Evaluating the Effectiveness of Radiofrequency Therapy and Manual Pelvic Fascial Release in Treating Myofascial Pelvic Pain.

INTRODUCTION AND HYPOTHESIS: Myofascial pelvic pain (MFPP), characterized by sensitive trigger points in the pelvic floor muscles, leads to chronic pain and affects various aspects of life. Despite the availability of different treatment modalities, there is limited comparative research on their effectiveness. This study compares radiofrequency (RF) therapy and myofascial manual therapy (MMT) in treating MFPP. We aimed to evaluate pelvic floor muscle strength changes, clinical symptoms, and patient comfort during treatment. METHODS: The study involved 176 participants, divided equally into RF and MMT groups. We assessed pelvic floor pain using the Visual Analogue Scale (VAS), muscle strength using the Modified Oxford Scale (MOS) and surface electromyography (sEMG), clinical symptom improvement through questionnaires, and patient discomfort during treatment. RESULTS: Both RF and MMT groups significantly reduced pelvic floor and paraurethral muscle pain (VAS scores, p < 0.001). RF treatment significantly decreased vaginal laxity in its group (p < 0.001), with no notable change in the MMT group (p = 0.818). RF therapy also resulted in greater patient comfort than MMT (p < 0.001). Although both treatments improved clinical symptoms, there was no significant difference between the two (p = 0.692). MOS scores and pelvic floor sEMG values showed no significant differences between the groups before and after treatment (p > 0.05). CONCLUSIONS: Both RF and MMT effectively alleviate pelvic floor pain and improve clinical symptoms in MFPP patients. RF therapy, however, offers additional benefits in reducing vaginal laxity and enhancing treatment comfort.

Efficacy of Myofascial Release With Transcutaneous Electrical Nerve Stimulation Conductive Glove for Neck Myofascial Syndrome: A Randomized Clinical Trial Study.

OBJECTIVE: The purpose of this study was to assess the efficacy of a myofascial release (MR) protocol applied with a transcutaneous electrical nerve stimulation (TENS) conductive glove. METHODS: Eighty individuals with neck myofascial syndrome were randomly divided into 4 groups: (1) MR protocol with a TENS conductive glove (MR+TENS), (2) MR protocol without TENS (MR), (3) conventional TENS protocol (TENS), and (4) placebo TENS (control). All participants attended 6 sessions over a period of 3 weeks. The following measures were evaluated at baseline, at the third week, and at the 1-month follow-up: Pain with the visual analog scale (VAS pain), upper trapezius pressure pain threshold (PPT) with pressure algometry, cervical range of motion (ROM) with goniometry, and disability with the neck disability index (NDI). A 2-way ANOVA with repeated measurements was applied. RESULTS: Significant changes between the 3 intervention groups and the control group were noted in the VAS and the NDI scores (P < .05) with the MR+TENS group exhibiting the biggest difference. Additionally, MR significantly increased PPT compared to TENS, and even further when applied with the conductive glove (P < .05). Regarding lateral flexion ROM, MR was equally effective either alone or in combination with the glove compared to TENS (P < .05). In contrast, TENS did not appear to affect neck PPT and ROM (P > .05). Finally, no difference between the groups was detected in cervical rotation ROM (P > .05). CONCLUSION: The MR protocol appears to be more effective in dealing with pain, disability, and lateral flexion ROM than conventional TENS. A TENS conductive glove significantly improves the effects of MR, possibly due to the combined mechanical and electrical stimulation of the muscle.

Instrument-Assisted Soft Tissue Mobilization 2-Handed Grip Force Production Consistency During Simulated Treatment: A Technical Report.

CONTEXT: Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip. DESIGN: Randomized crossover study conducted in a university biomechanics laboratory. METHODS: Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (Fpeak) and average mean forces (Fmean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland-Altman plots were assessed. RESULTS: The clinicians' average Fpeak ranged from 3.0 N to 11.6 N and average Fmean from 1.9 N to 8.1 N. Fpeak CVs for all instruments ranged from 14% to 31%, and Fmean CVs ranged from 15% to 35%. Bland-Altman plots indicated that for both Fpeak and Fmean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9 N (91.8 g) to 4.1 N (418.1 g) for Fpeak and from 1.0 N (102.0 g) to 2.8 N (285.5 g) for Fmean. Thus, CVs, box and density plots, and Bland-Altman plots supported general force application consistency. CONCLUSION: Trained IASTM clinicians produced consistent treatment application forces (ie, Fpeak and Fmean) within treatment sessions during 2-handed simulated application.

Effects of Foam Rolling Prior to Proprioceptive Neuromuscular Facilitation Stretching on Hamstring Flexibility and Thigh Skin Temperature.

CONTEXT: Proprioceptive neuromuscular facilitation stretching (PNFS) is suggested to improve the range of motion and flexibility as an active warm-up. Recently, the foam rolling (FR) methods have also emerged as a passive warm-up. However, the combined effects of PNFS and FR are still unclear, and no reports have compared their effects using thermal imaging. This study investigated the acute effects of combining nonvibration FR (NVFR) and vibration FR (VFR) prior to PNFS, in comparison with PNFS alone, on hamstring flexibility and thigh skin temperature. DESIGN: Randomized controlled trial. METHODS: Participants (n = 60) were randomly assigned to PNFS, NVFR + PNFS, VFR + PNFS, and control group (CG). Active knee-extension (AKE), sit and reach (SR) test, and thermal imaging were evaluated before (pre-int), immediately after (post-int), and 30-minutes after (post30-int) intervention. RESULTS: All intervention groups had a significant increase at all time periods (P < .001) except the CG in terms of AKE and sit and reach test (P > .05). Combined (NVFR + PNFS/VFR + PNFS) groups had also a significant increase in the post30-int compared with pre-int and post-int values of thigh skin temperature (P < .001). Combined groups, over time, had the best post30-int effect on increasing skin temperature. The study found a significant interaction effect between interventions and time across several measurements (P < .05). Combined groups showed more significant improvements in AKE compared to CG at post-int (P < .05). There is a similar change in AKE, SR test, and skin temperatures between combined groups and PNFS alone at both post-int and post30-int (P < .05). CONCLUSIONS: These findings indicate that using FR, with or without vibration, before PNFS does not provide an additional benefit in improving hamstring flexibility and thigh skin temperatures compared with PNFS alone.

The Effects of Different Myofascial Release Techniques on Pain, Range of Motion, and Muscle Strength in Athletes With Iliotibial Band Tightness: A Randomized Controlled Study.

CONTEXT: We designed this study to investigate the effects of 2 myofascial release techniques, Instrument-Assisted Soft Tissue Mobilization (IASTM) and Foam Roller (FR), on pain, joint range of motion, and muscle strength in athletes suffering from iliotibial band (ITB) tightness. DESIGN: A total of 39 male soccer players were enrolled in this randomized controlled trial, aged between 18 and 23 years who were divided into 3 groups: Only Exercise, IASTM, and FR. METHODS: All participants performed daily strengthening and stretching exercises, while 1 group added IASTM, and the other added FR to the exercise program. We evaluated ITB tightness with the Ober test and an inclinometer, pressure pain threshold, using an algometer, and we evaluated muscle strength with the Cybex Norm Isokinetic device. RESULTS: We found that all 3 groups exhibited an increase in the Ober inclination angle after the interventions (P = .001), but the increase was greater for participants in the IASTM and FR groups, compared with exercise alone. Additionally, both the IASTM and FR groups displayed an increased pressure pain threshold (P = .001), whereas there was no change in the control group. Moreover, while all 3 groups experienced an increase in hip muscle strength (P = .001), the IASTM and FR groups exhibited a greater increase compared with exercise alone (P = .001). CONCLUSIONS: Based on these findings, exercise improves pain, range of motion, and muscle strength in athletes with ITB tightness, and IASTM, and FR techniques enhanced exercise effects but did not differ from one another. While our study demonstrated that both IASTM and FR techniques significantly enhance the benefits of exercise for athletes with ITB tightness, further research could delve into the long-term effects of these interventions.

Acute Effects of Local High-Frequency Percussive Massage on Deep Fascial and Muscular Stiffness and Joint Range of Motion in Young Adult Men.

BACKGROUND: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. METHOD: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. RESULTS: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. CONCLUSIONS: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently.

Comparison of the effects of different foam rolling durations on knee extensors function.

Foam rolling (FR) intervention has recently attracted attention in sports and rehabilitation settings. However, the effects of FR using different rolling durations have not been fully clarified. Thus, this study focused on FR durations and examined the acute and prolonged (i.e., 20-min; 40-min, 60-min) effects of different FR intervention durations on maximal voluntary concentric contractions (MVC-CON), knee flexion range of motion (ROM), pain pressure threshold (PPT), and tissue hardness. The participants were 10 male university students (22.5 ± 1.0 years), and the target muscles were the dominant leg knee extensors. Three sets of 60-seconds FR interventions were performed in the randomized crossover trials in each condition. The three intervention conditions were fast (1 rolling/2 s, 30-repetition × 3 sets, 90 repetitions), medium (1 rolling/6 s, 10-repetition × 3 sets, 30 repetitions), and slow speed (1 rolling/12 s, 5-repetition × 3 sets, 15 repetitions). Before as well as immediately, 20-min, 40-min, and 60-min after the interventions, MVC-CON, ROM PPT, and tissue hardness were measured. The results showed no interaction effect in the acute effect but a main effect of time for all variables (p < 0.05). Also, no interaction was observed in prolonged effect, but main effects of time were observed in knee flexion ROM, PPT, and tissue hardness (p < 0.01) but not for MVC-CON. Post-hoc tests showed significant PPT (p < 0.05) and knee flexion ROM (p < 0.01) increases up to 20- and 60-minutes respectively after all interventions. Tissue hardness was significantly (p < 0.01) decreased up to 60-minutes after all interventions. This study showed that the FR intervention changed ROM, PPT, tissue hardness, and MVC-CON regardless of rolling duration and that the effects persisted up to 20-60 minutes.

Effects of a Manual Treatment on Lumbar Microcirculation and Tissue Stiffness Following Submaximal Eccentric Trunk Extensor Exercise: A Randomized Controlled Trial.

Recent studies have shown that the extramuscular connective tissue (ECT) is thickened and stiffened in delayed onset muscle soreness (DOMS). However, contrarily to the normal population, severe DOMS is rare in athletes or highly trained individuals. The present randomized, controlled trial therefore aimed to investigate pain as well as microcirculation and stiffness of the ECT and the erector spinae muscle following submaximal eccentric trunk extension exercise not causing DOMS. The effect of manual treatment by a therapist (myofascial release; MFR) on these parameters was to be studied. Trained healthy participants (n = 21; 31.3 ± 9.6 years; > 4 h exercise per week) performed submaximal eccentric exercise of the trunk extensors. One group was manually treated (n = 11), while the other group (n = 10) received placebo treatment with sham laser therapy. Stiffness of the ECT and the erector spinae muscle (shear wave elastography), microcirculation (white light and laser Doppler spectroscopy), palpation pain (100 mm visual analogue scale, VAS) and pressure pain threshold (indentometry, PPT) were assessed before (t0), 24 h (t24) and 48 h (t48) after conditions. Erector spinae muscle stiffness increased after eccentric exercise from t0 to t24 (0.875 m/s) and from t0 to t48 (0.869 m/s). After MFR, erector spinae muscle stiffness decreased in contrast to placebo treatment at t24 (-0.66 m/s), while ECT stiffness remained unchanged. Oxygen saturation increased (17-20.93%) and relative haemoglobin decreased (-9.1 - -12.76 AU) after eccentric exercise and MFR differed from placebo treatment at t48 (-3.71 AU). PPT differed after MFR from placebo treatment at t48 (20.69 N/mm), while VAS remained unchanged. Multiple linear regression showed that ECT stiffness and group membership predicted erector spinae muscle stiffness. MFR could have a positive effect on pain, microcirculation and muscle stiffness after submaximal eccentric exercise, suggesting better recovery, which needs to be confirmed by future work.

Application of Component Separation and Short-Term Outcomes in Ventral Hernia Repairs.

INTRODUCTION: Component separation (CS) techniques have evolved in recent years. How surgeons apply the various CS techniques, anterior component separation (aCS) versus posterior component separation (pCS), by patient and hernia-specific factors remain unknown in the general population. Improving the quality of ventral hernia repair (VHR) on a large scale requires an understanding of current practice variations and how these variations ultimately affect patient care. In this study, we examine the application of CS techniques and the associated short-term outcomes while taking into consideration patient and hernia-specific factors. METHODS: We retrospectively reviewed a clinically rich statewide hernia registry, the Michigan Surgical Quality Collaborative Hernia Registry, of persons older than 18 y who underwent VHR between January 2020 and July 2021. The exposure of interest was the use of CS. Our primary outcome was a composite end point of 30-d adverse events including any complication, emergency department visit, readmission, and reoperation. Our secondary outcome was surgical site infection (SSI). Multivariable logistic regression examined the association of CS use, 30-d adverse events, and SSI with patient-, hernia-, and operative-specific variables. We performed a sensitivity analysis evaluating for differences in application and outcomes of the posterior and aCS techniques. RESULTS: A total of 1319 patients underwent VHR, with a median age (interquartile range) of 55 y (22), 641 (49%) female patients, and a median body mass index of 32 (9) kg/m2. CS was used in 138 (11%) patients, of which 101 (73%) were pCS and 37 (27%) were aCS. Compared to patients without CS, patients undergoing a CS had larger median hernia widths (2.5 cm (range 0.01-23 cm) versus 8 cm (1-30 cm), P < 0.001). Of the CS cases, 49 (36%) performed in hernias less than 6 cm in size. Following multivariate regression, factors independently associated with the use of a CS were diabetes (odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.19-3.36), previous hernia repair (OR: 1.88, 95% CI: 1.20-2.96), hernia width (OR: 1.28, 95% CI: 1.22-1.34), and an open approach (OR: 3.83, 95% CI: 2.24-6.53). Compared to patients not having a CS, use of a CS was associated with increased odds of 30-d adverse events (OR: 1.88 95% CI: 1.13-3.12) but was not associated with SSI (OR: 1.95, 95% CI: 0.74-4.63). Regression analysis demonstrated no differences in 30-d adverse events or SSI between the pCS and aCS techniques. CONCLUSIONS: This is the first population-level report of patients undergoing VHR with concurrent posterior or aCS. These data suggest wide variation in the application of CS in VHR and raises a concern for potential overutilization in smaller hernias. Continued analysis of CS application and the associated outcomes, specifically recurrence, is necessary and underway.

The Role of Manual Therapies in the Treatment of Headache Disorders.

PURPOSE OF REVIEW: A comprehensive headache treatment plan typically requires both medication and non-medication treatment strategies. Manual therapies offer another therapeutic approach to headache treatment. This article reviews the evidence for manual therapies in the treatment of headache disorders. RECENT FINDINGS: Current evidence shows potential benefit from myofascial trigger point injections, myofascial release, and massage for the treatment of various headache types. There is also evidence for strain counterstrain technique, ischemic compression, and spinal manipulative therapies for cervicogenic headache. Although larger randomized clinical trials are necessary for many of these modalities, recent findings show that manual therapies could be an important tool for the treatment of some headache disorders.

Myofascial release for the treatment of pain and dysfunction in patients with chronic mechanical neck pain: Systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To explore the effects of myofascial release (MFR) on pain and dysfunction in individuals with chronic mechanical neck pain (MNP). DATA SOURCES: PubMed, Embase, Medline, Wiley Online Library, Web of Science, CNKI, VIP, WanFang Data, and the Cochrane Library were searched until 12 September 2022. REVIEW METHODS: This study was registered in PROSPERO (CRD42022302485). Methodological quality was assessed using Cochrane risk of bias assessment, and the quality of the evidence followed the GRADE recommendation. The outcomes pain, cervical mobility (Flexion, Extension, Rotation, lateral flexion), trapezius and suboccipital pressure pain thresholds (PPT), neck disability index (NDI), and adverse effects were extracted. RESULTS: After screening of 346 studies, 13 studies and 601 participants met the inclusion criteria. All studies were of moderate methodological quality. Compared with the control group, the participants in the MFR group showed significantly greater improvements trapezius PPT SMD 0.41 (95% CI 0.11-0.72), suboccipital PPT SMD 0.47 (95% CI 0.21-0.72), respectively. The differences were not significant to support the MFR treatment on pain, flexion, extension, rotation, lateral flexion angle, and NDI. None of the studies reported any adverse events. CONCLUSION: This systematic review suggests that MFR is an effective treatment for the improvement of PPT of trapezius and suboccipital muscle in patients with chronic MNP. However, there is low to moderate evidence and may change over time.

The contralateral effects of foam rolling on range of motion and muscle performance.

A single bout of foam rolling (FR) can acutely increase joint range of motion (ROM) without detrimental effects on subsequent muscle performance. Similarly, long-term FR training can increase ROM, while muscle performance seems to be unaffected. Although the acute and long-term effects of FR on the treated muscle are understood, the impact of FR on the contralateral side is not well known. Therefore, this scoping review aims to summarize the current evidence on the acute and long-term effect of FR on the ipsilateral limb on ROM and muscle performance (i.e., maximum force, rate of force development, jump height) for the contralateral (non-treated) limb. Potential explanatory mechanisms are also discussed. There is evidence that a single bout of FR on the ipsilateral limb increases ROM of the contralateral limb; however, evidence is limited for long-term effects. The most likely mechanism for contralateral ROM increases is a reduced perception of pain. With regard to isolated muscle contractions, no changes in muscle performance (i.e., maximum voluntary isometric contraction, maximum voluntary dynamic contraction) were found in the contralateral limb after a single bout of FR on the ipsilateral limb. Notably, only one study reported large impairments in rate of force development of the contralateral limb following FR on the ipsilateral leg, possibly due to decreased motor unit recruitment. Furthermore, to date there are only two studies examining the long-term FR training of the ipsilateral limb on performance (i.e., maximal strength and jump performance) which reported moderate improvements. Although, trivial to very large changes on a variety of parameters were found in this study, the functional and practical relevance of our findings should be interpreted with caution.

Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia.

PURPOSE: Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. METHODS: This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. RESULTS: Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). CONCLUSION: PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.

Is foam rolling as effective as its popularity suggests? A randomised crossover study exploring post-match recovery in female basketball.

This study aimed to assess the effectiveness of foam rolling as a post-match recovery tool in basketball. Using a crossover design, 13 female players completed two simulated matches, followed by foam rolling (FR) or placebo (CON). Countermovement jump height (CMJ), heart rate variability (Ln-rMSSD), muscle soreness (VAS), perceived recovery (TQR) and fatigue (Rating-of-Fatigue) were recorded at pre-match, post-match, post-recovery and 24 h post-match. No significant effect of time*intervention and intervention were found for any variable (p > 0.05), while a significant effect of time (p < 0.01) was reported for all variables. Post-hoc analyses revealed lower CMJ and Ln-rMSSD at post-match compared with all other time points (p < 0.001), increases in pre-match VAS scores at all subsequent time points (p < 0.01), and worse TQR and Rating-of-Fatigue scores from pre-to-post-match and pre-match-to-post-recovery (p < 0.01), except for unchanged TQR values from pre-match-to-post-recovery in FR (p > 0.05). Overall, the present data suggest that foam rolling was generally ineffective for improving post-exercise recovery in female basketball players after a single match. Future research investigating the effectiveness of foam rolling in players of different sex, age and/or competitive level is warranted to provide further insight on the topic.

Efficacy of orofacial myofunctional therapy combined with myofascial release in patients with mild obstructive sleep apnoea: a randomized controlled trial.

BACKGROUND: Obstructive sleep apnoea (OSA) is characterized by repetitive narrowing and collapse of pharyngeal airway during sleep, leading to apnoea or hypopnoea. In this context, myofunctional therapy and myofascial release might be effective, despite the literature on the combination of these approaches is still scarce. OBJECTIVES: This randomized controlled trial aimed to assess the efficacy of oro-facial myofunctional therapy combined with myofascial release in terms of functioning in patients with mild OSA. METHODS: Patients aged from 40 to 80 years with diagnosis of mild OSA were randomly allocated into intervention group (oro-facial myofunctional therapy plus myofascial release) and control group (only oro-facial myofunctional therapy). At the baseline (T0), after 4 weeks (T1), and after 8 weeks (T2), the following outcomes were assessed: apnoea/hypopnoea index (AHI), average oxygen saturation (SpO2 ), sleep time spent with oxygen saturation < 90% (T90), snoring index, and Pittsburgh Sleep Quality Index (PSQI). RESULTS: Out of the 60 patients enrolled, 28 (aged 61.46 ± 8.74 years) complete the treatment in the intervention group and 24 (aged 60.42 ± 6.61 years) in the control group. There were no significant differences in AHI between groups. A significant difference was reported for ΔT0-T1 SpO2 (p = .01), T90 (p = .030), ΔT0-T1 and ΔT0-T2 snoring index (p = .026 and <.001 respectively), and ΔT0-T1 and ΔT0-T2 Pittsburgh Sleep Quality Index (p = .003 and <.001 respectively). CONCLUSION: Taken together, a combination of oro-facial myofunctional therapy and myofascial release showed a potential treatment for sleep quality in patients with mild OSA. Future studies are necessary to better investigate the role of these interventions in OSA patients.

The Acute Effects of Pectoralis Major Foam Ball Rolling on Shoulder Extension Range of Motion, Isometric Contraction Torque, and Muscle Stiffness.

Although it is well known that foam rolling (FR) of the lower extremities can increase the range of motion (ROM) of a joint while likely having no detrimental effect on muscle performance, to date, this is not clear if this is the case for the upper body. Therefore, the purpose of this study was to analyze the effects of a 2-min FR intervention of the pectoralis major (PMa) muscle on muscle stiffness of the PMa, shoulder extension ROM, and maximal voluntary isometric contraction (MVIC) peak torque. Thirty-eight (n = 15 females) healthy, physically active participants were randomly assigned to either an intervention (n = 18) or a control group (n = 20). The intervention group performed a 2-min foam ball rolling (FBR) intervention of the PMa muscle (FB-PMa-rolling), while the control group rested for 2 min. Before and after the intervention, muscle stiffness of the PMa was measured with shear wave elastography, while shoulder extension ROM was recorded with a 3D-motion capture system, and shoulder flexion MVIC peak torque was measured with a force sensor. MVIC peak torque decreased in both groups (time effect: p = 0.01; η2 = 0.16), without any difference between groups (interaction effect: p = 0.49, η2 = 0.013). ROM (p = 0.24; η2 = 0.04) and muscle stiffness (FB-PMa-rolling p = 0.86; Z = -0.38; control group p = 0.7, Z = -0.17) did not change due to the intervention. The lack of changes in ROM and muscle stiffness following the FBR intervention might be explained by the small area of applied pressure with the FBR on the PMa muscle. Moreover, the decrease in MVIC peak torque is likely more related to the uncommon test situation of the upper limbs, rather than the FBR intervention itself.

Safety and efficacy of a self-induced myofascial release protocol using a foam roller in patients with haemophilic knee arthropathy.

BACKGROUND: Haemophilic knee arthropathy presents functional and structural alterations and chronic pain. Self-induced myofascial release aims to treat fascial restrictions and improve functionality. AIM: This study investigated the safety and effectiveness of a self-induced myofascial release protocol in patients with haemophilic knee arthropathy. METHODS: Twenty-five patients with bilateral haemophilic knee arthropathy were recruited (n = 50 knees). The patients followed an intervention protocol, with daily exercises for 8 weeks. The dependent variables were: safety of the technique (periodic telephone monitoring), joint state (Haemophilia Joint Health Score), pain intensity (visual analogue scale), pressure pain threshold (pressure dynamometer), range of motion (universal goniometer) and hamstring flexibility (Fingertip-To-Floor test). The resulting values were measured at baseline (T0) and after the intervention (T1). Paired t-test compared the means between the assessments. Effect size was obtained using Cohen's d mean difference formula. The minimum detectable change of each variable was calculated. RESULTS: There were no cases of joint bleeding either during or after the procedure. The results showed improvements after the experimental period in joint state (Mean difference [MD]: 1.38; 95% confidence interval [95%CI]: .94;1.81), pain intensity (MD: 1.19; 95%CI: .70;1.67), pressure pain threshold (MD: -23.25; 95%CI: -26.25;-19.84), flexion (MD: -4.36; 95%CI: -5.70;-3.01), loss of extension (MD: 4.10; 95%CI: 3.01;5.18) and hamstring flexibility (MD: 3.54; 95%CI: 2.61;4.46). CONCLUSIONS: Myofascial self-release using a foam roller is safe in patients with haemophilic knee arthropathy. A myofascial self-release protocol can improve perceived pain, range of motion and knee joint status, as well as hamstring flexibility in patients with haemophilic knee arthropathy.

Effectiveness of proprioceptive neuromuscular facilitation and myofascial release techniques in patients with subacromial impingement syndrome.

PURPOSE: To compare the effectiveness of proprioceptive neuromuscular facilitation and myofascial release technique in patients with subacromial impingement syndrome on pain, range of motion, muscle strength, quality of life, functionality and disability. METHODS: Thirty patients were randomly divided into two groups: proprioceptive neuromuscular facilitation group (n = 15) and proprioceptive neuromuscular facilitation combined with myofascial release technique group (n = 15). Both treatment methods were performed 3 times a week for 4 weeks. Pain severity was assessed by Visuel Analog Scale, range of motion by a goniometer, muscle strength by digital hand dynamometer, quality of life by Nottingham health profile, functionality by arm, shoulder and hand problems questionnaire, disability by shoulder pain and disability index. All measurements were used before and after treatments. Pain severity, range of motion and muscle strength were also evaluated after the first session. RESULTS: After the treatment, shoulder pain, range of motion, muscle strength, functionality and disability were improved in two groups (p < 0.05). Proprioceptive neuromuscular facilitation showed improvement in pain, whereas myofascial release technique improved pain, physical activity, emotional state, sleep and total dimensions of life quality (p < 0.05). Proprioceptive neuromuscular facilitation was more effective in reducing activity pain, whereas myofascial release technique was more effective in increasing flexion, external and internal rotation range of motion, flexion and abduction muscle strength after the first session (p < 0.05). CONCLUSIONS: The combined application of proprioceptive neuromuscular facilitation and myofascial release technique has a more acute and cumulative positive effect on pain, range of motion, muscle strength, functionality, disability and quality of life in patients with subacromial impingement syndrome.

Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact. METHODS: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria. RESULTS: Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was "very low". Other results were presented in a qualitative synthesis. CONCLUSIONS: In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.

A comparison of a single bout of stretching or foam rolling on range of motion in healthy adults.

PURPOSE: Stretching and foam rolling are common warm-up exercises and can acutely increase the range of motion (ROM) of a joint. However, possible differences in the magnitude of change on ROM between these two interventions on the immediate and prolonged effects (e.g., 10 min after the intervention) are not yet well understood. Thus, the purpose of this review was to compare the immediate and prolonged effects of a single bout of foam rolling with a single bout of stretching on ROM in healthy participants. METHODS: In total, 20 studies with overall 38 effect sizes were found to be eligible for a meta-analysis. For the main analysis, subgroup analysis, we applied a random-effect meta-analysis, mixed-effect model, respectively. The subgroup analyses included age groups, sex, and activity levels of the participants, as well as the tested muscles, the duration of the application, and the study design. RESULTS: Meta-analyses revealed no significant differences between a single stretching and foam rolling exercise immediately after the interventions (ES = 0.079; P = 0.39) nor a difference 10 min (ES = - 0.051; P = 0.65), 15 min (ES = - 0.011; P = 0.93), and 20 min (ES = - 0.161; P = 0.275) post-intervention. Moreover, subgroup analyses revealed no other significant differences between the acute effects of stretching and foam rolling (P > 0.05). CONCLUSION: If the goal is to increase the ROM acutely, both interventions can be considered as equally effective. Likely, similar mechanisms are responsible for the acute and prolonged ROM increases such as increased stretch tolerance or increased soft-tissue compliance.