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Immediate effects of myofascial release treatment on lumbar
microcirculation: a randomized, placebo-controlled trial
Andreas Brandl 1,2,3,*; Christoph Egner 3; Rüdiger Reer 1, Tobias Schmidt 4,5, Robert Schleip 3,6
Inflammatory processes in the thoracolumbar
fascia (TLF) lead to thickening, compaction,
and fibrosis and are thought to contribute to
the development of nonspecific low back
pain1. The blood flow (BF) of fascial tissue may play a
critical role in this process, as it may promote hypoxia-
induced inflammation. In osteopathic myofascial release
(MFR) treatment, mechanical shearing motion
(combination of compression and stretching) is applied
with low force and slow speed2. This is thought to result
in a lasting change in the morphology of the fascia and
also its hydration, because fascial tissue response to
balanced, sustained stretching is more likely than to
intermittent, uneven loads3.
The primary objective of the study was to
examine the immediate effects of a set of MFR
techniques and a sham treatment on the BF of
lumbar myofascial tissue. The secondary ob-
jectives were to evaluate the influence of TLF mor-
phology (TLFM), physical activity (PA), and body mass
index (BMI) on these parameters and their correlations
with each other.
Introduction
1University of Hamburg, 2Vienna School of Osteopathy, 3DIPLOMA Hochschule, 4Osteopathieschule Deutschland, 5Medical School Hamburg, 6Technical University of Munich; * correspondence: andreas.brandl@wso.at
Keywords Microcirculation; thoracolumbar fascia; fascia morphology; physical activity; myofascial release; osteopathy
Methodology
Objectives
Ethics Committee: DIPLOMA Hochschule (Nr. 1014/2021,27.10.2021).
Registration: German Clinical Trials Register (DRKS00028780)
This study was a single-blind, randomized,
placebo-controlled trial. Thirty pain-free subjects
(40.5 ±14.1 years) were randomly assigned to two
groups treated with a single set of MFR
techniques or a placebo intervention. Correlations between
PA, BMI, and TLFM were calculated at baseline. The effects
of MFR and TLFM on BF (measured with white light and laser
Doppler spectroscopy) were determined. A detailed descript-
tion of the MFR techniques can be found in Figure 1.
Results
Mense5described mechanosensitive varicosities (axonal wide-
nings storing neuropeptides and neurotrophins) in free nerve
endings of TLF innervating their arterioles. Mechanical stimuli
release these contents, leading to vasodilation of adjacent
arterioles and an increase in BF. The TLF is rhombically pervaded by this
dense nerve network.
Discussion/Conclusion
Original title available at DOI: 10.3390/jcm12041248
Figure 1. Myofascial release and placebo treatment at the
TLF. A. Sustained manual pressure to the lateral raphe. B.
Lateral stretching of the TLF. C. Longitudinal glide along the
lumbar paravertebral muscles. D. Longitudinal stretch of
the TLF. E. Unilateral longitudinal stretch of the TLF. Blue
arrows show the direction of tissue stretching in the
myofascial release treatment. In the placebo treatment, the
hands were instead left in place with minimal pressure.
Ultrasound images of the TLF were taken and the TLFM was divided into 4 groups
according to De Coninck et al.4: group 1: very disorganized, group 2: somewhat
disorganized, group 3: somewhat organized, group 4: very organized.
•The MFR group had a significant increase in BF after treatment
(31.6%) and at 40-minute follow-up (48.7%) compared with the
placebo group (p < 0.001).
•BF was significantly different and up to 2.5 fold higher in organized
than in disorganized TLFM (p < 0.001).
•There was a strong positive correlation between PA and TFLM
(r = 0.648; p < 0.001), and a strong negative correlation between, BMI
and TLFM (r = –0.798; p < 0.001).
The differences between MFR and placebo groups are shown in Figure 2.
The differences between TLFM groups are shown in excerpts in Table 1.
Figure 2. Relative changes in percent compared to baseline
measurement. For better readability, the error bars are only
shown on one side and represent the standard deviation. t0,
baseline measurement; t1, measurement after treatment; t2,
measurement 40 minutes after treatment; SO2, oxygen
saturation; rHb, relative hemoglobin. Group differences,
significant at the level * < 0.05,** < 0.01,**** < 0.001.
TLF groups Mean (AU; 95% CI) p (adj.)
1 (n=5) 3 (n=9) 31.0 (4.7 –57.3) 0.0167
1 (n=5) 4 (n=9) 75.2 (48.9 –102) < 0.001
2 (n=5) 4 (n=9) 74.3 (50.5 –98.1) < 0.001
Table 1. Influence of thoracolumbar fascia morphology on blood flow. AU,
arbitrary units; n, number, adj., Bonferroni adjusted.
Impaired blood flow
could lead to hyp-
oxia-induced inflam-
mation, possibly re-
sulting in pain and
impaired proprioce-
ptive function, there-
by likely contributing
to the development
of nonspecific low
back pain. Fascial re-
strictions of blood
vessels and free ner-
ve endings, which
are likely associated
with TLFM, could be
positively affected
by the osteopathic
intervention in this
study (Figure 3).
Figure 3. Thoracolumbar fascia of a patient with acute lumbar back pain. The red
circles show adhesions 24 hours after lumbago, likely causing the posterior layer to
take on an undulating shape (a). 10 days after myofascial release treatment, the
adhesions disappeared and the pain subsided completely. The fascia was then rated
as 'very organized' (b). *DER, dermis; *SAT, subcutaneous adipose tissue; *TFL,
thoracolumbar fascia; *ES, erector spinae; ROI, region of interest, zones rated.
References: 1. Willard, F.H. et al.The Thoracolumbar Fascia: Anatomy, Function and Clinical Considerations. J. Anat. 2012,221
2. Ajimsha, M.S. et al. Effectiveness of Myofascial Release: Systematic Review of RCT. J. Bodyw. Mov. Ther. 2015,19
3. Schleip, R.; et al. Strain Hardening of Fascia. J. Bodyw. Mov. Ther. 2012,16
4. De Coninck et al. Measuring the Morphological Characteristics of Thoracolumbar Fascia in Ultrasound Images.
BMC Musculoskelet. Disord. 2018, 19,
5. Mense, S. Innervation of the Thoracolumbar Fascia. Eur J Transl Myol 2019, 29
ORI Poster Award 2023