RESUMO
The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.
Assuntos
Adaptação Fisiológica , Traumatismos em Atletas/diagnóstico , Fáscia/lesões , Fáscia/fisiologia , Doenças Musculoesqueléticas/diagnóstico , Envelhecimento , Traumatismos em Atletas/prevenção & controle , Desempenho Atlético , Pesquisa Biomédica , Consenso , Exercício Físico/fisiologia , Humanos , Doenças Musculoesqueléticas/prevenção & controle , Esportes/fisiologia , Medicina EsportivaRESUMO
BACKGROUND: A future increase in total joint arthroplasties in patients with diabetes seems likely considering the prevalence of osteoarthritis and diabetes mellitus are increasing. However, the rates of arthroplasty in the population of patients with diabetes are unclear. QUESTIONS/PURPOSES: We sought to determine whether lower extremity arthroplasties in a veteran population with diabetes is different from a similar population without diabetes. The following specific questions were asked: (1) Is the rate of TKA in veterans with diabetes higher than in those without diabetes? (2) Is the rate of THA in veterans with diabetes higher than in those without diabetes? (3) Are arthroplasty revision rates greater in veterans with diabetes than in veterans without diabetes? METHODS: The US Department of Veterans Affairs Health administrative data from fiscal year 2000 was used to identify persons with primary or secondary TKA or THA. The rate of surgeries among a diabetic population was compared with that among a nondiabetic population. RESULTS: The diabetic cohort received total joint arthroplasties at a higher rate than the nondiabetic cohort at all ages younger than 66 years, with a range of odd ratios from 1.3 to 3.4. In answer to our specific questions, (1) the rate of TKA (95% CI, 2.1-3.7), (2) the rate of THA (95% CI, 1.0-2.6), and (3) the rates of arthroplasty revision (95% CI, 0.9-5.8 TKA and 0.7-6.8 THA) were higher in veterans with diabetes. Furthermore, those with diabetes in the youngest age group studied received total joint arthroplasties and revision surgeries at approximately double the rates of those without diabetes. CONCLUSIONS: If these findings hold true for the population as a whole, they imply that clinicians in the United States may see a sharp increase in younger diabetic candidates for joint arthroplasty.
Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Diabetes Mellitus/cirurgia , Artropatias/cirurgia , Veteranos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Prevalência , Reoperação , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
The cis-hydrindane motif is found in a number of natural products that display important biological activity. A flexible, stereoselective approach to the framework has been developed that features highly diastereoselective, SmI(2)-mediated cyclisations. The strategy has been exploited in the first synthesis of the proposed structure of faurinone and an approach to the skeleton of the antibacterial natural product, pleuromutilin.
Assuntos
Compostos Heterocíclicos de 4 ou mais Anéis/síntese química , Indanos/química , Samário/química , Produtos Biológicos/química , Ciclização , Diterpenos/síntese química , Modelos Moleculares , Estrutura Molecular , Oxirredução , Compostos Policíclicos , Estereoisomerismo , PleuromutilinasRESUMO
OBJECTIVES: To compare the rates of diabetes and macrovascular conditions in veterans with spinal cord injury (SCI) and to examine variations by patient-level demographic, socioeconomic, access, and health status factors. DESIGN: A retrospective analysis. Diabetes status was classified by merging with diabetes epidemiology cohort using a validated algorithm. Chi-square tests and logistic regressions used to compare rates in macro- and microvascular conditions in veterans with and without diabetes. SETTING: Veteran Health Administration clinic users in fiscal year (FY) 1999 to FY 2001. PARTICIPANTS: SCI patients (N=8769) with diabetes (n=1333), in FY 2000, identified through the SCI registry. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Macrovascular and microvascular conditions in the next year (February 2001). Derived from International Statistical Classification of Diseases, 9th Revision, Clinical Modification, codes in the patient treatment files. RESULTS: Overall, 15% of SCI veterans were identified with diabetes but this was an underestimate due to high mortality (8%). Among SCI veterans with diabetes, 49% had at least one macrovascular condition and 54% had microvascular conditions compared with 24% and 25% of those without diabetes (P<.001). CONCLUSIONS: Our study highlights the highly significant relationship between diabetes and macro- and microvascular conditions in veterans with SCI. Neurologic deficit combined with increased insulin resistance has a greater macrovascular impact on SCI veterans than on those who do not have diabetes. Increasing age and physical comorbidities compound the problem.
Assuntos
Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Infarto do Miocárdio/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Veteranos/estatística & dados numéricos , Idoso , Algoritmos , Doenças Cardiovasculares/epidemiologia , Causalidade , Estudos de Coortes , Comorbidade , Intervalos de Confiança , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Estilo de Vida , Masculino , Corpo Clínico Hospitalar , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Chronic Fatigue Syndrome (CFS) is a disorder of unknown etiology associated with debilitating fatigue. One symptom commonly reported is disequilibrium. The goal of this study was to determine if CFS patients demonstrated verified balance deficits and if this was effected by comorbid fibromyalgia (FM). METHODS: Twenty-seven patients with CFS (12 with comorbid FM) and 22 age and gender matched controls performed posturography. RESULTS: Balance scores were significantly correlated with physical functional status in the CFS group (R2â=â0.43, Pâ<â0.001), which was not found for mental functional status (R2â=â0.06, Pâ>â0.5). CFS patients (regardless of FM) had significantly higher anxiety subscale of the vertigo symptom scale scores. CFS patients, regardless of FM status, demonstrated significantly lower overall composite balance scores (Controls - 78.8±1.5; CFS - 69.0±1.4, Pâ<â0.005) even when controlling for anxiety and also had worse preference scores, indicating they relied on visual information preferentially even when visual information was incorrect. Interestingly, the CFS+FM group, not CFS only, demonstrated significantly worse vestibular scores (Controls - 70.2±2.4; CFS only - 67.9±3.8; CFS with FM - 55.4±4.6, Pâ=â0.013). INTERPRETATION: The major findings are that poor balance may be associated with poorer self-reported physical health. In addition, CFS patients seemed to rely preferentially on visual inputs, regardless of whether it was correct. The finding that vestibular function may be impaired in patients with CFS+FM but not in those with CFS alone suggests that the pathophysiology of CFS+FM may differ as has been suggested by some.
Assuntos
Síndrome de Fadiga Crônica/fisiopatologia , Fibromialgia/fisiopatologia , Equilíbrio Postural , Adulto , Síndrome de Fadiga Crônica/complicações , Feminino , Fibromialgia/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Altered connective tissue structure has been identified in adults with chronic low back pain (LBP). A self-care treatment for managing LBP is the MELT method. The MELT method is a hands-off, self-treatment that is said to alleviate chronic pain, release tension and restore mobility, utilizing specialized soft treatments balls, soft body roller and techniques mimicking manual therapy. The objective of this study was to determine whether thickness of thoracolumbar connective tissue and biomechanical and viscoelastic properties of myofascial tissue in the low back region change in subjects with chronic LBP as a result of MELT. This study was designed using a quasi experimental pre-post- design that analyzed data from subjects who performed MELT. Using ultrasound imaging and an algorithm developed in MATLAB, thickness of thoracolumbar connective tissue was analyzed in 22 subjects. A hand-held digital palpation device, called the MyotonPRO, was used to assess biomechanical properties such as stiffness, elasticity, tone and mechanical stress relaxation time of the thoracolumbar myofascial tissue. A forward bending test assessing flexibility and pain scale was added to see if MELT affected subjects with chronic LBP. A significant decrease in connective tissue thickness and pain was observed in participants. Significant increase in flexibility was also recorded.
Assuntos
Dorso/fisiopatologia , Tecido Conjuntivo/fisiopatologia , Dor Lombar/terapia , Massagem/métodos , Músculos Paraespinais/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos , Doença Crônica , Tecido Conjuntivo/diagnóstico por imagem , Fáscia/diagnóstico por imagem , Fáscia/fisiopatologia , Feminino , Humanos , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Músculos Paraespinais/diagnóstico por imagem , Autocuidado/métodos , UltrassonografiaRESUMO
Prostate cancer most commonly metastasizes to bone, lung and liver. Omental metastasis of prostate cancer is extremely rare, with only a few cases reported in the literature, many of which have associated ascites. We present a case of non-ascitic omental metastasis of prostate cancer without any bone metastases. Furthermore, this patient has had two negative measurements of circulating tumor cells (CTCs) in the blood, suggesting a non-hematogenous route of metastasis to the omentum.
RESUMO
Physical therapists and osteopaths want to know the quantitative force transmitted in the tissues during resistance exercise and also the relationship between tissue strength and the specific type of resistance exercise of the skeletal muscles. This paper uses the strain energy function for large deformations associated with the active and passive response of transversely isotropic skeletal muscle tissue to evaluate muscle strength and force transmitted in tissues during resistance exercises for the quadriceps muscle at the knee during isometric training exercise at different knee angles in vivo. It is found that after an exercise program, the muscle stiffness is halved when the bending angle of the knee increases from 50° to 100°. The muscle strength generated is marginally greater at 100° than at 50°. The stress transmitted in the lateral direction for 100° bending is double that for 50°.
Assuntos
Articulação do Joelho/fisiologia , Músculo Quadríceps/fisiologia , Idoso , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Contração Isométrica/fisiologia , Masculino , Modelos Teóricos , Força Muscular , Treinamento ResistidoRESUMO
Complementary and integrative treatments, such as massage, acupuncture, and yoga, are used by increasing numbers of cancer patients to manage symptoms and improve their quality of life. In addition, such treatments may have other important and currently overlooked benefits by reducing tissue stiffness and improving mobility. Recent advances in cancer biology are underscoring the importance of connective tissue in the local tumor environment. Inflammation and fibrosis are well-recognized contributors to cancer, and connective tissue stiffness is emerging as a driving factor in tumor growth. Physical-based therapies have been shown to reduce connective tissue inflammation and fibrosis and thus may have direct beneficial effects on cancer spreading and metastasis. Meanwhile, there is currently little knowledge on potential risks of applying mechanical forces in the vicinity of tumors. Thus, both basic and clinical research are needed to understand the full impact of integrative oncology on cancer biology as well as whole person health. Cancer Res; 76(21); 6159-62. ©2016 AACR.
Assuntos
Tecido Conjuntivo/fisiologia , Fáscia/fisiologia , Neoplasias/terapia , Animais , Humanos , Neoplasias/patologia , Neoplasias/fisiopatologiaRESUMO
Fatigue in the elderly population is a complex phenomenon. Although a number of factors contributing to the fatigue have been identified, its basic mechanism remains elusive. Additional research on prevalence, identification, diagnosis, severity of fatigue, and associated factors and the role of exercise as an effective treatment modality could lead to a better understanding of the causal factors.
Assuntos
Fadiga , Idoso , Diagnóstico Diferencial , Terapia por Exercício , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/reabilitação , Avaliação Geriátrica , HumanosRESUMO
OBJECTIVE: As the muscle contracts, fibers get thicker, forcing the fascial tubular layers surrounding the muscle (endomysium, perimysium and epimysium) to expand in diameter and hence to shorten in length. We develop a mathematical model to determine the fraction of force generated by extremity muscles during contraction that is transmitted to the surrounding tubes of fascia. METHODS: Theory of elasticity is used to determine the modulus of elasticity, radial strain and the radial stress transmitted to the fascia. RESULTS: Starting with published data on dimensions of muscle and muscle force, we find radial stress is 50% of longitudinal stress in the soleus, medial gastrocnemius, and elbow flexor and extensor muscles. CONCLUSION: Substantial stress is transmitted to fascia during muscular exercise, which has implications for exercise therapies if they are designed for fascial as well as muscular stress. This adds additional perspective to myofascial force transmission research.
Assuntos
Exercício Físico/fisiologia , Fáscia/fisiologia , Modelos Teóricos , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Fenômenos Biomecânicos , Elasticidade/fisiologia , Humanos , Fibras Musculares Esqueléticas , Estresse MecânicoRESUMO
Fascia can be considered part of the connective tissues that permeates the human body. However, in medical training its definition is not clear, and even among specialists its role is not completely understood. Physiatrists have a unique opportunity to add to the growing scientific and clinical knowledge about fascia, particularly about how this connective tissue network may apply clinically to musculoskeletal disorders. In this narrative review, the structure and function of fascia is discussed from the perspective of physiatry.
Assuntos
Fáscia , Doenças Musculoesqueléticas/reabilitação , Dor , Medicina Física e Reabilitação/tendências , Humanos , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , Dor/etiologia , Dor/psicologia , Dor/reabilitaçãoRESUMO
CONTEXT: Osteopathic manipulative medicine techniques involve compressive and tangential forces to target the fascia. These forces are transmitted to the skin and adipose tissue before the fascia is encountered. Knowing the extent of deformation of these 2 tissue layers relative to the fascia will assist osteopathic physicians in evaluating techniques for manual therapies and adjusting these therapies to reduce patient discomfort and improve results. OBJECTIVE: To determine the magnitude of the forces transmitted to the skin, adipose tissue, and fascia, and to determine the magnitude of deformation produced in the skin and adipose tissue relative to the fascia using a mathematical model. METHODS: The large deformation theory of elasticity, valid for 3-dimensional deformations, was used to evaluate the forces that need to be applied such that a specified deformation is produced in any region of the skin, adipose tissue, or fascia layers. Similarly, if the forces are specified, then the deformation produced can be determined. RESULTS: The normal and tangential forces required to produce a deformation of 9% compression and 4% shear for the skin were 50 N and 11 N, respectively. Normal and tangential forces of about 100 N and 22 N were found for a similar deformation of fascia. For adipose tissue, these forces were 36 N and 8 N, respectively. In addition, the skin experienced more compression and shear-about 1.5 times as much as the fascia, and the adipose tissue experienced about 2.5 to 3.5 times the deformation of the fascia and 50% more than the skin when a given force was applied to the skin. CONCLUSION: The forces applied to the surface of the skin were transmitted through this layer and the adipose layer entirely to the fascia. Therefore, the skin and adipose tissue experienced the same magnitude of force as the fascia. However, the skin and adipose tissue experienced more compression and shear than the fascia.
Assuntos
Tecido Adiposo/fisiologia , Fáscia/fisiologia , Osteopatia , Modelos Teóricos , Fenômenos Fisiológicos da Pele , Estresse Mecânico , Fenômenos Biomecânicos , Elasticidade , HumanosRESUMO
More than 100 years ago A.T. Still MD founded osteopathic medicine, and specifically described fascia as a covering, with common origins of layers of the fascial system despite diverse names for individual parts. Fascia assists gliding and fluid flow and is highly innervated. Fascia is intimately involved with respiration and with nourishment of all cells of the body, including those of disease and cancer. This paper reviews information presented at the first three International Fascia Research Congresses in 2007, 2009 and 2012 from the perspective of Dr Still, that fascia is vital for organism's growth and support, and it is where disease is sown.
Assuntos
Fáscia/anatomia & histologia , Medicina Osteopática/história , Pesquisa Biomédica , Fáscia/irrigação sanguínea , Fáscia/inervação , História do Século XIX , História do Século XX , Humanos , Osteopatia , Pontos-Gatilho , Estados UnidosRESUMO
In this paper, we computed fluid pressure and force on fascia sheets during manual therapy treatments using Squeeze Film Lubrication theory for non-Newtonian fluids. For this purpose, we developed a model valid for three dimensional fluid flow of a non-Newtonian liquid. Previous models considered only one-dimensional flows in two dimensions. We applied this model to compare the one-dimensional flow of HA, considered as a lubricating fluid, around or within the fascia during sliding, vibration, and back-and-forth sliding manipulation treatment techniques. The fluid pressure of HA increases dramatically as fascia is deformed during manual therapies. The fluid force increases more during vertical vibratory manipulation treatment than in constant sliding, and back and forth motion. The variation of fluid pressure/force causes HA to flow near the edges of the fascial area under manipulation in sliding and back and forth motion which may result in greater lubrication. The fluid pressure generated in manual therapy techniques may improve sliding and permit muscles to work more efficiently.
Assuntos
Fáscia/química , Massagem , Líquido Sinovial/química , Fenômenos Biomecânicos , Fáscia/fisiologia , Humanos , Ácido Hialurônico/química , Lubrificação , Manejo da Dor , Líquido Sinovial/fisiologiaRESUMO
CONTEXT: More research is needed to understand the flow characteristics of hyaluronic acid (HA) during motions used in osteopathic manipulative treatment and other manual therapies. OBJECTIVE: To apply a 3-dimensional mathematical model to explore the relationship between the 3 manual therapy motions (constant sliding, perpendicular vibration, and tangential oscillation) and the flow characteristics of HA below the fascial layer. METHODS: The Squeeze Film Lubrication theory of fluid mechanics for flow between 2 plates was used, as well as the Navier-Stokes equations. RESULTS: The fluid pressure of HA increased substantially as fascia was deformed during manual therapies. There was a higher rate of pressure during tangential oscillation and perpendicular vibration than during constant sliding. This variation of pressure caused HA to flow near the edges of the fascial area under manipulation, and this flow resulted in greater lubrication. The pressure generated in the fluid between the muscle and the fascia during osteopathic manipulative treatment causes the fluid gap to increase. Consequently, the thickness between 2 fascial layers increases as well. Thus, the presence of a thicker fluid gap can improve the sliding system and permit the muscles to work more efficiently. CONCLUSION: The mathematical model employed by the authors suggests that inclusion of perpendicular vibration and tangential oscillation may increase the action of the treatment in the extracellular matrix, providing additional benefits in manual therapies that currently use only constant sliding motions.
Assuntos
Fáscia/química , Ácido Hialurônico/fisiologia , Osteopatia , Reologia , Humanos , Ácido Hialurônico/química , Lubrificação , Massagem , Modelos Biológicos , Pressão , Líquido Sinovial/fisiologia , VibraçãoRESUMO
This article reviews fascia research from our laboratory and puts this in the context of recent progress in fascia research which has greatly expanded during the past seven or eight years. Some readers may not be familiar with the terminology used in fascia research articles and are referred to LeMoon (2008) for a glossary of terms used in fascia-related articles.