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Abstract

To provide evidence for the existence of six myofascial meridians proposed by Myers (1997) based on anatomical dissection studies. Relevant articles published between 1900 and December 2014 were searched in MEDLINE (Pubmed), ScienceDirect and Google Scholar. Peer-reviewed human anatomical dissection studies reporting morphological continuity between the muscular constituents of the examined meridians were included. If no study demonstrating a structural connection between two muscles was found, papers on general anatomy of the corresponding body region were targeted. A continuity between two muscles was only documented if two independent investigators agreed that it was reported clearly. Also, two independent investigators rated methodological quality of included studies by means of a validated assessment tool (QUACS). The literature search identified 6589 articles. Of these, 62 papers met the inclusion criteria. The studies reviewed suggest strong evidence for the existence of three myofascial meridians: the superficial back line (all three transitions verified, based on 14 studies), the back functional line (all three transitions verified, 8 studies) and the front functional line (both transitions verified, 6 studies). Moderate to strong evidence is available for parts of the spiral line (five of nine verified transitions, 21 studies) and the lateral line (two of five verified transitions, 10 studies). No evidence exists for the superficial front line (no verified transition, 7 studies). The present systematic review suggests that most skeletal muscles of the human body are directly linked by connective tissue. Examining the functional relevance of these myofascial chains is the most urgent task of future research. Strain transmission along meridians would both open a new frontier for the understanding of referred pain and provide a rationale for the development of more holistic treatment approaches. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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... Owing to the known mechanical relationship between the hamstrings and lower back, improvement in hamstring flexibility and reduction in lower back pain (LBP) in people with nonspecific LBP were achieved after applying IAMT only to the dorsal thigh [22]. In this context, the thoracolumbar fascia (TLF) as a mechanical pivot and an anchor point of the dorsal chain [23][24][25][26][27] and a main actor in the force transmission between the upper and lower bodies [23,[25][26][27] plays an important role. Under physiological conditions, the myofascial connections are exposed to high peak loads of up to 160% of the original muscle force owing to the interaction with the synergists [28]; this can lead to visible changes in the fibrous tissue [29] and consequently to negative influences on the myofascial system [30,31] and musculoskeletal dynamics [32]. ...
... Owing to the known mechanical relationship between the hamstrings and lower back, improvement in hamstring flexibility and reduction in lower back pain (LBP) in people with nonspecific LBP were achieved after applying IAMT only to the dorsal thigh [22]. In this context, the thoracolumbar fascia (TLF) as a mechanical pivot and an anchor point of the dorsal chain [23][24][25][26][27] and a main actor in the force transmission between the upper and lower bodies [23,[25][26][27] plays an important role. Under physiological conditions, the myofascial connections are exposed to high peak loads of up to 160% of the original muscle force owing to the interaction with the synergists [28]; this can lead to visible changes in the fibrous tissue [29] and consequently to negative influences on the myofascial system [30,31] and musculoskeletal dynamics [32]. ...
... As in comparable studies with heat applications of 50-60 • C [42,[55][56][57], the CG demonstrated a sharp increase in temperature [13] and improved flexibility [79], followed by a rapid return of the transient hyperaemia [40,42] to baseline levels within 30-45 min depending on the application time (10-20 min) [40,42]. Nevertheless, IAMT yielded a longer-lasting temperature increase and resulting hyperaemia accompanied by a lasting effect on hamstring flexibility, which is likely attributed to the expected change in viscosity [61] affecting the corresponding myofascial chain [23,[25][26][27]79,80]. However, the strong increase in the ROM after IAMT suggests that, similar to the structural properties, other effects apart from hyperaemia (e.g., mechanical and sensory impacts) influence flexibility. ...
Article
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Background: Instrument-assisted manual therapy (IAMT) is indicated to improve flexibility, reduce pain, and induce hyperaemia locally and along myofascial chains. The underlying effects are largely unclear. This randomised, placebo-controlled pilot study aimed to gain first insights into these effects, primarily on the structural level, through ultrasonography. Methods: 67 healthy female soccer players aged 20.9 (±3.9) years were examined after right lumbar intervention (IAMT: intervention group (IG), heat application: comparison group (CG), pressure-less placebo: placebo group (PG)). Ultrasonography (absolute movement and shear motion), flexibility tests (passive straight leg raise test (PSLR), lumbar and thoracic double inclinometry), and superficial skin temperature were recorded before (t0), immediately (t1) and 45 min after the intervention (t2). Results: IAMT decreased the absolute mobility of the superficial lamina and its shear motion to the superficial fascia compared with the PG (t1; p < 0.05). PSLR improved in the IG compared with the CG (t2) and PG (t1, t2; p < 0.05). The temperature increased in the IG and CG compared with the PG (t1, t2) and in the CG compared with the IG (t1; p < 0.05). Conclusion: IAMT of the lumbar back briefly reduces absolute mobility of the superficial lamina and its shear motion to the superficial fascia, improves flexibility, and increases the temperature.
... In recent studies, more attention has been paid to connective tissue disorders such as inflammation, fibrosis, adhesions, fat penetration and structural disorders of the lumbar fascia tissue [19][20][21][22][23][24]. Studies showed that fascia structures and dysfunctions of muscles in the lumbopelvic area have important role in LBP occurrence [25,26]. Based on this theory, patients with LBP have increased lumbar fascia thickness than healthy individuals [27]. ...
... Another theory is that superficial fascia is more prone to injury than other layers in patients with LBP [28]. The deep muscles of the back and fascia form a myofascial system like a corset that helps maintain the posture alignment [25,26,[28][29][30]. Following LBP, the function of this corset-like myofascial system declines and leads to increased activity of superficial fascia. ...
... Following LBP, the function of this corset-like myofascial system declines and leads to increased activity of superficial fascia. This increased activity affects the structural properties of the superficial fascia and lead to an increase in thickness of superficial fascia and a decrease in its flexibility [25,26,[28][29][30][31][32]. ...
Article
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Introduction: This study aims to evaluate the effect of lumbar myofascial release (MFR) technique on pain and thickness of the lumbar fascia tissue in patients with non-specific low back pain. Materials and Methods: In this clinical trial, 20 subjects with non-specific low back pain were treated by MFR on the lumbar region at 4 sessions. Low back pain severity and thickness of the lumbar fascia tissue were assessed by ultrasonographic imaging before and after the intervention. Results: Subjects showed significant reduction in lumbar fascia thickness (P=0.000) and low back pain severity (P=0.000). Conclusion: The lumbar MFR technique is effective in patients with non-specific low back pain due to reducing the lumbar fascia thickness and low back pain.
... 24−26 There is growing evidence of a morphological connection between different fascia parts, suggesting that the fascia may be morphologically interconnected in other regions and can transmit tension from 1 component to another. 1,2 Therefore, it is hypothesized that disturbances in the structural features of fascia tissue (eg, thickness, flexibility, and elasticity) can cause disorders, such as increased pain, decreased range of motion, and decreased tissue function. 3−6 Ultrasound elastography imaging has been used to measure the elastic behavior of fascial tissue. ...
... 11 Among the fascia chains introduced by Myers, the superficial back line (SBL) pathway of fascia was demonstrated by experimental studies on human cadavers. 1 Evidence for the transfer of force by SBL to distant anatomical structures was also shown that resulted in changes in the range of motion in remote areas of the treatment site. 2,12,13 However, the timing, precise mechanism of such a force transmission, and other effects have not yet been adequately measured and confirmed. ...
... In this regard, Weisman et al, 12 in 2014, showed a significant relationship between the muscles in different parts of the superficial backline. Wilke et al, 1 in 2016, reported strong evidence for the existence of the superficial backline pathway, the anterior functional pathway, and the posterior functional pathway based on the Anatomy Train theory. In this regard, the present study's findings confirm the meaningful relationship between different parts of the superficial backline pathway. ...
Article
Objective The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP. Methods For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16). Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs. Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations. Results The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other (F 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 = 1.48, P = .230, 95% confidence interval) (effect size = 0.22). Conclusion The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP.
... In both sports and rehabilitation, the interest in connective tissues has increased, as they play an important role in force transmission, which has been observed within the socalled myofascial chains (Do Carmo Carvalhais et al., 2013;Krause et al., 2016;Stecco et al., 2018;Wilke et al., 2016). There is evidence that one such chain, the superficial backline (SBL), extends from the plantar fascia, over the Achilles tendon, the gastrocnemius muscle, the ischiocrural muscles, the sacrotuberous ligament, the thoracolumbar and spinal continuity to the skull attachment, thus connecting the muscles of the dorsal chain (Stecco et al., 2019;Wilke et al., 2016). ...
... In both sports and rehabilitation, the interest in connective tissues has increased, as they play an important role in force transmission, which has been observed within the socalled myofascial chains (Do Carmo Carvalhais et al., 2013;Krause et al., 2016;Stecco et al., 2018;Wilke et al., 2016). There is evidence that one such chain, the superficial backline (SBL), extends from the plantar fascia, over the Achilles tendon, the gastrocnemius muscle, the ischiocrural muscles, the sacrotuberous ligament, the thoracolumbar and spinal continuity to the skull attachment, thus connecting the muscles of the dorsal chain (Stecco et al., 2019;Wilke et al., 2016). The structures of the SBL are often affected in orthopedic disorders, which might also be influenced by pathological changes in the connective tissues or non-directly adjacent areas (Ajimsha et al., 2014;Freckleton et al., 2014;Langevin et al., 2011;Wilke et al., 2016;Zügel et al., 2018). ...
... There is evidence that one such chain, the superficial backline (SBL), extends from the plantar fascia, over the Achilles tendon, the gastrocnemius muscle, the ischiocrural muscles, the sacrotuberous ligament, the thoracolumbar and spinal continuity to the skull attachment, thus connecting the muscles of the dorsal chain (Stecco et al., 2019;Wilke et al., 2016). The structures of the SBL are often affected in orthopedic disorders, which might also be influenced by pathological changes in the connective tissues or non-directly adjacent areas (Ajimsha et al., 2014;Freckleton et al., 2014;Langevin et al., 2011;Wilke et al., 2016;Zügel et al., 2018). ...
Article
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This cohort-based cross-sectional study compares the original (OV) and a newly developed standardized version (SV) of the Bunkie Test, a physical test used to assess the dorsal chain muscles. Twenty-three participants (13 females, 10 males; median age of 26 ± 3 years) performed the test, a reverse plank, with one foot on a stool and the contralateral leg lifted. In the SV, the position of the pelvis and the foot were predefined. The test performance time (s) and surface electromyography (sEMG) signals of the dorsal chain muscles were recorded. We performed a median power frequency (MPF) analysis, using short-time Fourier transformation , and calculated the MPF/time linear regression slope. We compared the slopes of the linear regression analysis (be-tween legs) and the performance times (between the OV and SV) with the Wilcoxon test. Performance times did not differ between SV and OV for either the dominant (p = 0.28) or non-dominant leg (p = 0.08). Linear regression analysis revealed a negative slope for the muscles of the tested leg and contralateral erector spinae, with a significant difference between the biceps femoris of the tested (-0.91 ± 1.08) and contralateral leg (0.01 ± 1.62) in the SV (p = 0.004). The sEMG showed a clearer pattern in the SV than in the OV. Hence, we recommend using the SV to assess the structures of the dorsal chain of the tested leg and contralateral back.
... The Superficial Back Line is a continuous line of connective tissue extending from the bottom of the foot up the back side of the body over the top of the head. Tension, movement patterns, trauma, or strain here tends to transmit throughout this fascial line 18 . The superficial back line (SBL) is known to have an effect on the mobility, flexibility of the posterior group of muscles and postural compensations and having seven functional movements: Deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, rotator stability. ...
... Self-myofascial release using tennis ball Warm-up for 5 minutes. 18,46 Myofascial release with a tennis ball for lower limb muscles (hamstrings,Gastrocnemius, plantar fascia) ...
... Multiple theories are available in our literature. One of the theories explains about the property of fascia which states that if rolling friction is applied to the fascia, it generates heat and the fascia becomes more gel like allowing for a greater flexibility 18,19,22 Superficial backline stretching includes different poses which improves flexibility and range of Atef Khalil Rashad et al shows rates of ROM ranged between 19.69% and 308.6% in contract relax, while range was between 6.72% and 168.48% in static stretch. ...
Article
Background: Hamstring Strain is common among athletes which lead to development of injury. Superficial Backline stretching for improving range of motion and flexibility. Using Tennis ball is a form of self-myofascial release results in increasing range of motion. Literature lacks studies done on self- myofascial release and superficial backline stretching. Hence my intention towards this study in comparison to find out the effect of Self Myofascial Release using tennis ball and superficial backline stretching on hamstring strain in cricket players. Methodology: A total of 24 subjects who were between the age group of 15 -19 years were conveniently allocated based on the inclusion criteria. Subjects received self-myofascial release using tennis ball 60 sec with 3-4 repetitions and 1 min interval of rest between sessions and superficial backline stretching with different poses for 2-3 repetitions and then compared FMS score of all subjects pre and post intervention after giving the superficial backline stretches and myofascial release to all the subjects. Outcome measure: Functional movement screen (FMS) Results: The result shows that there is a significant difference in pre and post Score of FMS, pre-FMS score is 15.9167±2.60295 and post score increased to 19.2500±1.59483which shows thatthere is statistical and clinical difference between the pre and post intervention. Functional movement is measured as the primary outcome measure.There is an average improvement of 3.333 with t value 12.487 and p <0.05. Conclusion: The aim of the study was to compare and find out the effect of Self Myofascial Release using tennis ball and superficial backline stretching on hamstring strain in cricket players., the result showed that there is statistically significant self-myofascial release using tennis ball and superficial backline stretching.
... This concept of myofascial tissue connectivity was further supported by Cruz-Montecinos et al., 2015, who reported a significant correlation between the motion of forward tilting of the pelvis (pelvic anteversion), in a long sitting position (knees are fully extended) and the displacement of the deep fascia of the gastrocnemius medialis. Recent histologic findings showed that fascia contains contractile cells, free nerve endings, and mechanoreceptors and therefore plays a proprioceptive and mechanically active role Wilke, Krause et al. (2016). Langevin (2005) proposed that connective tissue may function as a body-wide mechanosensitive signaling network. ...
... Langevin (2005) proposed that connective tissue may function as a body-wide mechanosensitive signaling network. Wilke, Krause et al. (2016) found evidence to support the existence of several myofascial chainsspecifically six myofascial meridians proposed by Myers based on anatomic dissection studies (Myers, 2014) The flow of movements in Essentrics from one plane to another as they follow the myofascial chain may help the body move as a unit. Although the concept of myofascial chains or meridians remains to be further studied, it seems that it may provide a plausible explanation for the stretching benefits experienced by the participants in this study (Myers, 2014;Wilke, Krause et al., 2016). ...
... Wilke, Krause et al. (2016) found evidence to support the existence of several myofascial chainsspecifically six myofascial meridians proposed by Myers based on anatomic dissection studies (Myers, 2014) The flow of movements in Essentrics from one plane to another as they follow the myofascial chain may help the body move as a unit. Although the concept of myofascial chains or meridians remains to be further studied, it seems that it may provide a plausible explanation for the stretching benefits experienced by the participants in this study (Myers, 2014;Wilke, Krause et al., 2016). ...
... Classic anatomy textbooks describe the hamstring muscles from a traditional mechanistic view as being isolated from the adjacent structures [1][2][3] However, recent research has changed this perspective, proposing a connective tissue link between the active components of the movement system to form an extensive network of myofascial chains, or meridians [4]. Of these meridians, there is most anatomical evidence for the superficial back line (SBL) [4,5]. ...
... Classic anatomy textbooks describe the hamstring muscles from a traditional mechanistic view as being isolated from the adjacent structures [1][2][3] However, recent research has changed this perspective, proposing a connective tissue link between the active components of the movement system to form an extensive network of myofascial chains, or meridians [4]. Of these meridians, there is most anatomical evidence for the superficial back line (SBL) [4,5]. This myofascial chain, described by Myers, connects the hamstring muscles with the gastrocnemius muscles and the plantar fascia caudally, and with the thoracolumbar fasciae, the erector spinae muscle and the epicranial aponeurosis cranially [6]. ...
... The present study found that performing SMR on any segment of the SBL resulted in a statistically significant increase in hamstring flexibility and ankle dorsiflexion. These results reinforce the concept of the chain as an entity, not just from an anatomic perspective, as has been described previously [4,5], but also as a functional structure as reported in recent studies [42]. ...
Article
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Background: The hamstring muscles are described as forming part of myofascial chains or meridians, and the superficial back line (SBL) is one such chain. Good hamstring flexibility is fundamental to sporting performance and is associated with prevention of injuries of these muscles. The aim of this study was to measure the effect of self-myofascial release (SMR) on hamstring flexibility and determine which segment of the SBL resulted in the greatest increase in flexibility. Methods: 94 volunteers were randomly assigned to a control group or to one of the five intervention groups. In the intervention groups, SMR was applied to one of the five segments of the SBL (plantar fascia, posterior part of the sural fascia, posterior part of the crural fascia, lumbar fascia or epicranial aponeurosis) for 10 min. The analyzed variables were hamstring flexibility at 30 s, 2, 5, and 10 min, and dorsiflexion range of motion before and after the intervention. Results: Hamstring flexibility and ankle dorsiflexion improved when SMR was performed on any of the SBL segments. The segments with the greatest effect were the posterior part of the sural fascia when the intervention was brief (30 s to 2 min) or the posterior part of the crural fascia when the intervention was longer (5 or 10 min). In general, 50% of the flexibility gain was obtained during the first 2 min of SMR. Conclusions: The SBL may be considered a functional structure, and SMR to any of the segments can improve hamstring flexibility and ankle dorsiflexion.
... Furthermore, these forces in the fascia could be distributed over a distance, affecting the range of motion of segments far from the initial muscle contraction [8]. In a systematic review, Wilke et al. [9] demonstrated that there is good evidence for the existence of at least three myofascial chains based on anatomical dissection studies: the Superficial Back Line, the Back Functional Line and the Front Functional Line. However, the functional relevance of this fascial continuity has been a matter of debate. ...
... In this term, the posterior myofascial chain that connects the plantar aponeurosis àAchilles tendonàgastrocnemius muscleàhamstring musclesàsacrotuberous ligament à lumbar fascia à erector spinae muscles has been demonstrated to be more effective than the anterior one, which connects the adductors with the pyramidalis muscle, the rectus abdominis muscle and which follows the course of the abdominal linea alba, the sternal ligaments up to the neck. The connection between adductor and rectus abdominis was also reported by [9] as playing a key role in groin pain or athletic pubalgia; while the abdominal linea alba and the sternal ligaments is well known to perform a more perceptive than motor function for the trunk. Since tissues' structure, arranged in a way that supports and optimizes the transmission of mechanical forces, the mobility of the human body during the activities of daily life strengthens the connections between the structures subjected to in-vivo loads. ...
Article
In recent years, various studies have demonstrated that the fascia can transmit the mechanical tensions generated by muscle activity over a distance. However, it is not yet clear whether this transmission follows precise anatomical lines. The present study aims to understand if the exercises at a distance can influence the range of motion of the neck, and if the effects are different by performing the exercises in various directions. The study was attended by 30 healthy volunteers aged between 19 and 32 years. Anterior flexion of the neck was checked before the protocols and retested to compare the difference after stretching the hamstrings and adductors. All evaluations were performed by the same operator using an electronic goniometer. Cervical ROM increased during both procedures, but after the hamstrings stretch it increased significantly more than after the adductors stretch (6.22° versus 1.44°). This study highlighted how fascia can transmit forces at a distance, but only according to precise myofascial sequences. Consequently, it is important to know the fascial organization in order to properly train the fascial system.
... To date, this is the first study to measure the effect of SMR intervention on posterior muscular chain flexibility across one hour. The increasing flexibility immediately after the intervention (T1) is consistent with the literature [20,31,47], confirming the transmission of information along the myofascial chains [49][50][51]. However, the most important novelty of this research dwells in the prolonged duration of the effect, lasting for a full hour. ...
... It is well-known that muscles are wrapped by connective tissue with different layers, the so-called fascial system. The fascia is body widespread, linking the skeletal muscles [49]. The fascial system has proprioceptive and nociceptive functions [64][65][66][67] and is innervated by mechanoreceptors [66]. ...
Article
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This study evaluated the effects of a single exercise session of Self-Myofascial Release (SMR) on the posterior muscular chain flexibility after one hour from the intervention. Thirty-six participants performed SMR using a rigid ball under the surface of both feet. Participants were tested with the Sit and Reach (S&R) test at four different times: before (T0), immediately after (T1), 30 (T2), and 60 (T3) minutes after the SMR intervention. The sample (n = 36) was categorized into three groups: (1) flexible, (2) average, and (3) stiff, based on the flexibility level at T0 (S&R values of >10 cm, >0 but <10 cm and <0 cm, respectively). For the whole sample, we detected significant improvements in the S&R test between the T1, T2, and T3 compared to T0. The stiff group showed a significant (p < 0.05) improvement between T1–T2 and T1–T3. Results were similar between the average group and the whole sample. The flexible group did not show any significant difference (p > 0.05) over time. In conclusion, this investigation demonstrated that an SMR session of both feet was able to increase posterior muscular chain flexibility up to one hour after intervention. Considering that a standard training session generally lasts one hour, our study can help professionals take advantage of SMR effects for the entire training period. Furthermore, our results also demonstrate that physical exercise practitioners should also assess individuals’ flexibility before training, as the SMR procedure used in this work does not seem necessary in flexible individuals
... Beyond providing sensory input [2][3][4], fascial tissue has been demonstrated to connect both, parallelly [5] (e.g. gastrocnemius and soleus) and serially [6,7] (e.g. gastrocnemius and Hamstrings) arranged muscles. ...
... gastrocnemius and Hamstrings) arranged muscles. Following this paradigm, Wilke et al. [6] found strong evidence for the existence of a posterior myofascial chain, consisting of the plantar fascia, Achilles tendon, gastrocnemius muscle and fascia, Hamstring muscles and fasciae, sacrotuberous ligament, lumbar fascia, and erector spinae muscle and fascia. Interestingly, biomechanical experiments in cadavers showed that significant forces may be transmitted via the described tissue continuities [8,9]. ...
Article
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Background Connective tissue links the skeletal muscles, creating a body-wide network of continuity. A recent in-vivo experiment demonstrated that passive elongation of the calf caused a caudal displacement of the semimembranosus muscle, indicating force transmission across the dorsal knee joint. However, it remains unclear as to whether this observation is dependent on the joint angle. If force would not be transmitted at flexed knees, this would reduce the number of postures and movements where force transmission is of relevance. Our trial, therefore, aims to investigate the influence of passive calf stretching with the knee in extended and flexed position on dorsal thigh soft tissue displacement. Methods Participants are positioned prone on an isokinetic dynamometer. The device performs three repetitions of moving the ankle passively (5°/s) between plantar flexion and maximum dorsiflexion. With a washout-period of 24 hours, this procedure is performed twice in randomised order, once with the knee extended (0°) and once with the knee flexed (60°). Two high-resolution ultrasound devices will be used to visualize the soft tissue of the calf and dorsal thigh during the manoeuvre. Maximal horizontal displacement of the soft tissue [mm] during ankle movement will be quantified as a surrogate of force transmission, using a frame-by-frame cross-correlation analysis of the obtained US videos. Discussion Understanding myofascial force transmission under in-vivo conditions is a pre-requisite for the development of exercise interventions specifically targeting the fascial connective tissue. Our study may thus provide health and fitness professional with the anatomical and functional basis for program design. Trial registration The study is registered at the German Clinical Trials Register (TRN: DRKS00024420), registered 8 Februar 2021, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024420 .
... [19] Wilke et al reported that the myofascial release technique enhances muscular properties, functional capacity, and activities of daily living in patients with chronic stroke due to changes in myofascial chains. [20] This is a form of manual therapy of soft tissue release and muscle stretching to increase muscle length, soft tissue flexibility, and joint range of motion (ROM). [21] Several physiological benefits of myofascial release have been reported, such as capillary dilation, and metabolic and cutaneous temperature changes. ...
... The myofascial release approach can enhance muscle characteristics, function capacity, and activities of daily living in patients with chronic stroke. [20] Other benefits were also reported in previous studies, such as improved joint biomechanics, increased muscle flexibility, [22] and reduced fascial adhesion. [31] Park and Hwang conducted a pilot study and found that myofascial release using a tennis ball improved balance function in patients with chronic stroke who had spasticity in the lower extremity. ...
Article
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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.
... They explain that limbs should be considered as rigid overlapping segments connected via links or joints by a connective tissue continuum (58)(59)(60). It is suggested that myofascial tissue meridians (e.g., superficial back line, superficial front line, lateral line) link the entire body and thus movements in a targeted segment can be transferred through the myofascial chains to other adjacent segments (61)(62)(63)(64)(65). Hence, the stress or strain on a distant structure may be reduced through myofascial meridians diminishing the related stress and associated pain (Figure 1). ...
... While foam rolling studies have demonstrated remote decreases in pain (or increased pain pressure thresholds), the mechanism is attributed to an increased global pain (sensory) threshold (e.g., diffuse noxious inhibitory control or gate control theories) rather than release of strain through myofascial meridians (66,67). Other reports relate increases in nonlocal range of motion and an attenuation of nonlocal pain to myofascial tissue meridians (68), but there is little direct in vivo (i.e., in live individuals) evidence or consensus for this mechanism, and further studies are required to test for this possibility (65). ...
... They explain that limbs should be considered as rigid overlapping segments connected via links or joints by a connective tissue continuum (58)(59)(60). It is suggested that myofascial tissue meridians (e.g., superficial back line, superficial front line, lateral line) link the entire body and thus movements in a targeted segment can be transferred through the myofascial chains to other adjacent segments (61)(62)(63)(64)(65). Hence, the stress or strain on a distant structure may be reduced through myofascial meridians diminishing the related stress and associated pain (Figure 1). ...
... While foam rolling studies have demonstrated remote decreases in pain (or increased pain pressure thresholds), the mechanism is attributed to an increased global pain (sensory) threshold (e.g., diffuse noxious inhibitory control or gate control theories) rather than release of strain through myofascial meridians (66,67). Other reports relate increases in nonlocal range of motion and an attenuation of nonlocal pain to myofascial tissue meridians (68), but there is little direct in vivo (i.e., in live individuals) evidence or consensus for this mechanism, and further studies are required to test for this possibility (65). ...
Article
While muscle stretching has been commonly used to alleviate pain, reports of its effectiveness are conflicting. The objective of this review is to investigate the acute and chronic effects of stretching on pain, including delayed onset muscle soreness. The few studies implementing acute stretching protocols have reported small to large magnitude decreases in quadriceps and anterior knee pain as well as reductions in headache pain. Chronic stretching programs have demonstrated more consistent reductions in pain from a wide variety of joints and muscles, which has been ascribed to an increased sensory (pain) tolerance. Other mechanisms underlying acute and chronic pain reduction have been proposed to be related to gate control theory, diffuse noxious inhibitory control, myofascial meridians, and reflex-induced increases in parasympathetic nervous activity. By contrast, the acute effects of stretching on delayed onset muscle soreness are conflicting. Reports of stretch-induced reductions in delayed onset muscle soreness may be attributed to increased pain tolerance or alterations in the muscle's parallel elastic component or extracellular matrix properties providing protection against tissue damage. Further research evaluating the effect of various stretching protocols on different pain modalities is needed to clarify conflicts within the literature.
... They explain that limbs should be considered as rigid overlapping segments connected via links or joints by a connective tissue continuum (58)(59)(60). It is suggested that myofascial tissue meridians (e.g., superficial back line, superficial front line, lateral line) link the entire body and thus movements in a targeted segment can be transferred through the myofascial chains to other adjacent segments (61)(62)(63)(64)(65). Hence, the stress or strain on a distant structure may be reduced through myofascial meridians diminishing the related stress and associated pain (Figure 1). ...
... While foam rolling studies have demonstrated remote decreases in pain (or increased pain pressure thresholds), the mechanism is attributed to an increased global pain (sensory) threshold (e.g., diffuse noxious inhibitory control or gate control theories) rather than release of strain through myofascial meridians (66,67). Other reports relate increases in nonlocal range of motion and an attenuation of nonlocal pain to myofascial tissue meridians (68), but there is little direct in vivo (i.e., in live individuals) evidence or consensus for this mechanism, and further studies are required to test for this possibility (65). ...
... Myofascial chains refer to anatomical and neurophysiological observations, suggesting that the fascia, a soft tissue viscoelastic structure, serves as a functional envelopment connecting muscles throughout the entire body, providing rich sensorimotor communication between body segments (39,63). This idea of neural and musculoskeletal systems functioning as interconnected neuromuscular chains extends past the current dogma of understanding musculoskeletal functioning as numerous isolated single-joint muscular origins and insertions (65). Many studies have been able to confirm this myofascial force transmission theory, which states that intermuscular chains can transfer force through connective tissue envelopes to surrounding tissues and not solely working as an isolated unit, transmitting the force through tendinous attachments between muscles (26,68). ...
... Recent systematic literature reviews (16,39,64,65) that examined fascial concepts presented by Myers (46,47) have supported the existence of 5 myofascial lines on different sides of the body (e.g., ventral, dorsal, and lateral), with moderate-to-strong evidence. In addition to the BFL, this evidence supports the synergistic work of other myofascial muscular chain pathways through the body, allowing 3-dimensional movement, while attempting to balance stability and mobility (16). ...
... The term "biotensegrity" integrates complex biological aspects of living systems into a tensegrity biomechanical model where each "separate part" of the system is valued with relation to the whole (12). (iii) Fascia can transmit forces in the body to a distance with mechanical forces able to travel along myofascial chains (13). (iv) Fascia is able to actively contract (14). ...
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Acupuncture is a minimally invasive therapeutic method that uses small caliber needles while inserting them through the skin into various areas of the body. Some empirical studies find evidence to support the use of acupuncture as a treatment for certain medical conditions, however, this peculiar practice is widely considered as the domain of alternative and non-evidence-based medicine. Several mechanisms have been suggested in an attempt to explain the therapeutic action of acupuncture, but the way in which acupuncture alleviates chronic non-cancer pain or psychosomatic and psychiatric disorders is not fully understood. A recent study suggested a theoretical model (coined “Fascial Armoring”) with a cellular pathway to help explain the pathogenesis of myofascial pain/fibromyalgia syndrome and functional psychosomatic syndromes. It proposes that these syndromes are a spectrum of a single medical entity that involves myofibroblasts with contractile activity in fascia and aberrant extracellular matrix (ECM) remodeling, which may lead to widespread mechanical tension and compression. This can help explain diverse psycho-somatic manifestations of fibromyalgia-like syndromes. Fascia is a continuous interconnected tissue network that extends throughout the body and has qualities of bio-tensegrity. Previous studies show that a mechanical action by needling induces soft tissue changes and lowers the shear modulus and stiffness in myofascial tissue. This hypothesis and theory paper offers a new mechanism for acupuncture therapy as a global percutaneous needle fasciotomy that respects tensegrity principles (tensegrity-based needling), in light of the theoretical model of “Fascial Armoring.” The translation of this model to other medical conditions carries potential to advance therapies. These days opioid overuse and over-prescription are ubiquitous, as well as chronic pain and suffering.
... Performing injections into interfascial planes, which act as a potential space, leads to a wide dermatomal distribution of LA regarding its dynamic structure. Deep fascial planes are transmission routes surrounding the musculoskeletal system [33]. The rhomboid intercostal plane extends to the erector spinae muscles medially and the serratus anterior muscle laterally. ...
Article
Background: Myofascial pain syndrome (MPS) is a common chronic pain syndrome that may affect quality of life, daily living activities, and psychological status. Ultrasound (US)-guided rhomboid intercostal block (RIB) is a recently defined plane block and used for chronic pain such as postmastectomy syndrome and MPS. Our aim was to evaluate the efficacy of US-guided RIB for the management of pain, quality of life, physical disability, and patient satisfaction in MPS. Methods: In this prospective study, between February and March 2021, a total of 30 patients who applied with the diagnosis of MPS, were included. The patients received US-guided RIB. Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, and just after the intervention, at day 1, and 1, 2, 4, and 6 weeks after the intervention. At pretreatment and 6 weeks after treatment, Short Form-36 Health Survey (SF-36) for health-related quality of life, Neck Disability Index (NDI), and patient satisfaction were evaluated. Results: There was a statistically significant decrease in average NRS immediately after treatment, at day 1 and week 1,2,4, and 6 compared to the pretreatment (p < 0.0001). The average SF-36 scores advanced at 6 weeks after treatment. There was a statistically significant reduction in mean NDI scores throughout the follow-up period (p < 0.001). Discussion: Our study demonstrated that RIB had improved neck function, physical and mental quality of life, and patient satisfaction in MPS. Therefore, we think US-guided RIB could be an alternative treatment modality in patients suffering from MPS.
... Myers (2014) stated that any strain at a specific part of the SBL in an "anatomy train" may have adverse consequences, and decreased global flexibility, based on the "schematic map" of the body's fascia connections. The muscle is inked in identifiable chains and through fascial structures, creating a structural continuity system (Wilke et al., 2016). Wilke et al. (2018) explained that muscle tension in one of the areas of the superficial backline increase; the other connected area may increase muscle tension. ...
Article
Poor posture in sitting and standing exerts stress on the spine muscle leading to non-specific low back pain (LBP). Myofascial release (MFR) on the back and leg muscles may reduce fascial tension in an individual with LBP is unclear. This review describes the effects of MFR on flexibility, pain, disability, and stress level among non-specific LBP individuals. The findings showed that the direct or indirect apply MFR on the back or lower limbs improve flexibility, pain, and disability. However, insufficient information on stress levels. The MFR therapy is recommended to enhance low back pain rehabilitation. Keywords: low back pain; myofascial release; superficial backline; back rehabilitation eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v7i21.3752
... Since the connective tissue channel is composed of proteins and mucopolysaccharides with semiconductor properties. The loose connective tissue itself has a lot of body fluids; thus, its information transmission speed is 3 times faster than nervous system [28][29][30]. The positive piezoelectric effect spreads rapidly through the channel. ...
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Background: Neck pain is one of the most common musculoskeletal diseases. Fu's subcutaneous needling therapy is a special acupuncture method that targets muscle trigger points. It has been proven to have a positive effect on the treatment of neck pain. The access to its curative effect may be related to the improvement of muscle and soft tissue condition. The purpose of this study is to evaluate the outcome of Fu's subcutaneous needling therapy for patients with neck pain by collecting changes in the sEMG of the patient's neck muscles and related data from evaluation scales and explore the feasibility and safety of Fu's subcutaneous needling therapy for neck pain. Methods: 72 patients meeting the inclusion criteria were randomly divided into FSN group and acupuncture group for corresponding treatment. FSN group was treated once every other day for 5 consecutive treatments; the acupuncture group was treated once a day for 10 consecutive treatments. Result: Outcome indicators were measured at baseline, after the first treatment and the end of the treatment. Primary outcome indicators: average EMG (AEMG) and (mean power frequency) MPF of sternocleidomastoid muscle and superior trapezius muscle. Secondary outcome indicators: Mc Gill pain questionnaire (MPQ), neck disability index (NDI), and adverse reactions. Conclusions: This study will explore the efficacy, safety, and possible mechanism of Fu's subcutaneous needling therapy for patients with neck pain, thus to provide more evidence support for clinical decision-making. This trial is registered with Chinese Clinical Trial Register Center (registration number ChiCTR2100043529).
... The findings of the present cross-sectional study do not explain how the size of agonist and antagonist muscles affects muscle activity. We believe that fascial kinetic chains play a role in this force transmission, as these structures are surrounded by fascia that is included in the anterior and posterior superficial myofascial kinetic chains 37,38 . ...
Article
Objectives: The study aims to investigate the relationship between abdominal muscle activity and the cross-sectional area (CSA) of the lumbar muscles and assess their role in the functional assessment of patients with chronic non-specific low back pain (CNSLBP). Methods: 142 patients with CNSLBP were included in this study. Disability levels were evaluated with the Roland-Morris Low Back Pain and Disability Questionnaire. The functional assessments of the participants were evaluated with a 6-minute walk test. Abdominal muscle activity was measured using a pressure biofeedback unit. The CSA of the bilateral multifidus, erector spinae, and psoas muscles were measured T2-weighted MRI images at the L2-L5 levels. Results: Significant correlations were found between the abdominal muscle activity during the posterior pelvic tilt movement and the CSA of the erector spinae muscle at the L4 and L5 levels, and the psoas muscle at the L2-L5 levels (correlation coefficient range from 0.32 to 0.48). Abdominal muscle activity yielded a significant additional contribution to the variance on the functional assessment (R2 change=0.101). Conclusions: The relationship of abdominal muscle activity with lumbar muscles and the contribution of muscle activities to functional assessment should be considered in the management of patients with CNSLBP.
... Several definitions exist for the term "myofascial tissue", with some authors emphasizing the importance of the intramuscular and intermuscular fascial tissue [12,[32][33][34], while others weigh more the skeletal muscle [35][36][37][38][39][40] or both fascial and muscular tissue in conjunction [41]. In this study, we assume that the myofascial tissue is composed of the superficial fascia, deep fascia and the skeletal muscle with its connective tissue (e.g., endomysium, perimysium). ...
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Changes in tissue stiffness are associated with pathological conditions such as myofascial pain and increased risk of muscle injury. Furthermore, they have been shown to modify performance indicators such as running economy or jump height. Indentometry is an affordable way to assess tissue stiffness. However, to date, there is a paucity of studies examining the measurement properties of available devices. With this trial, we aimed to evaluate the reliability of the “IndentoPro”. Two investigators repeatedly measured the stiffness of the lateral head of the gastrocnemius muscle in healthy participants (N = 35), using 5 and 10 mm indentation depths. Intraclass Correlation Coefficients (ICC) revealed moderate inter-rater reliability (5 mm: ICC3,1 0.74, 95%CI = 0.54 to 0.86, p < 0.001; 10 mm: ICC3,1 0.59, 95%CI = 0.27 to 0.78, p < 0.001) and good intra-rater reliability (5 mm: ICC3,1 0.84, 95%CI = 0.71 to 0.92, p < 0.001; 10 mm: ICC3,1 0.83, 95%CI = 0.69 to 0.91, p < 0.001). No correlations between age, height, weight, BMI, skinfold thickness and myofascial tissue stiffness were observed (p > 0.5). In conclusion, the IndentoPro is reliable in assessing calf tissue stiffness, but the predictors of stiffness remain unclear.
... As a 4th step, the practitioner will perform a "myofascial release technique of the cervical aponeuroses" [50][51][52][53][54][55]. For the pre-vertebral deep cervical aponeurosis, one hand is placed at cephalic level at the base of the occiput exerting cephalic traction, the other hand is placed at the level of the posterior surface of Thoracic 4 (T4) and exerts anterior pressure and caudal traction- manubrium and exerts caudal traction- Fig. 2e. ...
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Background Falling is a major trauma that can occur with aging, leading to very significant psychological and physical health effects with financial and societal consequences. It is therefore essential to explore therapeutic treatments that can reduce this risk. Some recognized effective treatments exist, concerning in particular the re-education of the muscles of the lower limbs. However, to our knowledge, none of them focus on the cervical spine although the latter is located at an essential physiological crossroads. Manual therapy, which has already demonstrated its impact on pain and balance parameters in the elderly, could be a painless and non-invasive tool of choice in addressing this problem. Methods Interventional study (not related to a health product), monocentric, prospective, controlled, randomized double-blind (patient and evaluator performing the measurements). The experiment will take place over three measurement periods on D0, D7 and D21. On D0 subjects will be randomized in 2 groups: experimental and placebo group. Both groups will be assessed on: Short Physical Performance Battery test score, walking speed, lower limb strength, balance, heart rate variability and cervical spine strength and mobility. Then the experimental group will receive a myofascial release protocol applied to the cervical spine and the placebo group will receive a placebo light touch protocol. The intervention will be followed by the same measurements as before. This schedule will be reproduced on D7. On D21, only one assessment will be done. Discussion This study started in 2020 but could not go beyond the inclusion phase due to the COVID pandemic. It is envisaged that recruitment could resume during 2022. Trial registration : Registered by the Comité de Protection des Personnes—Sud Méditerranée; under the title “Prévention des troubles de l’équilibre chez le senior: influence de la thérapie manuelle appliquée au rachis sur les paramètres statiques et dynamiques», n° 19.12.27.47.259 in date of February 4, 2020. Registered by ClinicalTrials.gov ID: NCT05475652; under the title « The Influence of Manual Therapy Applied to the Cervical Spine in the Prevention of Balance Disorders in the Elderly (ManEq)”.
... Back functional line links latissimus dorsi (LD) and gluteus maximus (GMax) through TLF causing tensegrity-like network. [10] Bridge exercise activates this functional line via activating GMax. Adding arm extension also activates LD in this chain. ...
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Objectives: This study aims to evaluate the changes in the ultrasonographic thickness of transversus abdominis and internal oblique muscles during bridge with arm extension compared to bridge and abdominal hollowing. Patients and methods: Between March 1 st , 2019 and March 29 th , 2019, a total of 30 healthy individuals (15 males, 15 females; mean age: 28.8±8.1 years; range, 21 to 52 years) among hospital staff were included. Thickness of transversus abdominis, internal, and external oblique muscles of the participants were evaluated using ultrasound during four positions (rest, abdominal hollowing, bridge, and bridge with arm extension). Results: The mean body mass index was 23.8±4.1 kg/m ² . The thickness of transversus abdominis and internal oblique muscles increased during all positions (p<0.001), compared to rest. The thickness during bridge with arm extension was greater than abdominal hollowing and bridge. Conclusion: Co-activation of latissimus dorsi and gluteus maximus muscles during abdominal contraction increases the thickness of internal oblique and transversus abdominis muscles greater than abdominal contraction alone or co-activation of gluteus maximus alone. Simultaneous isometric contraction of latissimus dorsi muscle may enhance abdominal muscle function.
... The latter induces FHP that is associated with lower mandible and tongue position, which leads to crooked teeth due to a lack of support from the palatal side [15]. More importantly, this condition compromises airways and can cause obstructive sleep apnea that afflicts at least one in twenty people [39], whereas malocclusion affects one out of two individuals worldwide [40,41]. Therefore, efforts should be put in toreducing environmental factors such as bad posture. ...
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Changes in craniocervical posture are a critical issue in modern society. Alterations of the mandible position in the anterior-posterior direction in association with head and neck posture are reported. The objective of the present review was to evaluate the relationship between craniocervical posture and sagittal position of the mandible and to evaluate the risk of bias inthe included studies. Electronic databases used to perform the search were PubMed, Wiley Online Library, and Cochrane. Only clinical trials that assessed sagittal craniocervical posture and mandible position in lateral cephalograms were included. Selected inclusion criteria were used to assess the finally selected studies. The upper and lower cervical spine was evaluated by seven and six studies, respectively. The risk of bias in the included studies varied from low to moderate. Literature research identified 438 records from 3 databases. Eventually, seven eligible clinical trials were included in this review. Evaluating the relationship between craniocervical posture and mandible position in the sagittal plane, it can be concluded that increased cervical inclination and head upright position are associated with the posterior position of the mandible. Attention to patients’ craniocervical posture should be paid as a part of clinical evaluation since it might be the reason for the changed mandible position.
... These theoretical analyses suggest that most of human body's skeletal muscles are directly connected by fascial connective tissue and form myofascial chains (35,36). To understand the origin of pelvic floor dysfunctions, a few simulation models have been developed, like the one according to Giraudet et al. (10) most of them are incomplete and only contain the analysis of the structure of the levator ani, separated from other muscles of the perineum. ...
... e purpose of the preliminary test is to check for the existence of a musculofascial, according to the concept of Anatomy Trains, and examine whether the temporomandibular disorder can linearly affect distant tissues [22]. According to the tensegration theory, the damaging stimulus caused by excessive voltage, it is transmitted linearly in the human body [23][24][25][26]. For this reason, ailment pain and mobility limitations may appear in a place distant from the primary stimulus. ...
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Introduction: Temporomandibular disease (TMD) is a general term including a group of conditions that cause pain and dysfunction in the masticatory muscles, the temporomandibular joint (TMJ), and their related structures. The painful forms of these dysfunctions have become an increasing phenomenon among dental patients. A number of scientific publications indicated the relationship between the presence of postural dysfunctions and functional disorders of the masticatory system in humans. Nevertheless, dental procedures still very rarely include comprehensive diagnostics and procedures aimed at the normalization of the locomotor system related to TMD. Scientific literature usually refers to and describes the coexistence of postural disorders in patients with TMD in the context of anatomical connections, the so-called biokinematic chains, indicating specific types of postures that correlate with different positions of the mandible and/or teeth. Objective: The aim of the study was to investigate the effect of painless positioning of the mandibular head in the articular fossa on postural and functional changes in the musculoskeletal system. Materials and methods: The study was conducted on a group of 30 randomly selected patients who reported to the Department of Propaedeutic, Physical Diagnostics and Dental Physiotherapy of the Pomeranian Medical University in Szczecin (Poland). Before the examination, the dentists and the physiotherapist were calibrated by an examiner who had previously been calibrated and had three years of experience in the management of patients with TMD. Training of the appropriate palpation strength was performed, and then the results were discussed. In the study group, painful disorders in the temporomandibular joint with an abnormal position of the mandibular head in the articular fossa and individual posture defects were found. The patients complained of pain in the area of the TMJ, episodes of locked joints, and difficulty biting. None of them was treated for these disorders, previously rehabilitated or participated in any body posture examination. The patients were examined by an interdisciplinary team who also performed a preliminary test. The inclusion criterion for the study group was the presence of TMD symptoms in the past. Myofascial pain was diagnosed on the basis of diagnostic criteria for temporomandibular disorders (RDC/TMD Ia and Ib). On the other hand, the displacement of the articular disc was diagnosed on the basis of the diagnostic criteria of temporomandibular disorders (RDC/TMD IIa)-displacement of the articular disc without reduction. At the same time, the body posture was assessed by inspection and using computer techniques while standing and during motion. The examinations were repeated after positioning the mandibular heads in the articular fossa and stabilizing the condylar process using a temporary silicone occlusal splint. Since there is no DC/TMD protocol in Polish to date, RDC/TMD was used in the study. Results: Initial pilot studies and the authors' observations indicated that the positioning of the mandibular heads in the articular pits and stabilization of the condylar process by providing the oral cavity with a temporary, silicone occlusive splint significantly influenced the posture of the examined patients, both while standing and during locomotion. This correlation also applies to the corrective effect on the foot architecture during standing and patient gait. Conclusions: Diagnostic and therapeutic management in the course of TMD should be holistic. Nevertheless, the observed changes are often varied and largely dependent on individual posture defects, which is an important postulate for further research on a larger study group.
... Lack of research regarding myofascial continuities and dysfunction exists, As many anatomists stated that anatomical description has been completed and no new knowledge is to be expected, causing a gradual reduction of budgets and research of anatomy [41] . A systematic review of 2016 investigated existence of myofascial lines presented by Tomas Myers in his book (Anatomy trains), concluded that most muscles are connected directly by connective tissue, with evidence regarding the existence of specific myofascial continuities that he termed the superficial back line (SBL), back functional line, and front functional line, these findings can provide a better understanding of musculoskeletal pain and dysfunction development, with a major need for further research [42] . ...
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Background: Knee osteoarthritis is a common orthopedic condition. Imaging based pathoanatomical findings are utilized as a cornerstone for diagnosis of the condition, 97% of asymptomatic knees demonstrate pathoanatomical findings, causing doubt of diagnosis and efficiency of intervention based on asymptomatically present pathoanatomical features. Purpose: This study explores myofascial dysfunctions as an alternative explanation to knee pain. Identifying new syndromes termed as knee myofascial pain and knee-abdomen syndromes. Therapeutic intervention: Describing 3 cases of knee osteoarthritis and one case of rheumatoid arthritis treated to full recovery as myofascial dysfunction. All of these cases were investigated and treated to complete recovery from specific myofascial continuity known as deep front line dysfunction, as a cause of knee pain. Results: Both syndromes demonstrated 50% to 100% pain reduction after one session of myofascial release, with no recurrence over long-term follow-up after discharge. Conclusion: Knee myofascial pain and knee-abdomen syndromes are clinically present commonly misdiagnosed as arthritic changes. Myofascial release produced an immediate major pain reduction ranging from 50 to 100%. High quality research is required to identify more accurate diagnostic criteria and consequently best treatment strategies.
... The fascia is a connective tissue network that envelops and links the muscles, blood vessels, nerves, and viscera of the whole body (Wilke et al., 2016;Bordoni et al., 2019). Fascia is mainly responsible for transmitting and absorbing loads to connective tissues, depending on its viscoelasticity, thereby building an extensive tensegrity network linking the various human tissues (Huijing, 2009). ...
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Purpose: This study investigated the effects of isometric plantar-flexion against different resistances on the thoracolumbar fascia (TLF), erector spinae (ES), and gastrocnemius stiffness by shear wave elastography (SWE). The purpose was to explore the interaction between the lower limb muscle and lumbar tissue in the myofascial tensegrity network. Methods: Twenty healthy young female were recruited in this study. The stiffness of the TLF, ES, medial gastrocnemius (MG), and lateral gastrocnemius (LG) was measured by SWE under four isometric plantar-flexion resistance conditions. The resistance conditions involved 0% maximum voluntary isometric contraction (MVIC), 20% MVIC, 40% MVIC, and 60% MVIC. Results: There was a strong correlation between the stiffness change of MG and that of TLF ( r = 0.768–0.943, p < 0.001) and ES ( r = 0.743–0.930, p < 0.001), while it was moderate to strong correlation between MG and that of LG ( r = 0.588–0.800, p < 0.001). There was no significant difference in the stiffness between the nondominant and dominant sides of TLF and ES under the resting position ( p > 0.05). The increase in stiffness of the TLF, ES, MG, and LG, with MVIC percentage ( p < 0.05), and the stiffness of TLF and ES on the nondominant side is much higher than that on the dominant side. Conclusions: Our data shows that isometric plantar-flexion has a significant effect on the stiffness of the lumbar soft tissue and gastrocnemius. The gastrocnemius has a strong correlation with the stiffness changes of TLF and ES, which provides preliminary evidence for exploring the myofascial tensegrity network between the dorsal side of the lower limb muscle and lumbar tissue.
... Impaired muscle mechanical coordination, proprioception, balance, the occurrence of myofascial pain, and spasms are most commonly associated with dysfunctions of the deep fascia and the epimysium [1]. Changes in the mechanical properties of the fascia may therefore reduce muscle extensibility, generating a disturbance in joint range of motion (ROM) [35]. It is likely that a reduction in the extensibility, or flexibility of the fascial network results in impaired neuromuscular control and fiber recruitment patterns of these muscles [36][37][38]. ...
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The term “soft tissue therapy” (STT) refers to mechanical methods of treatment involving passive kneading, pressing and stretching of pathologically tense tissues in supporting the process of recovery after surgery or trauma to the musculoskeletal system. The objective of this study was to review current scientific reports evaluating the effectiveness of the use of STT in patients with diseases or after surgical procedures of the knee joint. A systematic search of the popular scientific databases PubMed, Scopus and Embase was performed from inception to 15 October 2021. Eight articles met eligibility criteria and were included in the review. Six papers were related to disorders of the knee joint, while the remaining two studies were related to dysfunctions associated with the conditions after surgical intervention. The findings presented confirmed the effectiveness of STT in orthopaedic patients who showed an increase in lower limb functional parameters. The research has shown that the use of various methods of STT has a significant impact on increasing muscle activity and flexibility as well as increasing the range of motion in the knee joint. The physiotherapeutic methods used had a significant impact on reducing pain and increasing physical function and quality of life. The techniques used reduced the time to descend stairs in patients with knee osteoarthritis. This review summarises the effectiveness of STT as an important form of treatment for orthopaedic patients with various knee joint dysfunctions.
... Here, by myofascial meridians, we mean, based on the ideas of Thomas V. Myers [3,4], muscles do not work by themselves, but as part of myofascial meridians, where the insufficiency of one muscle must be compensated for by the excessive tone of all other components of the meridians [5]. Accordingly, the treatment strategy should be aimed at analytical development: strengthening weak myofascial meridians and unloading overstrained myofascial meridians. ...
... Termin stworzony przez Buckminstera Fullera i Kennetha Snelsona wyjaśnia w jaki sposób nasz organizm działa jako całość oraz w jaki sposób kości naszego szkieletu, dzięki napięciom ścięgien, więzadeł i mięśni, pozwalają na utrzymanie pionowej postawy ciała wbrew sile grawitacji [6,25,26,27,28]. W modelu tensegracyjnym (jakim jest również ciało człowieka) kości (układ kompresyjny) zawieszony jest w układzie stałych napięć (układ mięśniowo-więzadłowy) [29,30,31,32]. Kluczową rolę odgrywa powięź, która jest łącznotkankową tkanką, a organy oplata jak rusztowanie, przenosząc napięcia wzdłuż włókien. ...
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Streszczenie Staw skroniowo-żuchwowy jest istotną częścią aparatu żującego i aparatu mowy. Jest parzystą strukturą zbudowaną z tkanek miękkich (mięśnie, powięzi, więzadła) i tkanek twardych (tkanka kostna). Dysfunkcje stawu skroniowo-żuchwowego występują często i obejmują wiele poszczególnych patologii, które manifestują się różnymi objawami, a najczęstsze z nich to dolegliwości bólowe. Wady postawy ciała to jakiekolwiek odchylenia od prawidłowego układu odcinków bez zmian patologicznych, które gwarantują stabilizację i równowagę przy minimalnym wysiłku fizycznym i zapewnieniu optymalnej wydolności statyczno-dynamicznej oraz zapewnieniu prawidłowego rozwoju i funkcjonowania narządów wewnętrznych. Niniejsza praca jest przeglądem literatury światowej i polskiej dotyczącej poszukiwania związku między wadami postawy ciała, a dysfunkcją stawu skroniowo-żuchwowego, którą, w świetle aktualnej wiedzy medycznej, tłumaczy się zjawiskiem biotensegracji. Jest próbą zwrócenia uwagi na ważny aspekt kliniczny, jakim jest wyżej opisany związek i obejmuje 88 pozycji bibliografii, które odnaleziono korzystając z wyszukiwarki PubMed. Na podstawie licznych prac światowych i polskich wysunięto wnio�sek, że istnieje zależność między dysfunkcjami stawu skroniowo-żuchwowego a wadami postawy ciała. Słowa kluczowe: dysfunkcje stawów skroniowo-żuchwowych, tensegracja, wady postawy Abstract The temporomandibular joint is an important part of the chewing apparatus and the speech apparatus. It is an even structure made up of soft tissues (muscles, fascia, ligaments) and hard tissues (bone tissue). Temporomandibular joint dysfunctions occur frequently and include many individual pathologies that manifest themselves in various symptoms, and the most common ones are pain complaints. Faulty body posture is any deviation from the normal system of sections without pathological changes, which guarantees stability and balance with minimal physical effort and ensuring optimal static-dynamic performance and ensuring proper development and functio�ning of internal organs. This work is a review of world and Polish literature regarding the search for a relationship between the defects of body posture and dysfunction of the temporomandibular joint, which, in the light of current medical knowledge, is explained by the phenomenon of biotensegracja. It is an attempt to draw attention to an important clinical aspect, which is the above-described rela�tionship and includes 88 items of bi-tracts, which were found using the PubMed search engine. On the basis of numerous world and Polish works, it was concluded that there is a relationship between temporomandibular joint dysfunctions and defects in body posture. Key words: dysfunction of stomatoghnatic system, tensegration, defects of posture
... This exercise affects more than one direction and facilitates multiple muscle works during exercise. 22 This study aimed to evaluate the effects of modified scapular exercise on neck disability index score, pain score, and contraction force of upper trapezius, rhomboid, and serratus anterior muscles. We hypothesized that the neck disability index (NDI) score, pain score, and muscle strength of upper trapezius, rhomboid, and serratus anterior were better in the intervention group. ...
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... One of these fascial chains is the superficial backline (SBL), whose existence is widely accepted. It expands from the plantar fascia (PF), over the Achilles tendon, the gastrocnemii muscles, the hamstrings, the sacrotubero-us ligament, the back and, eventually, the head (Myers, 2013;Stecco et al., 2019;Wilke et al., 2016). Prior reviews have shown that self-and manual massage techniques (SMM) increased acutely either the range of motion of single joints or along myofascial chains (Cheatham et al., 2015;Hughes and Ramer, 2019;Wiewelhove et al., 2019;Wilke et al., 2020a;. ...
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Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.
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Background: Acupuncture and myofascial meridians show great anatomical and clinical compatibility. Objectives: We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. Methods: We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Results: Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Conclusion: Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.
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Riassunto Questo articolo sotto forma di parere di esperti mira a fornire un aggiornamento sulle attuali conoscenze su una patologia che causa dolore anteriore al ginocchio: la sindrome femoro-rotulea. Sono elencati elementi di epidemiologia ed eziologia al fine di comprendere meglio il contesto di questa gestione. Sono dettagliati i mezzi diagnostici allo scopo di poter realizzare diagnosi differenziali che consentano di escludere altre patologie. Con l’obiettivo di migliorare la prognosi formulata dai clinici, sono proposti classificazioni e sottogruppi di patologia. Analogamente, è affrontata una dimensione psicosociale attraverso l’importanza dell’esame soggettivo e l’inclusione nel ragionamento clinico dei fattori non biomeccanici. Sono sviluppati diversi tipi di trattamento, ponderati in base al livello di evidenza nella letteratura scientifica, per rispondere al meglio ai risultati dell’esame.
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Resumen Este artículo, en forma de opinión de expertos, tiene como objetivo revisar los conocimientos actuales de una enfermedad que causa dolor anterior en la rodilla: el síndrome femoropatelar. Se presenta un inventario de elementos epidemiológicos y etiológicos, a fin de entender mejor el contexto de los tratamientos. Se detallan los medios diagnósticos destinados a llevar a cabo el diagnóstico diferencial y excluir otras enfermedades. Con el objetivo de mejorar el pronóstico que establecen los clínicos, se proponen clasificaciones y subagrupaciones de la enfermedad. Del mismo modo, se aborda la dimensión psicosocial a través de la importancia de la exploración subjetiva y la consideración de factores no biomecánicos en el razonamiento clínico. Se desarrollan diferentes tipos de tratamiento, ponderados por su nivel de evidencia en la literatura científica, con el fin de responder de la mejor manera posible a los resultados de la exploración.
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Foam rolling (FR) is a practice that has increased in popularity before and after resistance training. The purpose of this study was to compare the acute effects of different foam rolling periods for the lower body muscles on subsequent performance, myoelectric activity and rating of perceived exertion in trained men. Fourteen men (26.2 ± 3.2 years, 178 ± 0.04 cm, 82.2 ± 10 kg and body mass index 25.9 ± 3.3kg/m-2) volunteered for this study. Four repetition maximum (4-RM) loads were determined for hexagonal bar deadlift and 45°-angled leg press during test and retest sessions over two nonconsecutive days. The experimental conditions included a traditional protocol (TP) with no prior foam rolling, and four other conditions that involved FR applied to the quadriceps, hamstrings and triceps surae for one set of 30 sec (P1), two sets of 30 sec (P2), three sets of 30 sec (P3), or four sets of 30 sec (P4).The resistance training consisted of five sets with 4-RM loads. The number of repetitions completed, the myoelectric activity of lower limbs were recorded, as well as the rating of perceived exertion for each protocol. There were no differences between the protocols in the total repetitions for the hexagonal bar deadlift and 45° angled leg press exercises. Similar results between protocols were also noted for muscle activity and rated perceived exertion (RPE). Therefore, the results of the present study indicated that the FR didn't provide effects on performance, myoelectric activity and rating of perceived exertion responses during high intensity resistance performance for lower limb exercises.
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Background The fascial system not only enables the body to operate in an integrated manner but modifies its tension in response to the stress on it. Recent animal, cadaveric and in-vitro trials have shown that “myofascial force transmission” (MFT) can play a major role in homeostasis, musculoskeletal function and pain. Human evidence for the in-vivo existence of MFT is scarce. Objective This scoping review attempts to gather and interpret the available evidence of the in-vivo existence of MFT in humans, its role in homeostasis, and musculoskeletal function. Method A search of major databases using the keywords 'myofascial force transmission' and 'epimuscular force transmission' yielded 247 articles as of November 2021. For the final analysis, only original in-vivo human studies were considered. In-vitro human studies, cadaveric or animal studies, reviews, and similar studies were excluded. A qualitative analysis of the studies was conducted after rating it with the Oxford's Center for Evidence –based Medicine (CEBM) scale. Result Twenty studies ranging from randomized controlled trials (RCTs) to case studies covering 405 patients have been included in this review. The analysed trials were highly heterogeneous and of lower methodological quality meddling with the quantitative analysis. The majority of the appraised studies demonstrated a higher probability of MFT existence, while two studies revealed a lower probability. Conclusion Our search for proof of the in vivo existence of MFT in humans has led us to support such an existence, albeit prudently. Previous research on animals and human cadavers reinforces our finding. We are optimistic that the forthcoming studies on the topic will pave the way for the unraveling of several musculoskeletal riddles that are currently unknown or less well-known.
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[Purpose] This study aimed to clarify the change in hamstrings’ flexibility and its gender difference due to elastic taping of the sole of the dominant foot. [Participants and Methods] Thirty-three healthy university students’ (15 males, 18 females, average age 20.7 ± 0.6 years) hip joint range of motion (straight leg raising (SLR) angle), flexibility (finger-floor distance: FFD), muscle strength, and balance ability were measured. The measured items were compared between before and after the taping, and also between males and females. [Results] After the taping, the SLR angle and FFD significantly improved in both males and females. There was no gender difference in the rate of change in SLR. [Conclusion] It was clarified that elastic taping of the sole immediately and remotely improved the hip joint range of motion, and that the improvement effect of elastic tapes on the flexibility of hamstrings seems not to be affected by gender.
Thesis
Gymnastische Bewegungsprogramme sind Gegenstand vieler Aufwärm-, Regenerations- oder auch Belastungskompensations-Trainings. Im Fitness- und Präventionssport machen sie komplette Übungsprogramme aus. Myofasziale Dysbalancen prädisponieren zu Schädigungen der Weichteile, der Wirbel- und Körpergelenke sowie der Bandscheiben. Es gibt Hinweise, dass Bewegungsprogramme (Kraft- und Dehnungsprogramme) zur Vorbeugung von Verletzungen vorteilhaft sind. Diese Studie überprüft die Wirkung eines 30-minütigen Mobilitätstraining auf die Myofaszie des Rückens und der Extremitäten. Der Interventionszeitraum überdauerte 12 Wochen. Analysiert wurde die Veränderung des Bewegungsumfangs der Gelenke (ROM) an 27 Messbereichen, die Gewebesteifigkeit an 22 Messbereichen mit der Scherwellen Elastografie (SWE - large area shear wave elastopgraphy), die Druckschmerzschwellenveränderung (PPT) an zwei Körperregionen und die Veränderungen der subjektiven Befindlichkeit für Schmerz, Verspannung und Missempfindung. Die Stichprobe bildete eine Kohorte des Landeskriminalamtes, das SEK Niedersachsen. Die Analyse der Ergebnisse basiert auf dem aktuellen Forschungsstand zum faszialen System. Bisherige Studien an der Myofaszie erfolgten in vitro, an Tiermodellen und in der pathologischen humanen Anatomie. Die vorliegende Studie unternimmt den Versuch, Erklärungsmodelle für die Wirkung von Bewegung auf die Myofaszie am lebenden Menschen zu finden. Für dieses Verfahren wurden sechs Basistechniken für die Bewegung entwickelt. Die aus der Studie resultierenden Ergebnisse und Schlussfolgerungen könnten zukünftig helfen frühzeitige Diagnosen für myofaszialen Dysbalancen zu stellen und die daraus resultierenden Schmerzen sowie Funktionsstörungen zu vermeiden. Darüber hinaus ließen sich neue Strategien in der präventiven Sport- und Bewegungstherapie ableiten.
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Background Myofascial Pain Syndrome (MPS) is a common, overlooked, and underdiagnosed condition and has significant burden. MPS is often dismissed by clinicians while patients remain in pain for years. MPS can evolve into fibromyalgia, however, effective treatments for both are lacking due to absence of a clear mechanism. Many studies focus on central sensitization. Therefore, the purpose of this scoping review is to systematically search cross-disciplinary empirical studies of MPS, focusing on mechanical aspects, and suggest an organic mechanism explaining how it might evolve into fibromyalgia. Hopefully, it will advance our understanding of this disease. Methods Systematically searched multiple phrases in MEDLINE, EMBASE, COCHRANE, PEDro, and medRxiv, majority with no time limit. Inclusion/exclusion based on title and abstract, then full text inspection. Additional literature added on relevant side topics. Review follows PRISMA-ScR guidelines. PROSPERO yet to adapt registration for scoping reviews. Findings 799 records included. Fascia can adapt to various states by reversibly changing biomechanical and physical properties. Trigger points, tension, and pain are a hallmark of MPS. Myofibroblasts play a role in sustained myofascial tension. Tension can propagate in fascia, possibly supporting a tensegrity framework. Movement and mechanical interventions treat and prevent MPS, while living sedentarily predisposes to MPS and recurrence. Conclusions MPS can be seen as a pathological state of imbalance in a natural process; manifesting from the inherent properties of the fascia, triggered by a disrupted biomechanical interplay. MPS might evolve into fibromyalgia through deranged myofibroblasts in connective tissue (“fascial armoring”). Movement is an underemployed requisite in modern lifestyle. Lifestyle is linked to pain and suffering. The mechanism of needling is suggested to be more mechanical than currently thought. A “global percutaneous needle fasciotomy” that respects tensegrity principles may treat MPS/fibromyalgia more effectively. “Functional-somatic syndromes” can be seen as one entity (myofibroblast-generated-tensegrity-tension), sharing a common rheuma-psycho-neurological mechanism.
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Introduction Manual clinical tests must be highly reliable and valid to help in diagnosing, monitoring, and treating patients. Recent research highlighted the role of the fascia; thus, it is important to develop inexpensive, easy-to-use, and clinically valid procedures to assess this tissue in the field of manual therapy. The purpose of this study was to determine the level of inter- and intra-examiner concordance when performing a fascial standing flexion test in children. Design The present study is a descriptive observational study. Methods Two examiners tested 24 healthy children between 11 and 12 years of age performing two trials with the proposed fascial test. Inter- and intra-examiner data were analyzed using unweighted kappa coefficients and percentage agreement. Results We observed zero inter-examiner reliability in the fascial standing flexion test (mean = −0.071, mean percentage agreement of 43.7%), and moderate intra-examiner reliability (mean = 0.693, mean percentage agreement of 85.4%). Conclusion The reliability and validity of the fascial standing flexion test must be improved before it can be recommended for use in a clinical setting.
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Résumé Françoise Mézières peut être considérée comme l’une des figures marquantes de l’histoire de la physiothérapie. Le modèle théorico-technique qu’elle a élaboré dans les années 1950 reste encore vivant aujourd’hui, avec de nombreuses réinterprétations au fil des ans motivées par les progrès de la science et la capacité de recherche croissante des kinésithérapeutes. La Reconstruction posturale (RP), promue par Michaël Nisand, proche collaborateur de l’auteur durant sa dernière période d’enseignement, constitue une de ces réinterprétations. Dans les années 1990, Nisand formalise sa propre compréhension de la méthode Mézières en proposant, entre autres éléments, une manière différente d’interpréter l’origine des déformations corporelles et une autre vision des réponses neuromusculaires déclenchées par les manœuvres thérapeutiques de Mézières.Le grand tournant entre Mézières et Nisand a été le passage du paradigme mécanique, où les muscles raccourcis constituent l’élément principal, à un paradigme neuromusculaire où les déséquilibres du tonus musculaire constitueraient l’élément déclencheur des dysmorphies et donc, le facteur étiologique clé.
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Bernstein's (1996) levels of movement organization includes tonus, the muscular-contraction level that primes individual movement systems for (re)organizing coordination patterns. The hypothesis advanced is that the tonus architecture is a multi-fractal tensegrity system, deeply reliant on haptic perception for regulating movement of an individual actor in a specific environment. Further arguments have been proposed that the tensegrity-haptic system is implied in all neurobiological perception and -action. In this position statement we consider whether the musculoskeletal system can be conceptualized as a neurobiological tensegrity system, supporting each individual in co-adapting to many varied contexts of dynamic performance. Evidence for this position, revealed in investigations of judgments of object properties, perceived during manual hefting, is based on each participant's tensegrity. The implication is that the background organizational state of every individual is unique, given that no neurobiological architecture (musculo-skeletal components) is identical. The unique tensegrity of every organism is intimately related to individual differences, channeling individualized adaptations to constraints (task, environment, organismic), which change over different timescales. This neurobiological property assists transitions from one stable state of coordination to another which is needed in skill adaptation during performance. We conclude by discussing how tensegrity changes over time according to skill acquisition and learning.
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Objective To compare the effects of pre-planned and unplanned movement tasks on knee biomechanics in uninjured individuals. Design Systematic review with meta-analysis. Data sources Five databases (PubMed, Google Scholar, Cochrane Library, ScienceDirect and Web of Science) were searched from inception to November 2020. Cross-sectional, (randomised) controlled/non-controlled trials comparing knee angles/moments of pre-planned and unplanned single-leg landings/cuttings were included. Quality of evidence was assessed using the tool of the Grading of Recommendations Assessment, Development and Evaluation working group. Methods A multilevel meta-analysis with a robust random-effects meta-regression model was used to pool the standardised mean differences (SMD) of knee mechanics between pre-planned and unplanned tasks. The influence of possible effect modifiers (eg, competitive performance level) was examined in a moderator analysis. Results Twenty-five trials (485 participants) with good methodological quality (Downs and Black) were identified. Quality of evidence was downgraded due to potential risk of bias (eg, confounding). Moderate-quality evidence indicates that unplanned tasks evoked significantly higher external knee abduction (SMD: 0.34, 95% CI: 0.16 to 0.51, 14 studies) and tibial internal rotation moments (SMD: 0.51, 95% CI: 0.23 to 0.79, 11 studies). No significant between-condition differences were detected for sagittal plane mechanics (p>0.05). According to the moderator analysis, increased abduction moments particularly occurred in non-professional athletes (SMD: 0.55, 95% CI: 0.14 to 0.95, 5 studies). Conclusion Unplanned movement entails higher knee abduction and tibial internal rotation moments, which could predispose for knee injury. Exercise professionals designing injury-prevention protocols, especially for non-elite athletes, should consider the implementation of assessments and exercises requiring time-constrained decision-making. PROSPERO registration number CRD42019140331.
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Chiropractors, physiotherapists, and osteopaths receive training in the diagnosis and management of musculoskeletal conditions. As a result there is considerable overlap in the types of conditions that are encountered clinically by these practitioners. In Australia, the majority of benefits paid for these services come from the private sector. The purpose of this article is to quantify and describe the development in service utilization and the cost of benefits paid to users of these healthcare services by private health insurers. An exploration of the factors that may have influenced the observed trends is also presented. A review of data from the Australian Bureau of Statistics, Australian Health Practitioner Regulation Agency, and the Australian Government Private Health Insurance Administration Council was conducted. An analysis of chiropractic, physiotherapy and osteopathic service utilisation and cost of service utilisation trend was performed along with the level of benefits and services over time. In 2012, the number of physiotherapists working in the private sector was 2.9 times larger than that of chiropractic, and 7.8 times that of the osteopathic profession. The total number of services provided by chiropractors, physiotherapists, and osteopaths increased steadily over the past 15 years. For the majority of this period, chiropractors provided more services than the other two professions. The average number of services provided by chiropractors was approximately two and a half times that of physiotherapists and four and a half times that of osteopaths. This study highlights a clear disparity in the average number of services provided by chiropractors, physiotherapists, and osteopaths in the private sector in Australia over the last 15 years. Further research is required to explain these observed differences and to determine whether a similar trend exists in patients who do not have private health insurance cover.
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The pattern of formation of the human rectus sheath exhibits variations, it is not clear if these variations are population specific. This study aimed at describing the pattern of formation of the rectus sheath in a select Kenyan population. Formation of the rectus sheath was analyzed in eighty subjects (47 male, 33 female) during autopsies and cadaveric dissection. The anterior wall of the rectus sheath in all cases was aponeurotic and firmly attached to rectus abdominis muscle. The posterior wall of the rectus sheath was aponeurotic in 71 (88.5%) cases, the rest were musculoaponeurotic and only seen in males. In all cases the aponeurosis of internal oblique abdominis split into two lamina; a deep lamina that fused with the aponeurosis of transverses abdominis at the lateral border of rectus abdominis and a superficial lamina that fused with aponeurosis of external oblique abdominis mid-way between the medial and lateral borders of rectus abdominis muscle. The pattern of formation of the rectus sheath among Kenyans shows some variations which have not been reported by previous workers. Knowledge of these variations is important in surgery as this sheath is always incised when making most aabdominal incisions.
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Background: The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis. Methods: A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers. Results: Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of 94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study. Conclusion: Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants. Clinical relevance: The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol. Level of evidence: Level III, case control study.
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Background Chiropractic and osteopathy form a significant part of the healthcare setting in rural and regional Australia, with national registration of practitioners, public subsidies for services and high utilisation by the Australian public. However, despite their significant role in rural and regional Australia, there has been little exploration of the interface between chiropractic and osteopathy and conventional primary health care practitioners in this area. The study aim was to examine the referral practices and factors that underlie referral to chiropractors and osteopaths by rural and regional Australian general practitioners (GPs), by drawing on a sample of GPs in rural and regional New South Wales. Methods A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. Results A total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as “no longer at this address” (response rate: 40.7%). The majority of GPs (64.1%) referred to a chiropractor or osteopath at least a few times per year while 21.7% stated that they would not refer to a chiropractor or osteopath under any circumstances. Patients asking the GP about CAM (OR=3.59; CI: 1.12, 11.55), GP’s use of CAM practitioners as a major source of information (OR=4.39; 95% CI: 2.04, 9.41), lack of other treatment options (OR=2.41; 95% CI: 1.18, 5.12), access to a wide variety of medical specialists (OR=12.5; 95% CI: 2.4, 50.0), GP’s belief in the efficacy of chiropractic and osteopathy services (OR=3.39; 95% CI: 2.19, 5.25) and experiencing positive results from patients using these services previously (OR=1.67; CI: 1.02, 2.75) were all independently predictive of increased referral to chiropractic and osteopathy services amongst the rural GPs. Conclusions There is a significant interface between chiropractic and osteopathy and Australian rural and regional general practice in New South Wales. Although there is generally high support for chiropractic and osteopathy among Australian GPs, this was not absolute and the heterogeneity of responses suggests that there remain tensions between the professions. The significant interface between chiropractic and osteopathy may be due in part to the inclusion of these professions in the publicly subsidised national healthcare delivery scheme. The significant impact of chiropractic and osteopathy and general practice in rural and regional Australian healthcare delivery should serve as an impetus for increased research into chiropractic and osteopathy practice, policy and regulation in these areas.
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Summary. Sacroiliac joint dysfunction is often overlooked as a possible cause of low back pain. This is due to the use of reductionistic anatomical models. From a kinematic point of view, topographic anatomical models are generally inadequate since they categorize pelvis, lower vertebral column and legs as distinct entities. This functional-anatomical study focuses on the question whether anatomical connections between the biceps femoris muscle and the sacrotuberous ligament are kinematically useful. Forces applied to the tendon of the biceps femoris muscle, simulating biceps femoris muscle force, were shown to influence sacrotuberous ligament tension. Since sacrotuberous ligament tension influences sacroiliac joint kinematics, hamstring training could influence the sacroiliac joint and thus low back kinematics. The clinical implications with respect to 'short' hamstrings, pelvic instability and walking are discussed.
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[Purpose] The purpose of the present study was to examine the immediate effects of passive hamstring stretching exercises on cervical spine range of motion and balance. [Subjects] The present study was conducted with 60 healthy university students without any musculoskeletal dysfunction as subjects. They were divided into an experimental group consisting of 30 subjects and a control group consisting of 30 subjects. [Methods] Cervical spine range of motion was measured using a cervical range of motion goniometer, and the stability test was conducted to assess balance. The experimental group were administered hamstring stretching with ankle dorsiflexion for 30 seconds three times, whereas the control group received the same treatment without ankle dorsiflexion. [Results] Cervical spine range of motion and balance immediately increased in the experimental group while there was no change in the control group. [Conclusion] The results show that hamstring muscle stretching exercises the fascia of the skeletal muscles of the human body and that the fascia are connected to each other by interactions of force. The human skeletal muscles interacted with each other to increase the flexion and extension range of motion of the cervical spine. In addition, the transfer of these forces to the stabilizer muscles of the pelvis and spine were the most important factor in the improvement of the subjects' balance.
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[Purpose] The purpose of this study was to examine the effect of forward head posture on ankle joint range of motion and static balance. [Subjects] The study subjects were on 51 healthy undergraduates (22 males and 29 females) who had not experienced cervical or shoulder pains, or hospital diagnosis of musculoskeletal dysfunction in the previous four weeks. [Methods] The cranial vertical angle (CVA) was measured to investigate forward head posture, and the Tetrax Portable Multiple System (Tetrax Ltd, 56 Miryam Ramat Gan, Sunlight, Israil) was used to measure static balance using the stability test index (STI). Distal dualer-IQ (JTECH Medical, USA) was used to measure ankle joint range of motion. [Results] Cranial vertical angle had an influence on ankle joint plantarflexion, but no influence on static balance. [Conclusion] Forward head posture was shown to transmit tension to the ankle joint through the superficial back-line, one of the myofascial meridians connected to the fascia, which suggests that tension in the neck muscles influence the ankle joints.
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To investigate whether Myofascial release (MFR) when used as an adjunct to specific back exercises (SBE) reduces pain and disability in chronic low back pain (CLBP) in comparison with a control group receiving a sham Myofascial release (SMFR) and specific back exercises (SBE) among nursing professionals. Randomized, controlled, single blinded trial. Nonprofit research foundation clinic in Kerala, India. Nursing professionals (N = 80) with chronic low back pain (CLBP). MFR group or control group. The techniques were administered by physiotherapists certified in MFR and consisted of 24 sessions per client over 8 weeks. The McGill Pain Questionnaire (MPQ) was used to assess subjective pain experience and Quebec Back Pain Disability Scale (QBPDS) was used to assess the disability associated with CLBP. The primary outcome measure was the difference in MPQ and QBPDS scores between week 1 (pretest score), week 8 (posttest score), and follow-up at week 12 after randomization. The simple main effects analysis showed that the MFR group performed better than the control group in weeks 8 and 12 (P < 0.005). The patients in the MFR group reported a 53.3% reduction in their pain and 29.7% reduction in functional disability as shown in the MPQ and QBPDS scores in week 8, whereas patients in the control group reported a 26.1% and 9.8% reduction in their MPQ and QBPDS scores in week 8, which persisted as a 43.6% reduction of pain and 22.7% reduction of functional disability in the follow-up at week 12 in the MFR group compared to the baseline. The proportion of responders, defined as participants who had at least a 50% reduction in pain between weeks 1 and 8, was 73% in the MFR group and 0% in the control group, which was 0% for functional disability in the MFR and control group. This study provides evidence that MFR when used as an adjunct to SBE is more effective than a control intervention for CLBP in nursing professionals.
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The purpose of this case report is to describe the use of dry needling based on myofascial meridians for management of plantar fasciitis. A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity. Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient. Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis.
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Scarce evidence exists about effectiveness and mechanisms of action of Kinesio tape (KT) application. To evaluate the effect of KT application over the gastrocnemius or hamstring on range of motion and peak force. Thirty-six physical therapy students participated (18 per group). KT was applied with 30% tension for 48 h to: Group 1 - the gastrocnemius; Group 2 - the hamstrings. The straight leg raise (SLR), knee extension angle (KEA), weight bearing ankle dorsiflexion, gastrocnemius, quadriceps and hamstrings peak forces were evaluated prior to application, 15 min and 48 h after. A significant increase of peak force in the gastrocnemius group appeared immediately and two days later; no immediate change of peak force in the hamstrings group, however, two days later, peak force significantly increased. SLR and ankle dorsiflexion increased immediately in the gastrocnemius group; KEA improved significantly only after two days. It is possible that certain muscles react differently when KT is applied, and the effect may be subsequently detected.
Article
Objective To map the association of muscle activations along the superficial back line (SBL) using separate conditions of active range of motion with and without resistance and passive range of motion. Method Using surface electromyography, electrodes were placed at specific points along the SBL. Twenty healthy adult males (aged 25.35 ±1.24 years and body mass index 23.78±2.12) underwent five test conditions. Conditions 1-3 involved passive movement, active movement and active movement against maximum isometric resistance (IR) of the right gastrocnemius and conditions 4 and 5 involved neck extension without and with isometric resistance from prone position. Results Passive and active motion without resistance found no significant (p>0.05) correlations at any electrodes. Maximum IR yielded significant (p<0.05) correlations with medium to very strong correlations at almost all electrodes. Neck extension without and with resistance showed significant medium to very strong correlations though the posterior superior iliac spine and right hamstring, respectively. Conclusion Results demonstrated significant associations between the test condition muscle activations and muscle activations along the contiguous SBL. Thus, showing a need for a complete evaluation of the SBL in patients suffering from myofascial pain at all locations along it.
Article
Background Scarce evidence exists about effectiveness and mechanisms of action of Kinesio tape (KT) application. Objectives To evaluate the effect of KT application over the gastrocnemius or hamstring on range of motion and peak force. Methods Thirty-six physical therapy students participated (18 per group). KT was applied with 30% tension for 48 h to: Group 1 – the gastrocnemius; Group 2 – the hamstrings. The straight leg raise (SLR), knee extension angle (KEA), weight bearing ankle dorsiflexion, gastrocnemius, quadriceps and hamstrings peak forces were evaluated prior to application, 15 min and 48 h after. Results and conclusions A significant increase of peak force in the gastrocnemius group appeared immediately and two days later; no immediate change of peak force in the hamstrings group, however, two days later, peak force significantly increased. SLR and ankle dorsiflexion increased immediately in the gastrocnemius group; KEA improved significantly only after two days. It is possible that certain muscles react differently when KT is applied, and the effect may be subsequently detected.
Article
There is not full agreement regarding the distal insertions of the gluteus maximus muscle (GM), particularly the insertions into the iliotibial band and lateral intermuscular septum. 6 cadavers, 4 males and 2 females, mean age 69 yr, were dissected to evaluate the insertions of the GM into the iliotibial band, fascia lata, lateral intermuscular septum and femur. The iliotibial band is a reinforcement of the fascia lata and cannot be separated from it. Its inner side is in continuity with the lateral intermuscular septum, which divides the quadriceps from the hamstring. In all subjects the gluteus maximus presented a major insertion into the fascia lata, so large that the iliotibial tract could be considered a tendon of insertion of the gluteus maximus. The fascial insertion of the gluteus maximus muscle could explain the transmission of the forces from the thoracolumbar fascia to the knee.