ABSTRACT
The posterior myofascial chain (PMC) or superficial back line encompasses a series of muscles interlinked by the deep fascia, extending from the foot to the fascial sheath of the eyeball. The deep cervical fascia of the neck, the epicranial aponeurosis of the head, and the fascial sheath of eyeball, form the proximal PMC. Although the literature has reported an anatomical myofascial continuum between the neck, head, and eyes, the anatomical descriptions vary substantially. Moreover, there is still no plausible functional interrelationship between the proximal structural myofascial links. Chronic neck pain is usually associated with a plethora of symptoms including craniofacial pain and oculomotor disorders. Understanding the anatomy of the proximal myofascial chain could help clinicians improvise treatment strategies for managing such painful head and neck disorders.
Subject(s)
Chronic Pain , Fascia , Fascia/anatomy & histology , Humans , Muscle, Skeletal/physiology , Neck , Neck PainABSTRACT
BACKGROUND: The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration. OBJECTIVE: We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation). METHODS: This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed. RESULTS: Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI). CONCLUSION: This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.
ABSTRACT
Straying away from a sedentary lifestyle is essential, especially in these troubled times of a global pandemic to reverse the ill effects associated with the health risks as mentioned earlier. In the view of anticipated effects on immune system and prevention against influenza and Covid-19, globally moderate to vigorous exercises are advocated wearing protective equipment such as facemasks. Though WHO supports facemasks only for Covid-19 patients, healthy "social exercisers" too exercise strenuously with customized facemasks or N95 which hypothesized to pose more significant health risks and tax various physiological systems especially pulmonary, circulatory and immune systems. Exercising with facemasks may reduce available Oxygen and increase air trapping preventing substantial carbon dioxide exchange. The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases. Further contrary to the earlier thought, no evidence exists to claim the facemasks during exercise offer additional protection from the droplet transfer of the virus. Hence, we recommend social distancing is better than facemasks during exercise and optimal utilization rather than exploitation of facemasks during exercise.