Mechanistic basis of manual therapy in myofascial injuries. Sonoelastographic evolution control.

The term myofascia is referred to the skeleton of muscle fibres organized as an interconnected 3D network that surrounds and connects the musculoskeletal system. Extracellular matrix muscle is relevant in tissue structural support and transmission of mechanical signals between fibres and tendons. Acute and chronic musculoskeletal injuries (muscle strain) are one of the major problems faced by those who practice any type of sport, regardless of whether they are professionals or amateurs. Therapeutic boarding is of uncertain value in most cases because there are many contributing factors such as type, severity, functional implication of the damaged tissue, progression or risk of relapse. Different studies suggest that the musculoskeletal cell matrix is essential for the development, maintenance and regeneration of skeletal muscle. In this article, we highlight the action of "non-contractile" structures, in particular the myofascial system or muscle fascia, which can be responsible for the pathophysiology and healing process of muscular injuries. Manual therapy plays a predominant role in the treatment of these types of injuries and is key in the process of obtaining a scar capable of transmitting mechanical information. The scientific basis of this process is described in this article. Through real-time sonoelastography we have accurate information regarding the current stage of the repair process and, thus, guide our treatment at all times. Some new concepts are introduced, including local elasticity, the relationship between fascial pretension and the different stages of the physiological myofascia repair process, scar modelling technique, and sonoelastographic evolution control.

The muscular force transmission system: role of the intramuscular connective tissue.

The objective of this review is to analyze in detail the microscopic structure and relations among muscular fibers, endomysium, perimysium, epimysium and deep fasciae. In particular, the multilayer organization and the collagen fiber orientation of these elements are reported. The endomysium, perimysium, epimysium and deep fasciae have not just a role of containment, limiting the expansion of the muscle with the disposition in concentric layers of the collagen tissue, but are fundamental elements for the transmission of muscular force, each one with a specific role. From this review it appears that the muscular fibers should not be studied as isolated elements, but as a complex inseparable from their fibrous components. The force expressed by a muscle depends not only on its anatomical structure, but also the angle at which its fibers are attached to the intramuscular connective tissue and the relation with the epimysium and deep fasciae.

Management of Dupuytren contracture with ultrasound-guided lidocaine injection and needle aponeurotomy coupled with osteopathic manipulative treatment.

Dupuytren contracture is a debilitating disease that characteristically presents as a firm nodularity on the palmar surface of the hand with coalescing cords of soft tissue on the webs and digits. With few nonsurgical modalities providing clinical benefits, open surgical procedures are the standard of care for patients with this condition. However, recent studies have associated surgical intervention with many complications, necessitating further exploration of nonsurgical treatment options. We describe the case of a 64-year-old woman who presented with decreased extension of the fourth and fifth digits on the upper extremities bilaterally; previous conservative treatment regimens had been unsuccessful. After a diagnostic ultrasound, the patient was diagnosed as having Dupuytren contracture and underwent 5 treatments consisting of ultrasound-guided dry-needle aponeurotomy, lidocaine injections, and osteopathic manipulative treatment. During the fifth treatment session, the patient experienced dramatic relief of her symptoms after a palpable release during the manual manipulation portion of her therapeutic regimen. At 2-week follow-up, the patient was symptom-free. Based on this desirable outcome, the authors suggest future research be directed at minimally invasive therapeutic options in the management of Dupuytren contracture.

Electron microscopical and immunohistochemical studies on the induction of "Qi" employing needling manipulation.

During a sparrow-pecking and twisting-needle manipulation to the acupoints BL 23, 24 and 25 for an induction of "Qi", it was found that some transparent materials were binding to the needles after removed from the volunteer's skin. Electron-microscopical analysis of the transparent materials revealed that they corresponded to the injured fascia made up of collagen fibers, elastic fibers, fibroblasts, adipocytes and mast cells. Rarely were nerve fiber-like structures observed in the materials. Immunohistochemically, calcitonin gene-related peptide-positive nerve fibers could be demonstrated in the acupoint BL 24 associated fascia. A possible functional relationship between the needle manipulation and the induction of Qi-sensation is discussed along with the acupoint tissue constitution.