Thoracolumbar Fascia and Lumbar Muscle Stiffness in Athletes with A History of Hamstring Injury.

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.

Spinal cord fractalkine (CX3CL1) signaling is critical for neuronal sensitization in experimental nonspecific, myofascial low back pain.

Neuroactive substances released by activated microglia contribute to hyperexcitability of spinal dorsal horn neurons in many animal models of chronic pain. An important feedback loop mechanism is via release of fractalkine (CX3CL1) from primary afferent terminals and dorsal horn neurons and binding to CX3CR1 receptors on microglial cells. We studied the involvement of fractalkine signaling in latent and manifest spinal sensitization induced by two injections of nerve growth factor (NGF) into the lumbar multifidus muscle as a model for myofascial low back pain. Single dorsal horn neurons were recorded in vivo to study their receptive fields and spontaneous activity. Under intrathecal vehicle application, the two NGF injections led to an increased proportion of neurons responding to stimulation of deep tissues (41%), to receptive field expansion into the hindlimb (15%), and to resting activity (53%). Blocking fractalkine signaling by continuous intrathecal administration of neutralizing antibodies completely prevented these signs of spinal sensitization to a similar extent as in a previous study with the microglia inhibitor minocycline. Reversely, fractalkine itself induced similar sensitization in a dose-dependent manner (for 200 ng/mL: 45% deep tissue responses, 24% receptive field expansion, and 45% resting activity) as repeated nociceptive stimulation by intramuscular NGF injections. A subsequent single NGF injection did not have an additive effect. Our data suggest that neuron-to-microglia signaling via the CX3CL1-CX3CR1 pathway is critically involved in the initiation of nonspecific, myofascial low back pain through repetitive nociceptive stimuli.NEW & NOTEWORTHY Blocking fractalkine signaling by neutralizing antibodies completely prevented spinal sensitization induced by repetitive mild nociceptive input [2 nerve growth factor (NGF) injections into the multifidus muscle] Conversely, fractalkine given intrathecally caused the same pattern of spinal sensitization as the nociceptive NGF injections. Fractalkine signaling is critically involved in sensitization of dorsal horn neurons induced by repeated nociceptive low back muscle stimulation and may hence be a potential target for the prevention of nonspecific, myofascial low back pain.

Structural remodeling of the lumbar multifidus, thoracolumbar fascia and lateral abdominal wall perimuscular connective tissues: A search for its potential determinants.

Recently remodeling of lumbar soft tissues has received increased research attention. However, the major determinants that influence remodeling need to be elucidated in order to understand the impact of different rehabilitation modalities on tissue remodeling. The main aim of this study was to explore the between-subject variance of different measures of lumbar soft tissues quantified with rehabilitative ultrasound imaging (RUSI). RUSI measures (n = 8) were collected from 30 subjects without and 34 patients with LBP: (1) lumbar multifidus (LM) echogenicity (fatty infiltration/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1) (n = 3); (2) posterior layer thickness of the thoracolumbar fascia (n = 1); and (3) thickness of the fasciae surrounding the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) (n = 4). Forward stepwise multivariate regression modeling was conducted with these RUSI measures as dependent variables, using the following independent variables as potential determinants: age, sex, the presence of LBP, body size/composition characteristics (height, weight, trunk length, subcutaneous tissue thickness over the abdominal, and LM muscles), trunk muscle function (or activation) as determined with the percent thickness change of LM, EO, IO, and TrA muscles during a standardized effort (RUSI measures), and physical activity level during sport and leisure activities as estimated with a self-report questionnaire. Two or three statistically significant predictors (or determinants) were selected in the regression model of each RUSI measure (n = 8 models), accounting for 26-64% of their total variance. The subcutaneous tissue thickness on the back accounted for 15-30% variance of LM echogenicity measures and thoracolumbar fascia thickness while the subcutaneous tissue thickness over the abdominals accounted for up to 42% variance of the fascia separating the subcutaneous adipose tissues and the EO muscle. The thickness of IO at rest accounted for 13-21% variance of all investigated abdominal fasciae except the fascia separating the subcutaneous adipose tissue and EO. Pain status accounted for 13-18% variance of the anterior and posterior fasciae of the TrA. Age accounted for 11-14% variance of LM echogenicity at all investigated vertebral levels while sex accounted for 15-21% variance of LM echogenicity at L3/L4 and fascia separating subcutaneous adipose tissue and EO muscle. The function (or activation) of EO and LM at L3/L4 accounted for 8-11% variance of the thoracolumbar fascia and fascia separating TrA and intra-abdominal content (TrA posterior fascia), respectively. Finally, the physical activity level during sport activities accounted for 7% variance of the fascia separating the subcutaneous adipose tissues and the EO muscle. These findings suggest that determinants other than body size characteristics may impact the remodeling of lumbar soft tissues, more importantly the subcutaneous adipose tissue deposits (thickness RUSI measures), which are associated with ectopic fat deposition in the LM and in the fasciae that are more closely positioned to the surface. While age, sex, and pain status explain some variability, modifiable factors such as physical activity level as well as trunk muscle thickness and function were involved. Overall, these results suggest that rehabilitation can potentially impact tissue remodeling, particularly in terms of intramuscular and perimuscular adipose tissues.

Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae.

Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.

The Effect of Foam Rolling Versus IASTM on Knee Range of Motion, Fascial Displacement, and Patient Satisfaction.

CONTEXT: Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown. OBJECTIVE: To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction. DESIGN: Randomized controlled clinical trial. SETTING: Mid-Atlantic University. PARTICIPANTS: Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM. INTERVENTIONS: All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time. MAIN OUTCOME MEASURES: Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction. RESULTS: Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied. CONCLUSIONS: As both groups improved pretest to posttest, either treatment could be used.

Overuse Injury: The Result of Pathologically Altered Myofascial Force Transmission?

Overuse injuries are suggested to result from repetitive microdamage eliciting pain in the affected tissue. Therapy commonly focuses on the area of symptom localization; however, such approach may oversimplify the true etiopathology. This review hypothesizes that the development of some sports-related soft tissue disorders, such as plantar fasciitis or lumbago, is promoted by pathologically altered force transmission from anatomically connected structures.

Characterization of torque generating properties of ankle plantar flexor muscles in ambulant adults with cerebral palsy.

PURPOSE: Weakness of plantar flexor muscles is related to reduced push-off and forward propulsion during gait in persons with cerebral palsy (CP). It has not been clarified to what an extent altered muscle contractile properties contribute to this muscle weakness. Here, we investigated the torque generating capacity and muscle fascicle length in the triceps surae muscle throughout ankle range of motion (ROM) in adults with CP using maximal single muscle twitches elicited by electrical nerve stimulation and ultrasonography. METHODS: Fourteen adults with CP (age 36, SD 10.6, GMFCS I-III) and 17 neurological intact (NI) adults (age 36, SD 4.5) participated. Plantar flexor torque during supramaximal stimulation of the tibial nerve was recorded in a dynamometer at 8 ankle angles throughout ROM. Medial gastrocnemius (MG) fascicle length was tracked using ultrasonography. RESULTS: Adults with CP showed reduced plantar flexor torque and fascicle shortening during supramaximal stimulation throughout ROM. The largest torque generation was observed at the ankle joint position where the largest shortening of MG fascicles was observed in both groups. This was at a more plantarflexed position in the CP group. CONCLUSION: Reduced torque and fascicle shortening during supramaximal stimulation of the tibial nerve indicate impaired contractile properties of plantar flexor muscles in adults with CP. Maximal torque was observed at a more plantarflexed position in adults with CP indicating an altered torque-fascicle length/ankle angle relation. The findings suggest that gait rehabilitation in adults with CP may require special focus on improvement of muscle contractility.

Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee.

BACKGROUND: Biomechanical evidence suggests that the anterolateral structures of the knee may be important restraints against anterolateral rotatory instability (ALRI) in the setting of anterior cruciate ligament (ACL) injury. OBJECTIVE: To describe the anatomy and presence of injury of the capsule-osseous layer of the iliotibial band (CITB), the iliotibial band, and its deep distal femoral attachments in patients with a 'normal' knee (no pivot-shift bone marrow edema (BME) pattern) and patients with a pivot-shift BME pattern indicative of a pivot-shift injury associated with ACL tears. METHODS: Group 1: 20 consecutive patients with no MRI evidence of pivot-shift injury and group 2: 20 consecutive patients with a pivot-shift BME pattern on MRI were identified. Retrospective consensus analysis of the anatomy and appearances of the CITB and the 'proximal' and 'epicondylar' distal femoral attachments of the ITB was performed for each MRI by two experienced musculoskeletal radiologists. RESULTS: The positive predictive value (PPV) of CITB injury for pivot-shift ACL injury was 74%, negative predicted Value (NPV) was 80%. The PPV for injury of the 'proximal' ITB femoral attachment with pivot-shift ACL injury was 93%, NPV was 84%. The PPV for 'epicondylar' iliotibial femoral attachment injury was 62%, NPV was 45%. CONCLUSIONS: Injury of the CITB and 'proximal' deep femoral attachments of the ITB are good markers for ACL injury even in the absence of a Segond fracture and should be evaluated on all MRIs as they may prove important in the further management of ALRI.

Ultrasonography Features of the Plantar Fascia Complex in Patients with Chronic Non-Insertional Achilles Tendinopathy: A Case-Control Study.

PURPOSE: The goal of the present study was to assess, by ultrasound imaging (USI), the thickness of the plantar fascia (PF) at the insertion of the calcaneus, mid and forefoot fascial locations, and the calcaneal fat pad (CFP) in patients with Achilles tendinopathy (AT). METHODS: An observational case-control study. A total sample of 143 individuals from 18 to 55 years was evaluated by USI in the study. The sample was divided into two groups: A group composed of the chronic non-insertional AT (n = 71) and B group comprised by healthy subjects (n = 72). The PF thicknesses at insertion on the calcaneus, midfoot, rearfoot and CFP were evaluated by USI. RESULTS: the CFP and PF at the calcaneus thickness showed statistically significant differences (P < 0.01) with a decrease for the tendinopathy group with respect to the control group. For the PF midfoot and forefoot thickness, no significant differences (P > 0.05) were observed between groups. CONCLUSION: The thickness of the PF at the insertion and the CPF is reduced in patients with AT measured by USI.

Impaired sensorimotor control of the hand in congenital absence of functional muscle spindles.

Patients with hereditary sensory and autonomic neuropathy type III (HSAN III) exhibit marked ataxia, including gait disturbances. We recently showed that functional muscle spindle afferents in the leg, recorded via intraneural microelectrodes inserted into the peroneal nerve, are absent in HSAN III, although large-diameter cutaneous afferents are intact. Moreover, there is a tight correlation between loss of proprioceptive acuity at the knee and the severity of gait impairment. We tested the hypothesis that manual motor performance is also compromised in HSAN III, attributed to the predicted absence of muscle spindles in the intrinsic muscles of the hand. Manual performance in the Purdue pegboard task was assessed in 12 individuals with HSAN III and 11 age-matched healthy controls. The mean (±SD) pegboard score (number of pins inserted in 30 s) was 8.1 ± 1.9 and 8.6 ± 1.8 for the left and right hand, respectively, significantly lower than the scores for the controls (15.0 ± 1.3 and 16.0 ± 1.1; P < 0.0001). Performance was not improved after kinesiology tape was applied over the joints of the hand. In 5 patients we inserted a tungsten microelectrode into the ulnar nerve at the wrist. No spontaneous or stretch-evoked muscle afferent activity could be identified in any of the 11 fascicles supplying intrinsic muscles of the hand, whereas touch-evoked activity from low-threshold cutaneous mechanoreceptor afferents could readily be recorded from 4 cutaneous fascicles. We conclude that functional muscle spindles are absent in the short muscles of the hand and most likely absent in the long finger flexors and extensors, and that this largely accounts for the poor manual motor performance in HSAN III. NEW & NOTEWORTHY We describe the impaired manual motor performance in patients with hereditary sensory and autonomic neuropathy type III (Riley-Day syndrome), who exhibit congenital insensitivity to pain, poor proprioception, and marked gait ataxia. We show that functional muscle spindles are absent in the intrinsic muscles of the hand, which we argue contributes to their poor performance in a task involving the precision grip.

Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

BACKGROUND: Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. METHODS: We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. RESULTS: The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. CONCLUSION: Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Ultrasonographic evaluation of the ankle after unilateral traumatic lower limb amputations.

BACKGROUND: Unilateral lower limb amputation can alter the tissue morphology leading to increase future risk of degenerative secondary disorders. METHODS: Thirty-four consecutive male patients with unilateral lower limb amputations of different levels and 34 well matched male controls were included. To explore whether the ankles of traumatic lower limb amputees were undergoing morphological changes, three different tissue types i.e. talar cartilage, plantar fascia and Achilles tendon thicknesses in the intact limb of the lower limb amputee and healthy controls were measured by using ultrasound. RESULTS: Plantar fascia was found to be thicker (p=0.013) and talar cartilage was thinner (p<0.001) on the intact sides of the patients than those of the controls. Achilles tendon thickness was found to be similar. In patients group, plantar fascia thickness was positively correlated with age (r=0.601, p<0.001), BMI (r=0.454, p=0.007) and durations of amputation (r=0.443, p=0.009) and prosthetic use (r=0.429, p=0.011). Achilles tendon thickness was positively correlated with durations of amputation (r=0.338, p=0.05) and prosthetic use (r=0.468, p=0.005). In controls group, talar cartilage thickness was negatively correlated with age (r=-0.640, p<0.001) and BMI (r=-0.401, p=0.019). CONCLUSIONS: The talar cartilage seemed to be thinner and the plantar fascia to be thicker on the intact sides of the unilateral limb amputees.

Altered mechanical interaction between rat plantar flexors due to changes in intermuscular connectivity.

Connective tissue formation following muscle injury and remedial surgery may involve changes in the stiffness and configuration of the connective tissues linking adjacent muscles. We investigated changes in mechanical interaction of muscles by implanting either a tissue-integrating mesh (n = 8) or an adhesion barrier (n = 8) to respectively increase or decrease the intermuscular connectivity between soleus muscle (SO) and the lateral gastrocnemius and plantaris complex (LG+PL) of the rat. As a measure of mechanical interaction, changes in SO tendon forces and proximal-distal LG+PL force differences in response to lengthening LG+PL proximally were assessed 1 and 2 weeks post-surgery. The extent of mechanical interaction was doubled 1 week post-implantation of the tissue-integrating mesh compared to an unaffected compartment (n = 8), and was more than four times higher 2 weeks post-surgery. This was found only for maximally activated muscles, but not when passive. Implanting the adhesion barrier did not result in a reduction of the mechanical interaction between these muscles. Our findings indicate that the ratio of force transmitted via myofascial, rather than myotendinous pathways, can increase substantially when the connectivity between muscles is enhanced. This improves our understanding of the consequences of connective tissue formation at the muscle boundary on skeletal muscle function.

[The use of fascial distorsion model (FDM) in patient with limited mobility in the shoulder joint - a case report]. / Zastosowanie modelu znieksztalcania powieziowego (FDM ­ fascial distorsion model) u pacjentki z ograniczeniem ruchomosci w stawie barkowym ­ opis przypadku.

FDM is the anatomical model in which clinical signs in conjunction with the patient's body language allow to diagnose one or more of the six specific distortions of the fascial system described by the creator of the concept of FDM and doctor-osteopath Stephen Typaldos. AIM: The aim of the study is to present the use of therapy Fascial Distorsion Model to patient with limited mobility in the shoulder joint. A CASE REPORT: Here we report a 32 year old female patient with painful limitation of motion in the shoulder joint right continuing for three weeks. The patient is an office worker, three times a week swims. Pain appears periodicaly and only in certain ranges of motion of the right upper limb. In the functional study by FDM it is continuum distortion and triggerband distortion. Then the appropriate therapeutic techniques were used. CONCLUSIONS: The patient regained full range of motion in the shoulder joint after using FDM techniques without pain that prevented her making a move. During the test, the patient performed functional movements in the full range of movement without pain. Techniques of the FDM are an interesting complement workshop therapy which is treating limits in the range of motion and pain in the joints.

Cystocele and functional anatomy of the pelvic floor: review and update of the various theories.

INTRODUCTION AND HYPOTHESIS: We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. METHODS: PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. We retrieved 612 articles, of which 61 matched our topic and thus were selected. Anatomic structures of bladder support and their roles in cystocele onset were determined on the international anatomic classification; the various anatomic theories of pelvic organ support were reviewed and a synthesis was made of theories of cystocele pathophysiology. RESULTS: Anterior vaginal support structures comprise pubocervical fascia, tendinous arcs, endopelvic fascia, and levator ani muscle. DeLancey's theory was based on anatomic models and, later, magnetic resonance imaging (MRI), establishing a three-level anatomopathologic definition of prolapse. Petros's integral theory demonstrated interdependence between pelvic organ support systems, linking ligament-fascia lesions, and clinical expression. Apical cystocele is induced by failure of the pubocervical fascia and insertion of its cervical ring; lower cystocele is induced by pubocervical fascia (medial cystocele) or endopelvic fascia failure at its arcus tendineus fasciae pelvis attachment (lateral cystocele). CONCLUSIONS: Improved anatomic knowledge of vaginal wall support mechanisms will improve understanding of cystocele pathophysiology, diagnosis of the various types, and surgical techniques. The two most relevant theories, DeLancey's and Petros's, are complementary, enriching knowledge of pelvic functional anatomy, but differ in mechanism. Three-dimensional digital models could integrate and assess the mechanical properties of each anatomic structure.

Greater Resting Lumbar Extensor Myofascial Stiffness in Younger Ankylosing Spondylitis Patients Than Age-Comparable Healthy Volunteers Quantified by Myotonometry.

OBJECTIVE: To quantify resting lumbar erector myofascial stiffness in younger patients with ankylosing spondylitis (AS) and age-comparable healthy control subjects using a handheld mechanical impulse-based myotonometric device. DESIGN: A case-control study of 24 patients with AS and 24 age-comparable healthy control subjects. SETTING: University physical therapy department. PARTICIPANTS: Patients with AS (men: n=19; women: n=5; total: N=24) and healthy volunteers (men: n=19; women: n=5; total: N=24) without low back pain (age range, 18-46y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Lumbar myofascial stiffness. RESULTS: At the initial measurements, median stiffness (Nm) of the averaged right- and left-sided values was greater (P=.021) in 24 patients with AS than 24 control subjects (268.9 vs 238.9, respectively). Repeated measurements after a 10-minute prone resting period were also greater (P=.007) in patients with AS than control subjects (281.0 vs 241.4, respectively). The 48 averaged right- and left-sided values from baseline and 10-minute measurements were compared in each subject group. The patients with AS more frequently (P=.012) had stiffness values >250 Nm (35 [72.9%] vs 22 [45.8%] in control subjects). CONCLUSIONS: Lumbar myofascial stiffness was greater in 24 patients with AS than in the control subjects. A hypothesized biomechanical concept of increased resting lumbar myofascial stiffness in AS may be supported by this preliminary controlled study.

Biomechanical analysis of suture locations of the distal plantar fascia in partial foot.

PURPOSE: The aim of this study was to evaluate the rationality of the suture locations of distal plantar fascia (DPF) after foot amputation to avoid the risk factors of re-amputation or plantar fasciitis. METHODS: The tensile strain of plantar fascia (PF) in the different regions was measured by uni-axial tensile experiment. A three-dimensional (3D) finite element model was also developed to simulate tensile behaviour of PF in weight bearing conditions. The model includes 12 bones, ligaments, PF, cartilage and soft tissues. Four suture location models for the DPF were considered: the fourth and fifth DPF were sutured on the third metatarsal, the cuboid, and both the third metatarsal and the cuboid, and one un-sutured model. RESULTS: The peak tensile strain of the first, second and third PF was 0.134, 0.128 and 0.138 based on the mechanical test, respectively. The fourth and fifth DPF sutured at the cuboid and the third metatarsal could offer more favourable outcomes. The peak strain of 4.859 × 10(-2), 2.347 × 10(-2) and 1.364 × 10(-2) in the first, second and third PF showed the least outcomes in stance phase. Also, peak strain and stress of the residual PF reduced to 4.859 × 10(-2) and 1.834 MPa, respectively. The stress region was redistributed on the mid-shaft of the first and third PF and the peak stress of medial cuneiform bone evidently decreased. CONCLUSIONS: The fourth and fifth DPF suture at the third metatarsal and cuboid was appropriate for the partial foot. The findings are expected to suggest optimal surgical plan of the DPF suture and guide further therapeutic planning of partial foot patients.

Painful connections: densification versus fibrosis of fascia.

Deep fascia has long been considered a source of pain, secondary to nerve pain receptors becoming enmeshed within the pathological changes to which fascia are subject. Densification and fibrosis are among such changes. They can modify the mechanical properties of deep fasciae and damage the function of underlying muscles or organs. Distinguishing between these two different changes in fascia, and understanding the connective tissue matrix within fascia, together with the mechanical forces involved, will make it possible to assign more specific treatment modalities to relieve chronic pain syndromes. This review provides an overall description of deep fasciae and the mechanical properties in order to identify the various alterations that can lead to pain. Diet, exercise, and overuse syndromes are able to modify the viscosity of loose connective tissue within fascia, causing densification, an alteration that is easily reversible. Trauma, surgery, diabetes, and aging alter the fibrous layers of fasciae, leading to fascial fibrosis.

Clinical relevance of fascial tissue and dysfunctions.

Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role in force transmission has recently been disproven. Fascial tissue contains contractile elements enabling a modulating role in force generation and also mechanosensory fine-tuning. This hypothesis is supported by in vitro studies demonstrating an autonomous contraction of human lumbar fascia and a pharmacological induction of temporary contraction in rat fascial tissue. The ability of spontaneous regulation of fascial stiffness over a time period ranging from minutes to hours contributes more actively to musculoskeletal dynamics. Imbalance of this regulatory mechanism results in increased or decreased myofascial tonus, or diminished neuromuscular coordination, which are key contributors to the pathomechanisms of several musculoskeletal pathologies and pain syndromes. Here, we summarize anatomical and biomechanical properties of fascial tissue with a special focus on fascial dysfunctions and resulting clinical manifestations. Finally, we discuss current and future potential treatment options that can influence clinical manifestations of pain syndromes associated with fascial tissues.

Fascia wrapping technique: a modified method for the treatment of cubital tunnel syndrome.

Variations of the anterior transposition of the ulnar nerve for cubital tunnel syndrome include subcutaneous, submuscular, intramuscular, and subfascial methods. We introduce a modification of subfascial transposition, which is designed to facilitate nerve gliding by wrapping the nerve with fascia. Twenty patients with wrapping surgery following the diagnosis of cubital tunnel syndrome were reviewed retrospectively. Preoperative electrodiagnostic studies were performed in all patients and all of them were rechecked postoperatively. The preoperative mean value of motor conduction velocity (MCV) was 37.1 ± 6.7 m/s within the elbow segment and this result showed a decrease compared to the result of MCV with 53.9 ± 6.9 m/s in the below the elbow-wrist segment with statistical significance (P < 0.05). Postoperative mean values of MCV were improved in all of 20 patients to 47.6 ± 5.5 m/s (P < 0.05). 19 patients of 20 (95%) reported good or excellent clinical outcomes according to a modified Bishop scoring system. The surgical treatment methods for cubital tunnel syndrome have their own advantages and disadvantages, and the preferred method differs depending on the surgeon. The wrapping method of anterior transposition is a newly designed alternative method modified from subfascial transposition. This method could be an alternative option to treat cubital tunnel syndrome.