From Muscle-Bone Concept to the ArthroMyoFascial Complex: A Pragmatic Anatomical Concept for Physiotherapy and Manual Therapy.

BACKGROUND: In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. METHOD: This study is a narrative review and ultrasound observation. RESULTS: Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. CONCLUSION: The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.

Unlocking Pain Relief for Chronic Low Back Pain: The Potential of the 4xT Method® - A Dual Case Study Analysis.

BACKGROUND The 4xT method is a therapeutic approach involving 10 sequential steps. The 4xT method uses the steps test, trigger, tape, and train, sequentially executed until the patient can train with an acceptable level of pain. The report aimed to evaluate the effectiveness of 4xT therapy in managing chronic nonspecific low back pain (LBP) after the first treatment and after 6 weeks of therapy by measuring changes in range of motion (ROM) and pain levels using the numeric rating scale (pain NRS). CASE REPORT After the first treatment, patient 1 (42-year-old woman with 16 years of LBP, having a profession requiring standing) improved substantially in ROM, increasing flexion from 57° to 104° and extension from 5° to 21°. The pain NRS during flexion decreased from 8 to 0 (after step 6), and during extension, it decreased from 6 to 0 (after step 7). Similarly, patient 2 (43-year-old man with 13 weeks of LBP, having a sedentary occupation) showed ROM improvements, increasing extension from 16° to 25° and flexion from 58° to 101°. After step 8, pain NRS during extension decreased from 7 to 1, and during flexion, it decreased from 6 to 2 (after step 3). Pain further reduced to NRS0 after training. After 6 weeks of 4xT therapy, LBP improved, and mobility substantially increased in both patients. CONCLUSIONS The 4xT method was effective in reducing pain and improving mobility in 2 LBP patients after initial treatment and 6 weeks of therapy. Further research is necessary to validate these results in larger populations.

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy.

BACKGROUND: The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. METHODS: A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. RESULTS: Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L. CONCLUSIONS: The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.

Systematic Review of Lumbar Elastic Tape on Trunk Mobility: A Debatable Issue.

OBJECTIVES: To systematically review the literature to analyze the effect of lumbar elastic tape application on trunk mobility, surpassing the minimal detectable change of the used outcome measurement tool, and to analyze the additional effect of applied tension and direction of elastic tape application in low back pain and participants without low back pain. DATA SOURCES: Four databases were used: PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and Google Scholar. STUDY SELECTION: The inclusion criteria were randomized and clinical controlled trials evaluating the effectiveness of lumbar elastic tape application on trunk mobility. DATA EXTRACTION: Two researchers executed the search and a third author was consulted to resolve disagreements. The methodological quality was scored using the PEDro scale, with studies scoring ≤5 being excluded. DATA SYNTHESIS: Eight out of 6799 studies were included; 5 studied individuals with low back pain, and 3 studied participants without low back pain. Two studies scored low on the PEDro scale and were excluded. None of the reported significant changes in trunk mobility due to elastic tape application exceeded the indicated minimal detectable change. No conclusions can be drawn from the direction and applied tension of elastic tape application. CONCLUSIONS: Based on the results of this systematic review, there is no evidence supporting the effect of lumbar elastic tape application. We recommend consensus in the use of more reliable and valid instruments in future studies.