ABSTRACT
Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue's middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making. However, their accuracy can be compromised by variability in the tissue's loading history. This study investigates the effect of loading history on plantar fascia measurements to conclude whether mitigation measures are needed for more accurate diagnosis. The plantar fasciae of 29 healthy participants were imaged at baseline and after different clinically relevant loading scenarios. The average (±standard deviation) SW velocity was 6.5 m/s (±1.5 m/s) and it significantly increased with loading. Indicatively, five minutes walking increased SW velocity by 14% (95% CI: -1.192, -0.298, t(27), p = 0.005). Thickness between the calcaneal insertion and the middle of the plantar fascia did not change with the tissues' loading history. These findings suggest that preconditioning protocols are crucial for accurate SW elastography assessments of plantar fasciae and have wider implications for the diagnosis and management of plantar fasciopathy.
Subject(s)
Elasticity Imaging Techniques , Fascia , Humans , Male , Female , Fascia/diagnostic imaging , Fascia/physiology , Elasticity Imaging Techniques/methods , Adult , Fasciitis, Plantar/diagnostic imaging , Foot/diagnostic imaging , Foot/physiology , Biomechanical Phenomena/physiology , Young Adult , Ultrasonography/methods , Walking/physiologyABSTRACT
BACKGROUND: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. OBJECTIVES: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). DESIGN: A cross-sectional study was performed in 5 fresh frozen cadavers. METHODS: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. RESULTS: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). CONCLUSION: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain.
Subject(s)
Cadaver , Fascia , Median Nerve , Humans , Median Nerve/physiology , Cross-Sectional Studies , Female , Male , Fascia/physiology , Aged , Wrist , Middle Aged , Range of Motion, Articular/physiology , Biomechanical Phenomena , Aged, 80 and overABSTRACT
Superficial fascia is a fibrofatty tissue found throughout the body. Initially described in relation to hernias, it has only recently received attention from the scientific community due to new evidence on its role in force transmission and structural integrity of the body. Considering initial difficulties in its anatomical identification, to date, a characterization of the superficial fascia through mechanical tests is still lacking. The mechanical properties of human superficial fasciae of abdominal and thoracic districts (back) of different subjects (n = 4) were then investigated, focusing on anisotropy and viscoelasticity. Experimental tests were performed on samples taken in two perpendicular directions according to body planes (cranio-caudal and latero-medial axes). Data collected from two different uniaxial tensile protocols, failure (i.e., ultimate tensile strength and strain at break, Young's modulus and toughness) and stress-relaxation (i.e., residual stress), were processed and then grouped for statistical analysis. Failure tests confirmed tissue anisotropy, revealing the stiffer nature of the latero-medial direction compared to the cranio-caudal one, for both the districts (with a ratio of the respective Young's moduli close to 2). Furthermore, the thoracic region exhibited significantly greater strength and resultant Young's modulus compared to the abdomen (with greater results along the latero-medial direction, such as 6.13 ± 3.11 MPa versus 0.85 ± 0.39 MPa and 24.87 ± 15.23 MPa versus 3.19 ± 1.62 MPa, respectively). On the contrary, both regions displayed similar strain at break (varying between 38 and 47%), with no clear dependence from the loading directions. Stress-relaxation tests highlighted the viscous behavior of the superficial fascia, with no significant differences in the stress decay between directions and districts (35-38% of residual stress after 300 s). All these collected results represent the starting point for a more in-depth knowledge of the mechanical characterization of the superficial fascia, which can have direct implications in the design, implementation, and effectiveness of site-specific treatments.
Subject(s)
Abdomen , Fascia , Stress, Mechanical , Thorax , Humans , Anisotropy , Biomechanical Phenomena , Abdomen/physiology , Thorax/physiology , Fascia/physiology , Fascia/anatomy & histology , Tensile Strength , Mechanical Phenomena , Male , Viscosity , Mechanical Tests , Female , Materials Testing , Middle Aged , Aged , Elastic ModulusABSTRACT
The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0°, 45° and 90° angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury.
Subject(s)
Elasticity Imaging Techniques , Electromyography , Fascia , Hamstring Muscles , Soccer , Humans , Male , Soccer/injuries , Soccer/physiology , Young Adult , Hamstring Muscles/injuries , Hamstring Muscles/physiology , Hamstring Muscles/diagnostic imaging , Fascia/injuries , Fascia/diagnostic imaging , Fascia/physiology , Fascia/physiopathology , Elastic Modulus , Athletic Injuries/physiopathology , Athletic Injuries/diagnostic imaging , Adult , Lumbosacral Region/injuries , Lumbosacral Region/diagnostic imaging , Paraspinal Muscles/diagnostic imaging , Paraspinal Muscles/physiology , Paraspinal Muscles/physiopathology , AdolescentABSTRACT
The objective of this study is to develop a reliable tribological model to enable a more thorough investigation of the frictional behavior of fascia tissues connected to non-specific lower back pain. Several models were designed and evaluated based on their coefficient of friction, using a low-frequency, low-load reciprocating motion. The study found that two technical elastomers, layered on PDMS to simulate the fascia and underlying muscle, are suitable substitutes for biological tissue in the model. The influence of tribopair geometry was also examined, and the results showed that greater conformity of contact leads to a lower COF, regardless of the material combination used. Finally, the friction properties of HA of various molecular weights and concentrations were tested.
Subject(s)
Fascia , Friction , Materials Testing , Fascia/physiology , Dimethylpolysiloxanes/chemistry , Biomechanical Phenomena , Models, Biological , Elastomers/chemistryABSTRACT
OBJECTIVE: This study investigates the potential for stress shielding within musculoskeletal soft tissues through analysis of stress distributions between lumbar fascial and muscle tissues via mechanical testing. METHODS: Using a custom apparatus, 51 posterior thoracolumbar fascia (TLF) samples and 18 erector spinae (ES) cadaveric samples underwent tensile testing involving three loading-unloading cycles, followed by loading to 6% strain, to mechanically characterize samples. Parallel tensile testing using 20 pairs of two TLF samples, and seven pairs of TLF and ES samples was then conducted for stress distribution analysis between tissues. P<0.05 was deemed significant. RESULTS: The TLF and ES exhibited an average elastic modulus of 150.9 MPa and 0.69 MPa, respectively. At 6% strain, parallel testing of the TLF pairs yielded an average tensile stress of 8.49 MPa and 1.7MPa (p<0.001) exhibited by the stiffer and less stiff TLF samples, respectively. Similarly, TLF-ES parallel testing resulted in average tensile stresses of 7.19 MPa and 0.079 MPa of the TLF and ES (p<0.002). CONCLUSION: Results suggest elevated loading towards stiffer TLF samples relative to less stiff TLF and ES samples. In soft tissues affected by LBP, skewed stress distributions may result in the TLF withstanding the majority of stress, yielding cyclical stress shielding that may contribute to and/or promote LBP. SIGNIFICANCE: This novel study demonstrates a potential load allocation bias towards the TLF, laying the foundation for stress shielding within lumbar musculoskeletal soft tissues affected by degenerative musculoskeletal conditions.
Subject(s)
Cadaver , Fascia , Stress, Mechanical , Humans , Fascia/physiology , Male , Female , Aged , Middle Aged , Tensile Strength/physiology , Biomechanical Phenomena/physiology , Elastic Modulus/physiology , Lumbosacral Region/physiology , Adult , Lumbar Vertebrae/physiology , Aged, 80 and overABSTRACT
AIM: Previous stretching studies mostly investigated effects on the skeletal muscle but comprehensive explorations regarding the role of the connective tissue are scarce. Since the deep fascia has been demonstrated to be sensitive to mechanical tension, it was hypothesized that the fascia would also respond to stretching, contributing to enhanced range of motion (ROM). METHODS: Forty (40) recreationally active participants (male: n = 25, female: n = 15) were included in the randomized controlled cross-over trial and allocated to different groups performing 5 min static (STAT) or dynamic (DYN) plantar flexor stretching or control condition (CC) in a random order. Pre- and immediately post-intervention, muscle and fascia stiffness, as well as muscle and fascia thickness were measured using high-resolution ultrasound and strain elastography. ROM was assessed in the ankle joint via the knee to wall test (KtW) and goniometer. RESULTS: STAT reduced both, muscle and fascia stiffness (d = 0.78 and 0.42, p < 0.001, respectively), while DYN did not reduce stiffness compared to the control condition (p = 0.11-0.41). While both conditions showed significant increases in the KtW (d = 0.43-0.46, p = 0.02-0.04), no significant differences to the CC were observed for the isolated ROM testing (p = 0.09 and 0.77). There was a small correlation between fascia stiffness decreases and ROM increases (r = - 0.25, p = 0.006) but no association was found between muscle stiffness decreases and ROM increases (p = 0.13-0.40). CONCLUSION: Our study is the first to reveal stretch-induced changes in fascia stiffness. Changes of fascia`s but not muscle`s mechanical properties may contribute to increased ROM following stretching.
Subject(s)
Cross-Over Studies , Fascia , Muscle Stretching Exercises , Muscle, Skeletal , Range of Motion, Articular , Humans , Female , Male , Fascia/physiology , Fascia/diagnostic imaging , Muscle Stretching Exercises/physiology , Range of Motion, Articular/physiology , Muscle, Skeletal/physiology , Muscle, Skeletal/diagnostic imaging , Adult , Ankle Joint/physiology , Ankle Joint/diagnostic imaging , Young Adult , Elasticity Imaging Techniques/methodsABSTRACT
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.
Subject(s)
Ankle Joint , Elasticity Imaging Techniques , Fascia , Massage , Muscle, Skeletal , Range of Motion, Articular , Humans , Male , Massage/methods , Range of Motion, Articular/physiology , Young Adult , Muscle, Skeletal/physiology , Fascia/physiology , Ankle Joint/physiology , AdultABSTRACT
BACKGROUND: The intrinsic and extrinsic foot softtissue structures that apply force and support the medial longitudinal arch (MLA) have been implicated in the development of flat feet. However, the relationship between the changes in MLA height under increasing load and the morphological and mechanical properties of individual intrinsic and extrinsic foot soft tissue structures is not fully understood. RESEARCH QUESTION: To examine the morphological and mechanical characteristics of the foot soft tissue structures in flat feet when subjected to loading. METHODS: This study consisted of two studies focusing on the extrinsic foot muscles (10 normal feet/11 flat feet) and intrinsic foot muscles (14 normal feet/13 flat feet). Images of the extrinsic and intrinsic foot muscles and plantar fascia (PF) under 10%, 50%, and 90% body weight conditions were obtained using ultrasound-based shear-wave elastography. RESULTS: The cross-sectional area (CSA) of the peroneus brevis was larger in the flat-foot group than in the normal-foot group under all loading conditions. The CSAs of the intrinsic foot muscles (abductor hallucis, flexor digitorum brevis, and quadratus plantae) and thickness of the PF in the flat-foot group decreased significantly with increasing load. As for mechanical characteristics, the stiffness of the flexor digitorum longus and abductor hallucis was higher in the flat-foot group than in the normal group under high loading conditions. In addition, flat feet with greater flexibility tended to exhibit a greater decrease in PF thickness and smaller increase in stiffness. SIGNIFICANCE: Excessive stretching of the intrinsic foot muscles and PF occurs in flat feet, and excessive contraction of the flexor digitorum longus may counteract the excessive lowering of the foot arch. Therefore, it is necessary to promote the contraction of the intrinsic foot musculature in feet with greater flexibility of the MLA during loading.
Subject(s)
Flatfoot , Humans , Fascia/physiology , Foot/physiology , Muscle, Skeletal/physiology , UltrasonographyABSTRACT
Recent studies have demonstrated that fascial fibroblasts are susceptible to mechanical stimuli, leading to the remodeling of the extracellular matrix (ECM). Moreover, the extensive literature on Yes-associated protein (YAP) has shown its role in cell mechanics, linking cell properties, such as shape, adhesion, and size, to the expression of specific genes. The aim of this study was to investigate the presence of YAP in deep fascia and its activation after a mechanical stimulus was induced via a focal extracorporeal shockwave (fESW) treatment. Thoracolumbar fascia (TLF) samples were collected from eight patients (age: 30-70 years; four males and four females) who had undergone spine elective surgical procedures at the Orthopedic Clinic of University of Padova. YAP was measured in both tissue and TLF-derived fibroblasts through immunoblotting. COL1A1 and HABP2 gene expression were also evaluated in fibroblasts 2, 24, and 48 h after the fESW treatment. YAP was expressed in all the examined tissues. The ratio between the active/inactive forms (YAP/p-YAP) of the protein significantly increased in fascial fibroblasts after mechanical stimulation compared to untreated cells (p = 0.0022). Furthermore, COL1A1 and HABP2 gene expression levels were increased upon treatment. These findings demonstrate that YAP is expressed in the deep fascia of the thoracolumbar region, suggesting its involvement in fascial mechanotransduction processes, remodeling, regeneration, and fibrogenesis. This study indicates, for the first time, that YAP is a "new player" in the mechanobiology of deep fascia.
Subject(s)
Mechanotransduction, Cellular , YAP-Signaling Proteins , Adult , Aged , Female , Humans , Male , Middle Aged , Fascia/physiology , Fibroblasts/metabolismABSTRACT
PURPOSE: Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome. METHODS: Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg. RESULTS: The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome. CONCLUSION: The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.
Subject(s)
Compartment Syndromes , Leg , Adult , Humans , Leg/innervation , Fascia/diagnostic imaging , Fascia/physiology , Fibula , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/physiology , CadaverABSTRACT
Hyaluronan (HA) has been recently identified as a key component of the densification of thoracolumbar fascia (TLF), a potential contributor to non-specific lower back pain (LBP) currently treated with manual therapy and systemic or local delivery of anti-inflammatory drugs. The aim of this study was to establish a novel animal model suitable for studying ultrasound-guided intrafascial injection prepared from HA with low and high Mw. Effects of these preparations on the profibrotic switch and mechanical properties of TLF were measured by qPCR and rheology, respectively, while their lubricating properties were evaluated by tribology. Rabbit proved to be a suitable model of TLF physiology due to its manageable size enabling both TLF extraction and in situ intrafascial injection. Surprisingly, the tribology showed that low Mw HA was a better lubricant than the high Mw HA. It was also better suited for intrafascial injection due to its lower injection force and ability to freely spread between TLF layers. No profibrotic effects of either HA preparation in the TLF were observed. The intrafascial application of HA with lower MW into the TLF appears to be a promising way how to increase the gliding of the fascial layers and target the myofascial LBP.
Subject(s)
Fascia , Hyaluronic Acid , Animals , Rabbits , Fascia/physiology , Models, AnimalABSTRACT
BACKGROUND: Differential movement, or shear strain (SS), between layers of thoracolumbar fascia is reduced with chronic low back pain. To provide a foundation for clinical research involving SS, this study assessed temporal stability and the effect of paraspinal muscle contraction on SS in persons with chronic low back pain. METHODS: We used ultrasound imaging to measure SS in adults self-reporting low back pain ≥1 year. Images were obtained by placing a transducer 2-3 cm lateral to L2-3 with participants lying prone and relaxed on a table moving the lower extremities downward 15°, for 5 cycles at 0.5 Hz. To assess paraspinal muscle contraction effects, participants raised the head slightly from the table. SS was calculated using 2 computational methods. Method 1 averaged the maximum SS from each side during the third cycle. Method 2 used the maximum SS from any cycle (2-4) on each side, prior to averaging. SS was also assessed after a 4-week no manual therapy period. RESULTS: Of 30 participants (n = 14 female), mean age was 40 years; mean BMI 30.1. Mean (SE) SS in females with paraspinal muscle contraction was 66% (7.4) (method 1) and 78% (7.8) (method 2); 54% (6.9) (method 1) and 67% (7.3) (method 2) in males. With muscles relaxed, mean SS in females was 77% (7.6) (method 1) or 87% (6.8) (method 2); 63% (7.1) (method 1) and 78% (6.4) (method 2) in males. Mean SS decreased 8-13% in females and 7-13% in males after 4-weeks CONCLUSION: Mean SS in females was higher than males at each timepoint. Paraspinal muscle contraction temporarily reduced SS. Over a 4-week no-treatment period, mean SS (with paraspinal muscles relaxed) decreased. Methods less likely to induce muscle guarding and enabling assessment with broader populations are needed.
Subject(s)
Low Back Pain , Adult , Male , Humans , Female , Paraspinal Muscles/diagnostic imaging , Paraspinal Muscles/physiology , Feasibility Studies , Muscle Contraction/physiology , Fascia/diagnostic imaging , Fascia/physiologyABSTRACT
In the flexed end-of-range position (e.g., during slumped sitting), the trunk is passively stabilized. Little is known about the biomechanical consequence of posterior approaches on passive stabilization. The aim of this study is to investigate the effect of posterior surgical interventions on local and distant spinal regions. While being fixed at the pelvis, five human torsos were passively flexed. The change in spinal angulation at Th4, Th12, L4 and S1 was measured after level-wise longitudinal incisions of the thoracolumbar fascia, the paraspinal muscles, horizontal incisions of the inter- & supraspinous ligaments (ISL/SSL) and horizontal incision of the thoracolumbar fascia and the paraspinal muscles. Lumbar angulation (Th12-S1) was increased by 0.3° for fascia, 0.5° for muscle and 0.8° for ISL/SSL-incisions per lumbar level. The effect of level-wise incisions at the lumbar spine was 1.4, 3.5 and 2.6 times greater compared to thoracic interventions for fascia, muscle and ISL/SSL respectively. The combined midline interventions at the lumbar spine were associated with 2.2° extension of the thoracic spine. Horizontal incision of the fascia increased spinal angulation by 0.3°, while horizontal muscle incision resulted in a collapse of 4/5 specimens. The thoracolumbar fascia, the paraspinal muscle and the ISL/SSL are important passive stabilizers for the trunk in the flexed end-of-range position. Lumbar interventions needed for approaches to the spine have a larger effect on spinal posture than thoracic interventions and the increase of spinal angulation at the level of the intervention is partially compensated at the neighboring spinal regions.
Subject(s)
Lumbar Vertebrae , Thoracic Vertebrae , Humans , Thoracic Vertebrae/surgery , Thoracic Vertebrae/physiology , Lumbar Vertebrae/surgery , Lumbar Vertebrae/physiology , Fascia/physiology , Ligaments, Articular , Posture/physiology , Biomechanical Phenomena/physiologyABSTRACT
Recent physiological studies have shown that the deep fascia has received much attention concerning clinical medicine; however, histological examination of the deep fascia has not been well established. In this study, we aimed to clarify and visualize the structure of the deep fascia by taking advantage of cryofixation techniques and low-vacuum scanning electron microscopy. As a result, the ultrastructural observations revealed three-dimensional stratification of the deep fascia composed of three layers: the first superficial layer consisting of collagen fibers extending in various directions with blood vessels and peripheral nerves; the second intermediate layer formed by single straight and thick collagen fibers with flexibility; and the third deepest layer, consisting of relatively straight and thin collagen fibers. We explored the use of two hooks to hold a piece of deep fascia in place through the course of cryo-fixation. A comparative observation with or without the hook-holding procedure would indicate the morphological adaptation to physiological stretch and contraction of the deep fascia. The present morphological approach paves the way to visualize three-dimensional ultrastructures for future biomedical studies including clinical pathophysiology.
Subject(s)
Collagen , Fascia , Fascia/physiology , Vacuum , Microscopy, Electron, Scanning , Collagen/ultrastructure , Microscopy, ConfocalABSTRACT
The "motor unit" or the "muscle" has long been considered the quantal element in the control of movement. However, in recent years new research has proved the strong interaction between muscle fibers and intramuscular connective tissue, and between muscles and fasciae, suggesting that the muscles can no longer be considered the only elements that organize movement. In addition, innervation and vascularization of muscle is strongly connected with intramuscular connective tissue. This awareness induced Luigi Stecco, in 2002, to create a new term, the "myofascial unit", to describe the bilateral dependent relationship, both anatomical and functional, that occurs between fascia, muscle and accessory elements. The aim of this narrative review is to understand the scientific support for this new term, and whether it is actually correct to consider the myofascial unit the physiological basic element for peripheral motor control.
Subject(s)
Fascia , Muscle, Skeletal , Muscle, Skeletal/physiology , Fascia/physiology , Connective Tissue/physiology , Muscle Fibers, Skeletal , Muscle Contraction/physiologyABSTRACT
BACKGROUND: The characteristics of foot structure in adolescents and adults are different, affecting sports performance and leading to the progression of foot and lower extremity disorders. RESEARCH QUESTION: This study aimed to investigate the relationship between the intrinsic foot muscles (IFM) and plantar fascia morphology and the repetitive rebound jumping and jump landing ability in adolescent athletes. METHODS: A total of 60 adolescent athletes (35 boys and 25 girls) participated in this study. B-mode ultrasonography was used to obtain images of the IFM and plantar fascia morphology [thickness and cross-sectional area (CSA) of the abductor hallucis (AbH), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), and thickness of the plantar fascia]. The repetitive rebound jump performance was evaluated using the Optojump™ system. Participants were instructed to jump five times continuously with one leg, jumping as high as possible with minimal ground contact time. The jump landing was assessed by measuring the dynamic posture stability index (DPSI) using forward one-legged jump landings. RESULTS: The thickness and CSA of the AbH and FDB were positively correlated with the jump height and reactive jump index. The DPSI score was significantly correlated with the thickness of the AbH, but not with other IFMs or plantar fascia. In the multiple regression analysis, only the thickness of the FDB was associated with the jump height and reactive jump index, indicating that FDB thickness might facilitate adolescent athletes to jump higher with minimal contact time in repetitive rebounding movements. SIGNIFICANCE: The IFM (especially FDB) should be focused on when examining sports performance in adolescent athletes.
Subject(s)
Fascia , Foot , Adult , Male , Female , Adolescent , Humans , Fascia/diagnostic imaging , Fascia/physiology , Foot/diagnostic imaging , Foot/physiology , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/physiology , Ultrasonography , AthletesABSTRACT
The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.
Subject(s)
Analgesia , Hip Fractures , Humans , Fascia/physiology , Femoral Nerve , Hip Fractures/surgery , Morphine Derivatives , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Prospective StudiesABSTRACT
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.
Subject(s)
Fascia , Muscle, Skeletal , Animals , Cadaver , Fascia/physiology , Humans , Muscle, Skeletal/physiology , Randomized Controlled Trials as TopicABSTRACT
The mechanical properties of the deep fascia, particularly their stiffness, strongly affect the development of muscle pathologies (such as compartment syndrome) and the action of the muscles. However, the mechanical characteristics of the deep muscular fascia are still not clearly understood. The present study focuses on examining the reliability of ultrasonic shear wave elastography (USWE) devices in quantifying the shear modulus of the gastrocnemius fascia in healthy individuals, particularly their ability to measure the shear modulus of the deep fascia of the gastrocnemius during ankle dorsiflexion. Twenty-one healthy males (age: 21.48 ± 1.17 years) participated in the study. Using USWE, the shear moduli of the medial gastrocnemius fascia (MGF) and lateral gastrocnemius fascia (LGF) were quantified at different angles during passive lengthening. The two operators took turns measuring each subject's MGF and LGF over a 1-h period, and operator B took an additional measurement 2 h later. For the intra-operator test, the same subjects were measured again at the same time of day 5 days later. Both the intrarater [intraclass correlation coefficient (ICC) = 0.846-0.965)] and interrater (ICC = 0.877-0.961) reliability values for measuring the shear moduli of the MGF and LGF were rated as excellent; the standard error of the mean (SEM) was 3.49 kPa, and the minimal detectable change (MDC) was 9.68 kPa. Regardless of the ankle angle, the shear moduli of the LGF were significantly greater than that of the MGF (p < 0.001). Significant increases in the shear moduli of both the MGF and the LGF were observed in the neutral position compared to the relaxed position. These results indicate that USWE is a reliable technique to assess the shear modulus of the gastrocnemius fascia and detect its dynamic changes during ankle dorsiflexion. USWE can be used for biomechanical studies and intervention experiments concerning the deep fascia.