Evidence of in-vivo myofascial force transfer in humans- a systematic scoping review.

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.

Effectiveness of external myofascial mobilisation in the management of male chronic pelvic pain of muscle spastic type: A retrospective study.

OBJECTIVE: To evaluate the outcome of men with muscle spastic chronic pelvic pain syndrome (CPPS) who underwent a comprehensive five-session fascial connectivity based external myofascial mobilisation (EMM) approach. PATIENTS AND METHODS: A retrospective chart review of patients who underwent EMM for CPPS at the Pelvic Pain Unit of Hamad Medical Corporation, Qatar between January 2019 and October 2020 was conducted. Patient's symptoms were measured with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale and the numerical rating scale (NRS) before and after the completion of the sessions. The patients were given five EMM sessions as a 'once-a-week' programme. RESULTS: A total of 31 patients who completed all the EMM sessions were included. The mean (range) age of patients was 38 (20-54) years. The mean (SD) NIH-CPSI score at initial evaluation was 29.41 (8.3) and decreased to 9.14 (3.45) after the fifth visit. All the patients in the study group had a reduction of >6 points in the NIH-CPSI score, indicating a robust treatment response. The NRS reading also revealed significant improvement in pain (P < 0.001). CONCLUSIONS: : An EMM approach based on fascial connectivity led to significant symptom improvement in all the studied patients. EMM may be an effective treatment option for muscle spastic type of CPPS. Future high-quality studies with control groups are needed to confirm the present findings. Durability and long-term results are yet to be determined. ABBREVIATIONS: CP/CPPS: chronic prostatitis/chronic pelvic pain syndrome; EMM: external myofascial mobilisation; EO: external oblique; FM: fascial manipulation; GMx: gluteus maximus; HAC: hip adductor complex; HMC: Hamad Medical Corporation; IO: internal oblique; LD: latissimus dorsi; MFR: myofascial release; MM: myofascial mobilisation; NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index; NRS: numerical rating scale; PFPT: pelvic floor physical therapy; QoL, quality of life; TLF: thoracolumbar fascia; UPOINT: urinary (U), psychosocial (P), organ-specific (O), infection (I), neurological/systemic (N) and tenderness of pelvic floor skeletal muscles (T).

Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review.

INTRODUCTION: Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. METHODS: A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring). RESULTS: Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. CONCLUSION: Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

Improving the quality of myofascial release research - A critical appraisal of systematic reviews.

INTRODUCTION: Myofascial release (MFR) is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex intended to restore optimal length, decrease pain and improve function. MFR is being used to treat patients with a wide variety of conditions, with favourable evidence supporting its efficacy. Critical appraisal of the recent research trials or reviews aims to improve the quality and reliability of future works in this field. OBJECTIVE: This work attempts to examine and categorize the strength and limitations of current MFR research by critically appraising recent systematic reviews (SRs) to synthesise recommendations for improving quality and reliability of future clinical trials. METHODOLOGY: SRs on MFR published until 2018 were selected for this analysis. The methodological qualities of the SRs were assessed by AMSTAR II tool. RESULTS: The SRs demonstrated moderate methodological quality. The overall confidence rating of the results of the review by AMSTAR II was low to moderate, mainly due to the omission of a risk of bias analysis in two of the reviews. CONCLUSION: This review concludes that the SRs analysed were completed with moderate methodological quality, but with procedural weaknesses and interpretation biases. The most recent review was qualitatively superior due to the inclusion of risk of bias analysis and effect size calculation. This critical appraisal and the derived recommendations can act as 'stepping stones' on which high quality future MFR trials and evidence can be built.

The role of EEG and EMG combined virtual reality gaming system in facial palsy rehabilitation - A case report.

BACKGROUND: The recovery rates for facial palsy are usually excellent; however, regularly patients present with problems with their fine facial movements that affect their emotional expressions. OBJECTIVE: To discover the viability and ease of using an Electroencephalogram (EEG) and Electromyography (EMG) combined Virtual Reality (VR) gaming system - the 'Oculus Rift' device in the evaluation and rehabilitation of facial palsy. DESIGN: Single case study. PATIENT INFORMATION: A young 23-year-old female with facial palsy. CLINICAL FINDINGS: Most of the patient's facial features were re-established within the recovery time frame, except for her right forehead and eyebrow movements. INTERVENTION: A 10 day exercise program (Day 2-11) with an immersive virtual reality device, which randomly shoots virtually animated white balls in an unpredictable and testing pattern. OUTCOME MEASURES: EEG and EMG patterns corresponding to the facial upper quadrant were taken at baseline, post-intervention, and at follow up. RESULTS: EMG and EEG investigation revealed a progressive improvement in the muscle activation in response to the impulsive and unpredictable activities in the virtual environment provided through the immersive VR device. CONCLUSION: The case report found a positive relationship between VR, facial upper quadrant EMG activation and EEG pattern changes following the intervention.

Effectiveness of myofascial release: systematic review of randomized controlled trials.

INTRODUCTION: Myofascial release (MFR) is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex, intended to restore optimal length, decrease pain, and improve function. Anecdotal evidence shows great promise for MFR as a treatment for various conditions. However, research to support the anecdotal evidence is lacking. OBJECTIVE: To critically analyze published randomized controlled trials (RCTs) to determine the effectiveness of MFR as a treatment option for different conditions. DATA SOURCES: Electronic databases: MEDLINE, CINAHL, Academic Search Premier, Cochrane library, and Physiotherapy Evidence Database (PEDro), with key words myofascial release and myofascial release therapy. No date limitations were applied to the searches. STUDY SELECTION: Articles were selected based upon the use of the term myofascial release in the abstract or key words. The final selection was made by applying the inclusion and exclusion criteria to the full text. Studies were included if they were English-language, peer-reviewed RCTs on MFR for various conditions and pain. DATA EXTRACTION: Data collected were number of participants, condition being treated, treatment used, control group, outcome measures and results. Studies were analyzed using the PEDro scale and the Center for Evidence-Based Medicine's Levels of Evidence scale. CONCLUSIONS: The literature regarding the effectiveness of MFR was mixed in both quality and results. Although the quality of the RCT studies varied greatly, the result of the studies was encouraging, particularly with the recently published studies. MFR is emerging as a strategy with a solid evidence base and tremendous potential. The studies in this review may help as a respectable base for the future trials.

Effectiveness of autogenic training in improving motor performances in Parkinson's disease.

BACKGROUND: Relaxation training can be an important adjunct in reducing symptoms associated with Parkinson's disease (PD). Autogenic Training (AT) is a simple, easily administered and inexpensive technique for retraining the mind and the body to be able to relax. AT uses visual imagery and body awareness to promote a state of deep relaxation. OBJECTIVE: To investigate whether AT when used as an adjunct to Physiotherapy (PT) improves motor performances in PD in comparison with a control group receiving PT alone. DESIGN: Randomized, controlled, single blinded trial. SETTING: Movement Disorder Clinic and Department of Physiotherapy, Sree Chithira Thirunal Institute of Medical Sciences and Technology in Trivandrum, Kerala, India. PARTICIPANTS: Patients with PD of grade 2 or 3 of Hoehn & Yahr (H&Y) scale (N = 66). INTERVENTIONS: AT group or control group. The techniques were administered by Physiotherapists trained in AT and consisted of 40 sessions per patient over 8 weeks. MAIN OUTCOME MEASURE: Motor score subscale of Unified Parkinson's Disease Rating Scale (UPDRS) was used to measure the motor performances. The primary outcome measure was the difference in Motor score subscale of UPDRS scores between Week 1 (pretest score), Week 8 (posttest score), and follow-up at Week 12 after randomization. RESULTS: The simple main effects analysis showed that the AT group performed better than the control group in weeks 8 and 12 (P < .005). Patients in the AT and control groups reported a 51.78% and 35.24% improvement, respectively, in their motor performances in Week 8 compared with that in Week 1, which persisted, in the follow-up (Week 12) as 30.82% in the AT group and 21.42% in the control group. CONCLUSIONS: This study provides evidence that AT when used as an adjunct to PT is more effective than PT alone in improving motor performances in PD patients.

Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial.

BACKGROUND: Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain (PHP). However, it is unclear whether myofascial release (MFR) can improve the outcomes in this population. OBJECTIVE: To investigate whether myofascial release (MFR) reduces the pain and functional disability associated with plantar heel pain (PHP) in comparison with a control group receiving sham ultrasound therapy (SUST). DESIGN: Randomized, controlled, double blinded trial. SETTING: Nonprofit research foundation clinic in India. METHOD: Sixty-six patients, 17 men and 49 women with a clinical diagnosis of PHP were randomly assigned into MFR or a control group and given 12 sessions of treatment per client over 4 weeks. The Foot Function Index (FFI) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in FFI scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. Additionally, pressure pain thresholds (PPT) were assessed over the affected gastrocnemii and soleus muscles, and over the calcaneus, by an assessor blinded to the treatment allocation. RESULTS: The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<0.001). Patients in the MFR and control groups reported a 72.4% and 7.4% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 60.6% in the follow-up at week 12 in the MFR group compared to the baseline. The mixed ANOVA also revealed significant group-by-time interactions for changes in PPT over the gastrocnemii and soleus muscles, and the calcaneus (P<0.05). CONCLUSIONS: This study provides evidence that MFR is more effective than a control intervention for PHP.

Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals.

OBJECTIVE: 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. DESIGN: Randomized, controlled, single blinded trial. SETTING: Nonprofit research foundation clinic in Kerala, India. PARTICIPANTS: Nursing professionals (N = 80) with chronic low back pain (CLBP). INTERVENTIONS: MFR group or control group. The techniques were administered by physiotherapists certified in MFR and consisted of 24 sessions per client over 8 weeks. MAIN OUTCOME MEASURE: 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. RESULTS: 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. CONCLUSIONS: 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.

Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals.

OBJECTIVE: To investigate whether myofascial release (MFR) reduces the pain and functional disability of lateral epicondylitis (LE) in comparison with a control group receiving sham ultrasound therapy in computer professionals. DESIGN: Randomized, controlled, single blinded trial. SETTING: Nonprofit research foundation clinic in Kerala, India. PARTICIPANTS: Computer professionals (N=68) with LE. INTERVENTIONS: MFR group or control group. The techniques were administered by certified MFR practitioners and consisted of 12 sessions per client over 4 weeks. MAIN OUTCOME MEASURE: The Patient-Rated Tennis Elbow Evaluation (PRTEE) scale was used to assess pain severity and functional disability. The primary outcome measure was the difference in PRTEE scale scores between week 1 (pretest score), week 4 (posttest score), and follow-up at week 12 after randomization. RESULTS: The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<.005). Patients in the MFR and control groups reported a 78.7% and 6.8% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 63.1% in the follow-up at week 12 in the MFR group. CONCLUSIONS: This study provides evidence that MFR is more effective than a control intervention for LE in computer professionals.

Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache.

BACKGROUND: Tension-type headache (TTH) is essentially defined as bilateral headache of a pressing or tightening quality without a known medical cause. Myofascial release (MFR) is currently being applied for patients with TTH but its efficacy has not been evaluated formally. OBJECTIVE: To investigate whether direct technique myofascial release (DT-MFR) reduces the frequency of headache more effectively than the indirect technique myofascial release (IDT-MFR) in comparison to a Control Group receiving slow soft stroking. DESIGN: Randomized, controlled, single blinded trial. SETTING: The clinical wing of Myofascial Therapy and Research Foundation, Kerala, India. PARTICIPANTS: 63 patients with episodic or chronic tension-type headache. INTERVENTIONS: DT-MFR, IDT-MFR or Control. The techniques were administered by certified myofascial release practitioners and consisted of 24 sessions per patient over 12 weeks. MAIN OUTCOME MEASURE: Difference in numbers of days with headache between Weeks 1-4 (i.e. 4 weeks prior to start of Intervention) and Weeks 17-20, following 12 weeks of Intervention between Weeks 5-16 as recorded by participants in headache diaries. RESULTS: The number of days with headache per 4 weeks decreased by 7.1 (2.6) [mean (SD)] days in the DT-MFR group compared with 6.7 (1.8) days in the IDT-MFR group and 1.6 (0.5) days in the control group, (P < 0.001). Patients in the DT-MFR Group, IDT-MFR Group and Control Group reported a 59.2%, 54% and 13.3% reduction in their headache frequency in Weeks 17-20 compared to that in Weeks 1-4. CONCLUSIONS: This study provides evidence that Direct Technique or Indirect Technique Myofascial Release is more effective than the Control Intervention for tension headache.