were analysed with mixed factorial ANOVA for intergroup linear motor performance differences and dependent t-student test for intragroup pain differences.
Results
PG had a linear MP lower than the HG before treatment (p < 0.05). After IC, the PG showed a significant decrease of pain (4.07 ± 1.91 p < 0.001). Furthermore, the movement time (15.70 ± 2.05 p < 0.001) and the Fitts' Law coefficient (0.80 ± 0.53 p < 0.001) were significantly reduced. However, one IC session did not allow the PG to get the same MP than the HG (p < 0.05).
Conclusion
The results suggest the IC effectiveness on pain and MP impairment in subjects with LTrPs. However, the MP of these patients is only partially improved after the IC application.
... FR also results in reduced arterial stiffness and improved vascular endothelial function (Okamoto et al. 2014). The vast majority of experimental research revealed that FR may offer different kinds of benefits in terms of motor performance, flexibility and recovery (for reviews, see Cheatham et al., 2015;Schroeder and Best, 2015;Kalichman and Ben David, 2017;Mauntel and Padua, 2014). Two studies even demonstrated that rolling the contralateral limb contributed to significant decreases in pain in the affected limb (Aboodarda et al., 2015;Cavanaugh et al., 2016). ...
Both foam rolling and joint distraction training with elastic bands are very popular interventions designed to improve muscular function, motor performance, and joint range of motion, as well as to reduce feeling of fatigue and delayed onset of muscle soreness. The heterogeneity of methods used among studies however prevents from drawing firm conclusions about the optimal content of pre/post interventions. The present study aims at answering the following questions: i) Do foam rolling and joint distraction with elastic band training improve joint range of motion in national rugby players? ii) Do short and long rolling durations have similar effects on range of motion? In a first experiment, we compared ankle, knee, and hip flexibility scores in 30 national rugby players after a 7-week foam rolling training program involving either a short (20s) or long (40s) rolling duration. Data revealed that foam rolling substantially improved all range of motion scores, regardless the rolling duration (performance gains ranged from 9 to 18° in the foam rolling groups, i.e. 8 to 20% increase, but remained under 2° in the control group). In a second experiment, we investigated the effect of a 5-week joint distraction with elastic band training program on hamstring and adductor range of motion in 23 national rugby players. Data showed that elastic band training significantly improved sit-and-reach (29.16% increase, p = 0.01) as well as side split (2.31% increase, p < 0.001) stretching performances. Taken together, present findings confirm that both foam rolling and joint distraction exercises with elastic bands are likely to enhance joint range of motion and specific mobility patterns during sport performance, and further serve prophylaxis. Such effects therefore constitute a promising avenue for clinical, home therapy, and personal flexibility training.
... Alguns pesquisadores e estudiosos do complexo miofascial descrevem que a integridade desse complexo tem influência no sistema de locomoção, na flexibilidade dinâmica e na transmissão de força 8,9 . Vale ressaltar que evidências sugerem que alterações miofasciais tem impacto negativo na transmissão de força, função muscular e na amplitude de movimento 10 . No entanto, o mecanismo pelo qual a utilização do FR obtém tais benefícios ainda permanece em especulações entre mecanismos periféricos e centrais. ...
Introdução: Ao iniciar uma sessão de treinamento de força é recomendado aquecimento como forma de preparação à atividade principal, com o objetivo de melhorar a capacidade fisiológica do indivíduo para determinadas tarefas motoras. Objetivo: O objetivo do presente estudo foi comparar o efeito de diferentes métodos de aquecimento no desempenho de repetições na cadeira extensora. Métodos: Participaram do presente estudo 10 homens (26,9 ± 3,3 anos). Foram feitas 6 visitas, com intervalo de 72 horas. Foram realizadas a familiarização, teste e reteste de 10 repetições máximas e as demais visitas para a execução dos protocolos experimentais. Resultados: Em relação ao total de repetições, a autoliberação miofascial proporcionou maior desempenho em comparação aos demais protocolos de aquecimento. Conclusão: Podemos concluir que a autoliberação miofascial pode ser uma ferramenta importante para treinadores no que concerne à prescrição do aquecimento com a manutenção do desempenho de repetições no treinamento de força.
... [54][55][56] Ultrasound therapy may have a limited role in managing plantar fasciitis 56 but has not demonstrated effectiveness in other studies. 57 Electrical stimulation, 49 58-60 massage therapy, 48 61-63 myofascial trigger point treatments [64][65][66][67] and acupuncture [68][69][70] have not shown reliable and consistent efficacy for relief of pain resulting from musculoskeletal injury. ...
Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic.
Using leg weights (LW), both with and without weights is a training method in the re- and prehabilitation of dogs. Previous research indicates increased range of motion (ROM) in the hind legs when using LW corresponding to 0.5% body mass (BM) in dogs at trot. The effect on ROM and stride length with LW at a walk and with
lower weights is unclear, so as with empty LW. This study aimed to investigate the effects of empty LW and LW corresponding to 0.4% BM on stride length and ROM in hind limbs in healthy dogs walking on a treadmill.
Although myofascial release techniques (MRT) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRT may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effect of MRT on the ROM performance of athletes; Methods: This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using robust variance estimator, and subgroup analyses were conducted with the Hotelling Zhang test; Ten studies met the inclusion criteria. Overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the control group; Conclusions: Alternative MRT, such as myofascial trigger points therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRT.
Therapists and strength and conditioning specialists use self-myofascial release (SMR) as an intervention tool through foam rollers or massage rollers for soft tissue massage, with the purpose of improving mobility in the muscular fascia. Moreover, the use of SMR by professional and amateur athletes during warm-ups, cool downs, and workouts can have significant effects on their physical performance attributes, such as range of motion (ROM) and strength. The purpose of this study was to analyse the literature pertaining to these types of interventions and their effects found in different physical performance attributes for athletes. A systematic search was carried out using the following databases: PUBMED, ISI Web of Science, ScienceDirect, and Cochrane, including articles up to September 2023. A total of 25 articles with 517 athletes were studied in depth. SMR seems to have acute positive effects on flexibility and range of motion, without affecting muscle performance during maximal strength and power actions, but favouring recovery perception and decreasing delayed-onset muscle soreness. Some positive effects on agility and very short-range high-speed actions were identified, as well. In conclusion, although there is little evidence of its method of application due to the heterogeneity in that regard, according to our findings, SMR could be used as an intervention to improve athletes’ perceptual recovery parameters, in addition to flexibility and range of motion, without negatively affecting muscle performance.
Background and purpose:
Palpation evaluates the fascia, a three-dimensional web of connective tissues. We propose altered fascia system displacement in patients with myofascial pain syndrome. This study determined the concurrent validity of palpation and musculoskeletal ultrasound (MSUS) videos played on Windows Media Player 10 (WMP) when evaluating the direction of the fascia system's displacement at the end of the cervical active range of motion (AROM).
Methods:
This cross-sectional study used palpation as index test and MSUS videos on WMP as reference test. First, three physical therapists palpated right and left shoulders for each cervical AROM. Second, during cervical AROM, PT-Sonographer recorded the fascia system displacement. Third, using the WMP, the physical therapists evaluated the direction of skin, superficial and deep fascia displacements at the end of cervical AROM. MedCalc Version 19.5.3 determined the "exact" Clopper-Pearson Interval (CPI).
Results:
We found strong accuracy between palpation and MSUS videos on WMP when determining the direction of skin displacement during cervical flexion and extension (CPI= 78.56 to 96.89). There was moderate agreement between palpation and MSUS videos on WMP when determining the direction of the skin, superficial fascia, and deep fascia displacements during cervical lateral flexion and rotation (CPI= 42.25 to 64.13).
Conclusion:
Skin palpation during cervical flexion and extension may be useful in evaluating patients with myofascial pain syndrome (MPS). It is unclear what fascia system was evaluated when shoulders were palpated at the end of cervical lateral flexion and rotation. Palpation as diagnostic tool for MPS was not investigated.
Adhesive capsulitis is frequently recognized as ‘Frozen Shoulder’, which is characterized by primarily painful joint range of motions and later progressively restricted range of motion of the glenohumeral joint. Other common names used for adhesive capsulitis includes ‘Periarthritis and Painful stiff shoulder’ and ‘Shoulder arthrofibrosis’. Objective: To compare the effects of scapular proprioceptive neuromuscular facilitation and Myofascial release techniques on pain and function in scapular dyskinesia associated with adhesive capsulitis. Methods: Quasi Experimental study was conducted on 34 patients of Scapular dyskinesia associated with Adhesive Capsulitis. Subjects were allocated to either to PNF technique group and Myofascial release technique groups. Both were treated for 12 sessions in 6 weeks. NPRS and SPADI scale were used to evaluate the treatment effects at baseline, 2 weeks, 4 weeks and 6 weeks. Results: The mean age of Group A was 43.12± 5.25. The mean age of Group B was 43.0±5.95. There was a significant difference between the mean value of baseline, 2 weeks, 4 week and 6-week NPRS score and baseline, 2-week, 4 week and 6-week SPADI score with P value <0.05 in both study groups. There was more significant mean difference of 6.23 between baseline and week 6 NPRS in Group A but there was less significant mean difference of 4.00 between baseline and week 6 NPRS in Group B. There was more significant mean difference of 70.70 between baseline and week 6 SPADI in Group A but there was less significant mean difference of 46.17 between baseline and week 6 SPADI in Group B. Conclusions: The study concluded that PNF technique and Myofascial release techniques were led to significant difference in NPRS and SPADI score, but PNF technique had shown more significant results than myofascial release technique to improve pain and function in scapular dyskinesia associated with Adhesive capsulitis.
İnsan türü evrimsel görüşe göre daha uzun alt uzuvlar, iki ayaklılık (bipedalizm), vücut boyutundaki ve metabolizmadaki değişiklikler ile yeni ekosistemde yiyecek arama ve hayatta kalma davranışını oldukça kolaylaştırmıştır. Bu nedenle, Afrika Homo erectusu olarak kabul edilen insan türünün en eski temsilcisi gerçekten de “koşmak için doğmuş (born to run)” sayılabilir. Yani önceki hominidlerin (büyük insansı maymun) yiyecek topladığı ormanlık alanlardan çarpıcı biçimde farklı bir ortamda doğal seçilim baskısı ile başa çıkmak (survival of the fittest: çevreye olan uyuma göre en iyinin hayatta kalması) için evrilmiş olabilir. Arkaik atalarımızın değişmiş kalça eklemi, daha hafif iskelet dahil olmak üzere çeşitli kas- iskelet sistemi adaptasyonları gibi anatomik değişiklikleri, vücutlarının dayanıklılık ve fiziksel aktivite için özelleşmesi yoluyla uzun mesafeler ve süreler boyunca yürümesine/ koşmasına izin vermiştir. Bu açıdan belki de türümüzün devamının bedensel hareket kabiliyetimize bağlı oluşu bizleri fiziksel hareketin doğasını keşfetmeye daha da meraklı hale getirmektedir. Nitekim bu doğrultuda yapılan güncel çalışmalar da aslında günümüzde sedanter yaşam tarzlarımızın bizlere getirdiği birçok hastalığa karşı tekrar türümüzü kurtaracak en etkili ve umut verici yöntemin düzenli egzersiz olduğunu göstermektedir. Bu yüzden bu kitapta yer alan tüm çalışmaların egzersiz bilincini topluma yaymak adına oldukça önemli olacağını düşünüyorum.
Mustafa Kemal Atatürk “Benim manevi mirasım ilim ve akıldır. Benden sonra, beni benimsemek isteyenler, bu temel mihver üzerinde akıl ve ilmin rehberliğini kabul ederlerse, manevi mirasçılarım olurlar. Bilim ve fen nerede ise oradan alacağız ve her ulus kişisinin kafasına koyacağız.” sözüyle bilimsel bilgiyi edinmenin ve yaymanın önemini vurgulamıştır. Nitekim bu manevi mirasa ortak olarak bu kitabın oluşturulmasına katkı sunan değerli yazarlarımıza teşekkürlerimi sunuyorum. Açıkçası bu süreçte birbirinden değerli ve güncel çalışmaların bir araya getirilmesini titizlikle sağlayan Eğitim Yayınevi ailesini de ayrıca tebrik etmek gerekiyor.
Son olarak her zaman koşulsuz şekilde yanımda olan sevgili aileme teşekkür ve minnetlerimi sunuyorum.
Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF—myofascial release, E—the exercise program, MFE—myofascial release and the exercise program, C—no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.
Background and purpose
There is limited evidence on the effects of myofascial release on fibromyalgia symptoms. This review aims to update the evidence on the effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome.
Methods
The review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, Physiotherapy Evidence Database, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Complete, and ProQuest Medical library were searched from their inception to April 1, 2021 for randomized or nonrandomized clinical trials published in English. Studies consisting of myofascial release alone or in combination with exercise as the intervention were included. The quality of the studies was evaluated using Cochrane Risk of Bias 2.0.
Results
Six studies, including a total of 279 participants, were included in the review. The meta-analysis showed a large significant effect of myofascial release on pain posttreatment (−0.81[95% CI = −1.15 to −0.47], p < 0.00001) and a moderate effect at 6 months post-treatment (−0.61, 95% CI = −0.95 to −0.28, p = 0.0003).
Conclusion
The review demonstrated moderate evidence for the effect of therapist administered and self-myofascial release in improving pain, sleep subscales, and quality of life against sham and no treatment, respectively, in fibromyalgia syndrome patients. However, more high-quality randomized controlled trials with manual control group are required to be conducted at different geographical locations to generalize the findings.
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.
Objective:
To investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain.
Methods:
Seventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days.
Results:
Current VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556).
Conclusion:
Adding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength.
Resumen
Objetivo
El propósito del estudio fue evaluar la efectividad inmediata de la técnica de liberación de la fascia toracolumbar para aumentar la resistencia muscular del esternocleidomastoideo bilateral, y disminuir el ángulo de anteposición de cabeza y cuello en mujeres jóvenes de la Universidad Autónoma de Chile.
Material y métodos
Este estudio longitudinal, está basado en la medición inmediata (5 minutos) de la resistencia muscular (segundos) a través de la prueba de fatiga mediante electromiografía de superficie en el esternocleidomastoideo bilateral, y análisis del ángulo de anteposición de cabeza y cuello posterior a la aplicación de la técnica de liberación de la fascia toracolumbar (TLFT). Las 35 mujeres evaluadas reunieron los criterios de inclusión de: sexo femenino, edad entre 22 y 27 años, sedentarias, estudiantes de nivel superior de la Universidad Autónoma de Chile, anteposición de cabeza y cuello entre 43,8 y 51 grados, índice de masa corporal normal y sobrepeso, sin enfermedades de columna y firmar consentimiento informado.
Resultados
Hubo cambios estadísticamente significativos de manera inmediata en la resistencia muscular del esternocleidomastoideo, con un aumento de 27,4 segundos promedio (p < 0,05) y la disminución del ángulo de anteposición de cabeza y cuello de 2,8 grados promedio (p < 0,05), posterior a la aplicación de la TLFT.
Conclusión
La TLFT produce un efecto inmediato en el aumento de la resistencia muscular del esternocleidomastoideo bilateral y una disminución del ángulo de anteposición de cabeza y cuello en mujeres jóvenes que presenten anteposición de cabeza y cuello.
Context:
Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy.
Objective:
The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF.
Design:
Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05.
Setting:
A convenience sample study.
Participants:
A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate.
Interventions:
Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques.
Main outcome measures:
Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96).
Results:
Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7) cm, 0.700 (0.7) cm, and 0.907 (1.4) cm, respectively.
Conclusion:
Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.
Körperliches Training wird in unterschiedlichen medizinischen Kontexten von der Prävention über die Rehabilitation bis hin zum Disease Management genutzt. Das vorliegende Kapitel befasst sich mit der Gestaltung und den Effekten unterschiedlicher Formen körperlichen Trainings, sowie ausgewählter unterstützender Methoden. Die Dosierung von Ausdauer-, Kraft-, Koordinations- und Beweglichkeitstraining orientiert sich an wissenschaftlicher Evidenz, bezieht aber auch Erfahrungen aus der Trainingspraxis mit ein. Fragebogen- und testbasierte Assessments erlauben eine individuelle Anpassung und Steuerung des Trainings. Körperliches Training induziert spezifische Effekte auf körperliche Funktion, Leistungsfähigkeit, Gesundheit und Teilhabe. Die resultierenden Effekte hängen auch von individuellen Eigenschaften der trainierenden Person ab. Neben etablierten Trainingsmethoden werden auch weniger konventionelle Methoden behandelt. Es wird ein komprimierter Überblick über einige populäre Methoden - Foam Rolling, Blood Flow Restriction Training, Elektromyostimulation, Ganzkörpervibrationstraining – gegeben, insbesondere im Hinblick auf die aktuelle wissenschaftliche Datenlage zu ihren Effekten und Mechanismen.
Greater lower extremity joint stiffness may be related to the development of tibial stress fracture in runners. Musculotendinous stiffness is the largest contributor to joint stiffness, but it is unclear what factors contribute to musculotendinous stiffness. The purpose of this study was to compare plantarflexor musculotendinous stiffness, architecture, geometry, and Achilles tendon stiffness between male runners with and without a history of tibial stress fracture. 19 healthy runners (age=21±2.7 years; mass=68.2±9.3 kg; height=177.3± 6.0 cm) and 19 runners with a history of tibial stress fracture (age=21±2.9 years; mass=65.3±6.0 kg; height=177.2±5.2 cm) were recruited from community running groups and the university's varsity and club cross-country teams. Plantarflexor musculotendinous stiffness was estimated from the damped frequency of oscillatory motion about the ankle follow perturbation. Ultrasound imaging was used to measure architecture and geometry of the medial gastrocnemius. Dependent variables were compared between groups via one-way ANOVAs. Previously injured runners had greater plantarflexor musculotendinous stiffness (P<.001), greater Achilles tendon stiffness (P=.004), and lesser Achilles tendon elongation (P=.003) during maximal isometric contraction compared to healthy runners. No differences were found in muscle thickness, pennation angle, or fascicle length.
Foam rollers are used to mimic myofascial release techniques and have been used by therapists, athletes, and the general public alike to increase range of motion (ROM) and alleviate pressure points. The roller-massager was designed to serve a similar purpose but is a more portable device that uses the upper body rather than body mass to provide the rolling force. OBJECTIVES/PURPOSE: A roller massager was used in this study to examine the acute effects on lower extremity ROM and subsequent muscle length performance.
Seven male and ten female volunteers took part in 4 trials of hamstrings roller-massager rolling (1 set - 5 seconds, 1 set - 10 seconds, 2 sets - 5 seconds, and 2 sets - 10 seconds) at a constant pressure (13 kgs) and a constant rate (120 bpm). A group of 9 participants (three male, six female) also performed a control testing session with no rolling intervention. A sit and reach test for ROM, along with a maximal voluntary contraction (MVC) force and muscle activation of the hamstrings were measured before and after each session of rolling.
A main effect for testing time (p<0.0001) illustrated that the use of the roller-massager resulted in a 4.3% increase in ROM. There was a trend (p=0.069) for 10s of rolling duration to increase ROM more than 5s rolling duration. There were no significant changes in MVC force or MVC EMG activity after the rolling intervention.
The use of the roller-massager had no significant effect on muscle strength, and can provide statistically significant increases in ROM, particularly when used for a longer duration.
Objectives: Investigate the effects of ischemic compression [IC] technique and passive stretching [PS] in isolation and in combination on the reduction of spontaneous electrical activity [SEA] and perceived pain in trigger points [TrPs] located in the upper trapezius muscle. Methods: Ninety participants with TrPs in the upper trapezius muscle were randomly assigned to three treatment groups: IC, PS, and IC + PS. TrP compression was applied on the TrP for three applications of 60 seconds each, followed by a 30-second rest period. PS was applied for three 45-second applications, with 30-second rest intervals. All patients received the same amount of therapy. Results: Significant decreases were found in pain perception and on SEA for all study participants. The IC + PS group evidenced greater declines in pain perception and SEA when compared to the IC and PS groups. Conclusion: Because of ethical considerations, a control group design was not possible, thereby limiting the robustness of the findings. Although each technique significantly reduced pain perception and SEA, the combination of IC and PS was superior, apparently because of the complementary nature of the therapeutic interventions.
Unlabelled:
It is important to identify the most effective therapeutic modality in the management of myofascial trigger points (MTPt). Thus we aimed to study the effect of therapeutic ultrasound, laser and ischemic compression in reducing pain and improving cervical range of motion among patients with MTPt. Experimental study comparing three groups was designed as a 5 days trial, a co-relational design was considered.
Outcome measures:
VAS for pain, provocative pain test using "soft tissue tenderness grading scheme" and active cervical lateral flexion using inch tape. Methods- Patients were divided into 3 groups, Gr 1 underwent treatment using therapeutic ultrasound, Gr 2 with therapeutic laser and Gr 3 with ischemic compression. Assessments were done on day 1 and day 5 of treatment respectively.
Results:
ANOVA revealed improvement among all 3 groups as statistically significant difference (p<0.05) between the start and end of trial. Analysis using Chi square test shows a statistically significant difference in the improvement between laser and the other 2 groups. Mean difference in the change of scores between the assessments showed laser therapy to have a tendency towards progressive improvement over the treatment period and a better improvement than the other 2 groups. We conclude that laser can be used as an effective treatment regimen in the management of myofascial trigger points thereby reducing disability caused due to musculoskeletal pathology.
Foam rolling is thought to improve muscular function, performance, overuse and joint range of motion (ROM), however, there is no empirical evidence demonstrating this. Thus, the objective of the study was to determine the effect of self-myofascial release (SMR) via foam roller application on knee extensor force and activation and knee joint range of motion. Eleven healthy male (height 178.9 ± 3.5 cm, mass 86.3 ± 7.4 kg, age 22.3 ± 3.8 years) subjects who were physically active participated. Subjects' quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM were measured prior to, two minutes, and 10 minutes following two conditions; 1) two, one minute trials of SMR of the quadriceps via a foam roller and 2) no SMR (Control). A two-way ANOVA (condition x time) with repeated measures was performed on all dependent variables recorded in the pre- and post-condition tests. There were no significant differences between conditions for any of the neuromuscular dependent variables. However, following foam rolling, subjects' ROM significantly (ρ < 0.001) increased by 10 and 8% at 2 and 10 minutes, respectively. There was a significant (ρ < 0.01) negative correlation between subjects' force and ROM prior to foam rolling, which no longer existed following foam rolling. In conclusion an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint range of motion without a concomitant deficit in muscle performance.
Background and purpose:
Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions.
Method:
In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]).
Results:
The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76).
Discussion and conclusion:
The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."
Objective:
The purpose of this study was to investigate effects of different manual techniques on cervical ranges of motion and pressure pain sensitivity in subjects with latent trigger point of the upper trapezius muscle.
Methods:
One hundred seventeen volunteers, with a unilateral latent trigger point on upper trapezius due to computer work, were randomly divided into 5 groups: ischemic compression (IC) group (n=24); passive stretching group (n=23); muscle energy technique group (n=23); and 2 control groups, wait-and-see group (n=25) and placebo group (n=22). Cervical spine range of movement was measured using a cervical range of motion instrument as well as pressure pain sensitivity by means of an algometer and a visual analog scale. Outcomes were assessed pretreatment, immediately, and 24 hours after the intervention and 1 week later by a blind researcher. A 4×5 mixed repeated-measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used.
Results:
A group-by-time interaction was detected in all variables (P<.01), except contralateral rotation. The immediate effect sizes of the contralateral flexion, ipsilateral rotation, and pressure pain threshold were large for 3 experimental groups. Nevertheless, after 24 hours and 1 week, only IC group maintained the effect size.
Conclusions:
Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain sensitivity. These effects persist after 1 week in the IC group.
This article considers specific treatment approaches and the role of etiological mechanisms in terms of clinical feature characteristics of MTrPs: increased muscle tension, pain and tenderness, painful stretch range of motion, initiating causes of MTrPs. Final sections note additional treatments that are currently used, and summarize the etiological and clinical distinctions between MTrPs and fibromyalgia.
Context:
Two-dimensional (or medial knee displacement [MKD]) and 3-dimensional (3D) knee valgus are theorized to contribute to anterior cruciate ligament injuries. However, whether these displacements can be improved in the double-legged squat (DLS) after an exercise intervention is unclear.
Objective:
To determine if MKD and 3D knee valgus are improved in a DLS after an exercise intervention.
Design:
Randomized controlled clinical trial.
Setting:
Research laboratory.
Patients or other participants:
A total of 32 participants were enrolled in this study and were randomly assigned to the control (n = 16) or intervention (n = 16) group. During a DLS, all participants demonstrated knee valgus that was corrected with a heel lift.
Intervention(s):
The intervention group completed 10 sessions of directed exercise that focused on hip and ankle strength and flexibility over a 2- to 3-week period.
Main outcome measure(s):
We assessed MKD and 3D knee valgus during the DLS using an electromagnetic tracking system. Hip strength and ankle-dorsiflexion range of motion were measured. Change scores were calculated for MKD and 3D valgus at 0%, 10%, 20%, 30%, 40%, and 50% phases, and group (2 levels)-by phase (6 levels) repeated-measures analyses of variance were conducted. Independent t tests were used to compare change scores in other variables (α < .05).
Results:
The MKD decreased from 20% to 50% of the DLS (P = .02) and 3D knee valgus improved from 30% to 50% of the squat phase (P = .001). Ankle-dorsiflexion range of motion (knee extended) increased in the intervention group (P = .009). No other significant findings were observed (P > .05).
Conclusions:
The intervention reduced MKD and 3D knee valgus during a DLS. The intervention also increased ankle range of motion. Our inclusion criteria might have limited our ability to observe changes in hip strength.
A class of treatment methods have emerged from osteopathic medicine over the past half-century which are categorized as “positional release techniques.” These have been found to be particularly useful in treatment of acute musculoskeletal dysfunction, involving both soft tissues and joints. Their value as part of a protocol of treatment for chronic conditions such as myofascial pain syndrome or fibromyalgia is suggested.
Objective:
To demonstrate proof-of-principle measurement for physiologic change within an active myofascial trigger point (MTrP) undergoing trigger point release (ischemic compression).
Design:
Interstitial fluid was sampled continuously at a trigger point before and after intervention.
Setting:
A biomedical research clinic at a university hospital.
Participants:
Subjects (N=2) from a pain clinic who had chronic headache pain.
Interventions:
A single microdialysis catheter was inserted into an active MTrP of the upper trapezius to allow for continuous sampling of interstitial fluid before and after application of trigger point therapy by a massage therapist.
Main outcome measures:
Procedural success, pain tolerance, feasibility of intervention during sample collection, and determination of physiologically relevant values for local blood flow as well as glucose and lactate concentrations.
Results:
Both patients tolerated the microdialysis probe insertion into the MTrP and treatment intervention without complication. Glucose and lactate concentrations were measured in the physiologic range. After intervention, a sustained increase in lactate was noted for both subjects.
Conclusions:
Identifying physiologic constituents of MTrPs after intervention is an important step toward understanding pathophysiology and resolution of myofascial pain. The present study forwards that aim by showing that proof-of-concept for collection of interstitial fluid from an MTrP before and after intervention can be accomplished using microdialysis, thus providing methodological insight toward treatment mechanism and pain resolution. Of the biomarkers measured in this study, lactate may be the most relevant for detection and treatment of abnormalities in the MTrP.
In this review we provide the updates on last years' advancements in basic science, imaging methods, efficacy, and safety of dry needling of myofascial trigger points (MTrPs). The latest studies confirmed that dry needling is an effective and safe method for the treatment of MTrPs when provided by adequately trained physicians or physical therapists. Recent basic studies have confirmed that at the site of an active MTrP there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response. Two new modalities, sonoelastography and magnetic resonance elastography, were recently introduced allowing noninvasive imaging of MTrPs. MTrP dry needling, at least partially, involves supraspinal pain control via midbrain periaqueductal gray matter activation. A recent study demonstrated that distal muscle needling reduces proximal pain by means of the diffuse noxious inhibitory control. Therefore, in a patient too sensitive to be needled in the area of the primary pain source, the treatment can be initiated with distal needling.
Reduced flexibility has been documented in athletes with lower limb injury, however, stretching has limited evidence of effectiveness in preventing injury or reducing the risk of recurrence. In contrast, it has been proposed that eccentric training can improve strength and reduce the risk of injury, and facilitate increased muscle flexibility via sarcomerogenesis.
This systematic review was undertaken to examine the evidence that eccentric training has demonstrated effectiveness as a means of improving lower limb flexibility.
Six electronic databases were systematically searched by two independent reviewers to identify randomised clinical trials comparing the effectiveness of eccentric training to either a different intervention, or a no-intervention control group. Studies evaluating flexibility using both joint range of motion (ROM) and muscle fascicle length (FL) were included. Six studies met the inclusion/exclusion criteria, and were appraised using the PEDro scale. Differences in the muscles studied, and the outcome measures used, did not allow for pooled analysis.
There was consistent, strong evidence from all six trials in three different muscle groups that eccentric training can improve lower limb flexibility, as assessed using either joint ROM or muscle FL.
The results support the hypothesis that eccentric training is an effective method of increasing lower limb flexibility. Further research is required to compare the increased flexibility obtained after eccentric training to that obtained with static stretching and other exercise interventions.
To compare the effects of pressure release (PR), phonophoresis of hydrocortisone (PhH) 1%, and ultrasonic therapy (UT) in patients with an upper trapezius latent myofascial trigger point (MTP).
Repeated-measure design.
A pain control medical clinic.
Subjects (N=60; mean±SD age, 21.78±1.76y) with a diagnosis of upper trapezius MTP participated in this study. Subjects were randomly divided into 4 groups: PR, PhH, UT, and control (15 in each group). All patients had a latent MTP in the upper trapezius muscle.
PR, PhH, UT.
Subjective pain intensity, pain pressure threshold (PPT), and active cervical lateral flexion range of motion were assessed in 6 sessions.
All 3 treatment groups showed decreases in pain and PPT and an increase in cervical lateral flexion range of motion (P<.001) compared with the control group. Both PhH and PR techniques showed more significant therapeutic effects than UT (P<.001).
Our results indicate that all 3 treatments used in this study were effective for treating MTP. According to this study, PhH is suggested as a new method effective for the treatment of MTP.
The primary aim of this study was to investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of trigger point (TrP) pressure release on latent soleus myofascial trigger points (MTrPs). The secondary aim was to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research.
A pilot randomised control trial.
Twenty healthy volunteers (5 men and 15 women; mean age 21.7±2.1 years) with a restricted active ankle joint dorsiflexion.
Participants underwent a screening process to establish both a restriction in active ankle dorsiflexion and the presence of active and latent MTrPs in the soleus muscle. Participants were then randomly allocated to an intervention group (TrP pressure release) or control group (no therapy).
The results showed a statistically significant (p=0.03) increase of ankle ROM in the intervention compared to the control group.
This study identified an immediate significant improvement in ankle ROM after a single intervention of TrP pressure release on latent soleus MTrPS. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinical significant ROM (5°). Suggestions for methodological improvements may inform future MTrP research and ultimately benefit clinical practice in this under investigated area.
The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle.
Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer.
The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained.
In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.
The Stick is a muscle massage device used by athletes, particularly track athletes, to improve performance. The purpose of this project was to assess the acute effects of The Stick on muscle strength, power, and flexibility. Thirty collegiate athletes consented to participate in a 4-week, double-blind study, which consisted of 4 testing sessions (1 familiarization and 3 data collection) scheduled 1 week apart. During each testing session subjects performed 4 measures in the following sequence: hamstring flexibility, vertical jump, flying-start 20-yard dash, and isokinetic knee extension at 90 degrees x s(-1). Two minutes of randomly assigned intervention treatment (visualization [control], mock insensible electrical stimulation [placebo], or massage using The Stick [experimental]) was performed immediately prior to each performance measure. Statistical analyses involved single-factor repeated measures analysis of variance (ANOVA) with Fisher's Least Significant Difference post-hoc test. None of the variables measured showed an acute improvement (p < or = 0.05) immediately following treatment with The Stick.
To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle.
Randomized controlled trial.
Institutional practice.
One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs).
Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release).
The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect.
In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05).
Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM.
Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions.
In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]).
The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was.56 (95% confidence interval=.47-.65) for ratings by individuals, and the ICC for consensus ratings was.68 (95% confidence interval=.57-.76).
The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDro score was "fair" to "good."
To determine if Active Release Technique (ART) protocols could be used as an effective way to influence strength and muscle inhibition in the quadriceps muscles of athletes with anterior knee pain.
Pilot clinical outcome study.
The sample consisted of 9 athletes (4 male athletes, 5 female athletes) who were identified as suffering from unilateral anterior knee pain. A Biodex dynamometer and the interpolated twitch technique were used to determine isometric strength and inhibition in the quadriceps muscles, respectively. The treatment intervention consisted of the Active Release Technique treatment protocols for anterior knee pain. The experimental leg and contralateral leg were tested pretreatment and posttreatment, and the experimental leg was tested a third time approximately 20 minutes posttreatment.
Knee extensor moments were calculated by multiplying the moment arm by the forces measured by the Biodex dynamometer. Percentage of muscle inhibition was calculated by dividing the interpolated twitch torque (ITT) by the resting twitch torque (RTT), that is (ITT/RTT*100). A repeated measures analysis of variance (ANOVA) was used to compare pretreatment and posttreatment values for strength and muscle inhibition for the experimental and contralateral knees. The results showed no statistical significance.
ART protocols did not reduce inhibition or increase strength in the quadriceps muscles of athletes with anterior knee pain. Further study is required.
Dense connective tissue sheets, commonly known as fascia, play an important role as force transmitters in human posture and movement regulation. Fascia is usually seen as having a passive role, transmitting mechanical tension which is generated by muscle activity or external forces. However, there is some evidence to suggest that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics. General support for this hypothesis came with the discovery of contractile cells in fascia, from theoretical reflections on the biological advantages of such a capacity, and from the existence of pathological fascial contractures. Further evidence to support this hypothesis is offered by in vitro studies with fascia which have been reported in the literature: the biomechanical demonstration of an autonomous contraction of the human lumbar fascia, and the pharmacological induction of temporary contractions in normal fascia from rats. If verified by future research, the existence of an active fascial contractility could have interesting implications for the understanding of musculoskeletal pathologies with an increased or decreased myofascial tonus. It may also offer new insights and a deeper understanding of treatments directed at fascia, such as manual myofascial release therapies or acupuncture. Further research to test this hypothesis is suggested.
The article introduces the hypothesis that intramuscular connective tissue, in particular the fascial layer known as the perimysium, may be capable of active contraction and consequently influence passive muscle stiffness, especially in tonic muscles. Passive muscle stiffness is also referred to as passive elasticity, passive muscular compliance, passive extensibility, resting tension, or passive muscle tone. Evidence for the hypothesis is based on five indications: (1) tonic muscles contain more perimysium and are therefore stiffer than phasic muscles; (2) the specific collagen arrangement of the perimysium is designed to fit a load-bearing function; (3) morphological considerations as well as histological observations in our laboratory suggest that the perimysium is characterized by a high density of myofibroblasts, a class of fibroblasts with smooth muscle-like contractile kinetics; (4) in vitro contraction tests with fascia have demonstrated that fascia, due to the presence of myofibroblasts, is able to actively contract, and that the resulting contraction forces may be strong enough to influence musculoskeletal dynamics; (5) the pronounced increase of the perimysium in muscle immobilization and in the surgical treatment of distraction osteogenesis indicates that perimysial stiffness adapts to mechanical stimulation and hence influences passive muscle stiffness. In conclusion, the perimysium seems capable of response to mechanostimulation with a myofibroblast facilitated active tissue contraction, thereby adapting passive muscle stiffness to increased tensional demands, especially in tonic musculature. If verified, this new concept may lead to novel pharmaceutical or mechanical approaches to complement existing treatments of pathologies which are accompanied by an increase or decrease of passive muscle stiffness (e.g., muscle fibroses such as torticollis, peri-partum pelvic pain due to pelvic instability, and many others). Methods for testing this new concept are suggested, including histological examinations and specific in vitro contraction tests.
The aim of this study is to determine if active release technique (ART) significantly increases hamstring flexibility in healthy male participants.
Twenty physically active male participants with no current or previous history of lower extremity injury received ART on the origins and insertions of the hamstrings and dorsal sacral ligament. The sit-and-reach test was used before and after treatment to determine hamstring flexibility. Summary statistics were calculated, and pre and post hamstring flexibility scores were compared using a related samples t test.
There was a significant difference between the pre- and posttest groups (mean pre = 35.5 cm, df = 19, SD = 7.56; mean post = 48.3 cm, df = 19, SD = 7.07; P = .0015). All 20 participants increased their sit-and-reach scores following the application of ART.
This study demonstrated that a single ART treatment increased hamstring flexibility in a group of healthy, active male participants.
- J Travell
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