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ABSTRACTS RELATED TO MYOFASCIAL RELEASE AND FASCIA

Understanding the Process of Fascial Unwinding by Budiman Ninasny, PhD http://www.ijtmb.org/index.php/ijtmb/article/view/43/68

Cubik EE, et al. “Sustained release myofascial release as treatment for a patient with complications of rheumatoid arthritis and collagenous colitis: a case report“.Int J Ther Massage Bodywork. 2011;4(3):1-9. Epub 2011 Sep 30.
http://www.ncbi.nlm.nih.gov/pubmed/22016756
Abstract
BACKGROUND:
Myofascial release (MFR) is a manual therapeutic technique used to release fascial restrictions, which may cause neuromusculoskeletal and systemic pathology.
PURPOSE:
This case report describes the use of sustained release MFR techniques in a patient with a primary diagnosis of rheumatoid arthritis (RA) and a secondary diagnosis of collagenous colitis. Changes in pain, cervical range of motion, fatigue, and gastrointestinal tract function, as well as the impact of RA on daily activities, were assessed.
METHODS:
A 54-year-old white woman presented with signs and symptoms attributed to RA and collagenous colitis. Pre and post measurements were taken with each treatment and during the interim between the initial and final treatment series. The patient recorded changes in pain, fatigue, gastrointestinal tract function, and quality of life. Cervical range of motion was assessed. Six sustained release MFR treatment sessions were provided over a 2-week period. Following an 8-week interim, two more treatments were performed.
RESULTS:
The patient showed improvements in pain, fatigue, gastrointestinal tract function, cervical range of motion, and quality of life following the initial treatment series of six sessions. The patient maintained positive gains for 5 weeks following the final treatment, after which her symptoms returned to near baseline measurements. Following two more treatments, positive gains were achieved once again.
CONCLUSIONS:
In a patient with RA and collagenous colitis, the application of sustained release MFR techniques in addition to standard medical treatment may provide short-term and long-term improvements in comorbid symptoms and overall quality of life.

Jennie C.I. Tsao “Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review“. Evid Based Complement Alternat Med. 2007 June; 4(2): 165–179.
Putative Mechanisms of Massage Therapy for Chronic Pain
The precise mechanism of action in massage therapy is not known. It has been proposed that increased parasympathetic activity (41) and a slowed-down physiological state may underpin the behavioral and physiological processes associated with massage. As discussed by Wright and Sluka (42), massage is thought to induce a variety of positive physiological effects that may contribute to tissue repair, pain modulation, relaxation, and improved mood. For example, these authors point to research showing that massage has beneficial effects on arterial and venous blood flow and edema (43). In addition, they note that vigorous massage has been shown to increase local blood flow and cardiac stroke volume (44), as well as improve lymph drainage (45); massage also appears to have an anticoagulant effect (46). Finally, Wright and Sluka maintain that massage may activate segmental inhibitory mechanisms to suppress pain and that some techniques may activate descending pain inhibitory systems (43), as suggested by gate theory
(discussed subsequently).
The main theories regarding the analgesic effects of massage include gate theory, the serotonin hypothesis, and the restorative sleep hypothesis (47). According to gate theory (48), pressure receptors are longer and more myelinated than pain fibers, and thus pressure signals from massage are transmitted faster, closing the gate to pain signals. The serotonin hypothesis maintains that massage increases levels of serotonin, a neurotransmitter that modulates the pain control system (49). The restorative sleep hypothesis holds that because substance P, a neurotransmitter associated with pain is released in the absence of deep sleep, the ability of massage to increase restorative sleep reduces substance P and consequent pain (50). There is little definitive data to support these major theories concerning the mechanisms underlying the analgesic benefits of massage.
Clinical Implications: The Application of Massage Therapy for Chronic Pain
The existing literature suggests that massage therapy may be a useful approach for pain relief in a number of chronic, non-malignant pain conditions, particularly musculoskeletal pain complaints (e.g., shoulder pain, low back pain). Massage is typically administered as adjunct therapy to help prepare the patient for exercise or other interventions and is rarely administered as the main treatment (3).

Fernández-Lao C et al. “The Influence of Patient Attitude Toward Massage on Pressure Pain Sensitivity and Immune System after Application of Myofascial Release in Breast Cancer Survivors: A Randomized, Controlled Crossover Study”. J Manipulative Physiol Ther. 2011 Oct 20. [Epub ahead of print] PubMed PMID: 22018755. CONCLUSION:
The current study suggests that myofascial release may lead to an immediate increase in salivary flow rate in BCS with cancer-related fatigue. We also found that the effect of myofascial release on immune function was modulated by a positive patient’s attitude toward massage.

Fernández-Lao C et al.“Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design.” Eur J Cancer Care (Engl). 2011 Nov 8. doi:10.1111/j.1365-2354.2011.01306.x. [Epub ahead of print] PubMed PMID: 22060159
This controlled trial suggests that massage leads to an immediate increase of heart rate variability and an improvement in mood inbreast cancer survivors with cancer-related fatigue. Further, the positive impact of massage on cancer-related fatigue is modulated by the attitude of the patient towards massage.

 Ultrasound Evidence of Altered Lumbar Connective Tissue Structure in Human Subjects with Chronic Low Back Pain
http://www.biomedcentral.com/1471-2474/10/151/abstract
 J Manipulative Physiol Ther. 2009 Jun;32(5):364-71.

Jarvinen, Tero A. et al. “Organization and distribution of intramuscular connective tissue in normal and immobilized skeletal muscles”. Journal of Muscle Research and Cell Motility, 2002; 23: 245-254.
http://www.ncbi.nlm.nih.gov/pubmed/15360131

Okita M, et al. “Effects of reduced joint mobility on sarcomere length, collagen fibril arrangement in the endomysium, and hyaluronan in rat soleus muscle“. J Muscle Res Cell Motil. 2004;25(2):159-66.
http://www.ncbi.nlm.nih.gov/pubmed/15360131

Influence of the temporomandibular joint on range of motion of the hip joint in patients with complex regional pain syndome. 

Fischer MJ, Riedlinger K, Gutenbrunner C, Bernateck M.
Department of Rehabilitation Medicine, Hanover Medical School, Hanover, Germany. fischer.michael@mh-hannover.de

OBJECTIVE: This study evaluated if patients with complex regional pain syndrome (CRPS) would have an increase in range of motion (ROM) after myofascial release and a similar ROM decrease after jaw clenching, whereas in healthy subjects these effects would be minimal or nonexistent. METHODS: Documentation of patients with CRPS (n = 20) was established using the research diagnostic criteria for CRPS, questionnaires, average pain intensity for the past 4 weeks, and the temporomandibular index (TMI). Healthy subjects (n = 20, controls) also underwent the same testing. Hip ROM (alpha angle) was measured at 3 time points as follows: baseline (t1), after myofascial release of the temporomandibular joint (t2), and after jaw clenching for 90 seconds (t3). Comparison of the CRPS and control groups was made using t tests. RESULTS: Mean TMI total score and mean pain reported for the last 4 weeks were significantly different between the 2 groups (P < .0005). Hip ROM at t1 was always slightly higher compared to t3, but t2 was always lower in value compared to t1 or t3 for both groups. The differences of all hip ROM values between the groups were significant (P < .0005). Moreover, the difference between t1 or t3 and t2 was significantly different within the CRPS group (t1 = 48.7 degrees ; t2 = 35.8 degrees ; P < .0005). CONCLUSIONS: The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.
PMID: 19539119 [PubMed – indexed for MEDLINE]
J Bodyw Mov Ther. 2008 Oct;12(4):356-63. Epub 2008 Jun 4.

The effect of myofascial release (MFR) on an adult with idiopathic scoliosis.

LeBauer A, Brtalik R, Stowe K.
Elon University, Department of Physical Therapy Education, Elon, NC 27244, USA. alebauer@gmail.com

BACKGROUND: The lack of evidence of conservative treatment has led to an interest in exploring myofascial release (MFR) as an effective means of controlling spinal curvature progression in adolescents with idiopathic scoliosis. OBJECTIVE: The purpose of this case study is to measure the effects of MFR as a manual therapy technique in the treatment of idiopathic scoliosis. METHODS: One 18-year-old female subject underwent 6 weeks of MFR treatment consisting of two sessions each week for 60min. Pain, pulmonary function, and quality of life were measured. Six goniometric measurements were taken encompassing trunk flexion, extension, and rotation. RESULTS: The subject improved with pain levels, trunk rotation, posture, quality of life, and pulmonary function. CONCLUSIONS: The results suggest further investigation is needed using MFR, as an effective manual therapy treatment for idiopathic scoliosis.
PMID: 19083694 [PubMed – indexed for MEDLINE]
J Bodyw Mov Ther. 2008 Jul;12(3):274-80. Epub 2008 Mar 5.

Efficacy of myofascial release techniques in the treatment of primary Raynaud’s phenomenon.

Walton A.
Kiné-Concept Institute Ontario, Ontario, Canada. awalton@hotmail.com

OBJECTIVE: This study investigated whether myofascial release techniques performed on upper body connective tissue could mitigate the frequency, duration or pain intensity associated with primary Raynaud’s phenomenon. METHODS: Five treatments were administered over a 3-week treatment period on a 35-year-old female experiencing primary Raynaud’s phenomenon for the past 12 years. A log was kept documenting frequency, duration and severity of pain. The myofascial work targeted the upper back, neck and arms according to hypothetical fascial meridian lines. RESULTS: Symptom duration was the one characteristic that showed improvement. After the first treatment, the duration of the subject’s vasospastic episodes was reduced by almost half and continued to decrease throughout the 3 weeks of treatments. Neither the frequency or number of affected digits varied significantly from the pre-treatment weeks. CONCLUSIONS: The results suggest that by releasing restricted fascia, myofascial techniques may influence the duration and severity of the vasospastic episodes experienced in primary Raynaud’s phenomenon.
PMID: 19083682 [PubMed – indexed for MEDLINE]
Int J Radiat Oncol Biol Phys. 1996 Mar 15;34(5):1188-9.

Myofascial release provides symptomatic relief from chest wall tenderness occasionally seen following lumpectomy and radiation in breast cancer patients.
Crawford JS, Simpson J, Crawford P.
PMID: 8600109 [PubMed – indexed for MEDLINE]
Tidsskr Nor Laegeforen. 2007 Mar 1;127(5):604-8.

[Rehabilitation of chronic myofascial pain disorders]

[Article in Norwegian]
Wigers SH, Finset A.
Opptreningssenteret Jeløy Kurbad, Bråtengaten 94, 1515 Moss. sigrid.wigers@c2i.net

BACKGROUND: Chronic musculoskeletal pain of diffuse origin affects many, and at a significant cost. Evidence-based guidelines for therapeutic interventions are presented and exemplified. MATERIAL AND METHODS: 200 patients with chronic myofascial pain and/or fibromyalgia who participated in a 4-week multidimensional rehabilitation programme, were included in the study. The programme included education and pain management in a cognitive setting, various forms of aerobic exercises, myofascial pain treatment, relaxation and medication as needed. The patients filled in questionnaires on arrival, at follow-up after six and 12-months and at discharge. They completed visual analogue scales (pain, fatigue, sleep problems, depression), the Nottingham Health Profile, the Fibromyalgia Impact Questionnaire, global subjective improvement, and during the follow-up period also the physical activity level, changes in quality of life and occupational workload. Work capacity, a tender point count and whether patients met the diagnostic criteria for fibromyalgia were assessed at baseline and at discharge. RESULTS: Significant improvements were seen in all variables throughout the follow-up period. 30% of the fibromyalgia patients no longer met the diagnostic criteria at discharge. There was a significant increase in quality of life over time. After one year, more patients had returned to work and fewer were off sick, but there was also an increased number on disability pensions. The majority did exercise training on a regular basis. INTERPRETATION: Our findings confirm the existing evidence-based guidelines by showing that multidimensional rehabilitation is an effective intervention for patients with widespread chronic pain. It is a challenge for health politicians to change today’s common practice towards that described in evidence-based guidelines.
PMID: 17332816 [PubMed – indexed for MEDLINE

Ann Acad Med Singapore. 2007 Jan;36(1):43-8.

Myofascial pain–an overview.

Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore. eng_ching_yap@ttsh.com.sg

Skeletal muscle is the largest organ in the human body. Any of these muscles may develop pain and dysfunction. In modern society, myofascial pain is a major cause of morbidity. It may present as regional musculoskeletal pain, as neck or back pain mimicking radiculopathy. It may also present as shoulder pain with concomitant capsulitis, and hip or knee pain with concomitant osteoarthritis. The condition is treatable. However, it is often under-diagnosed and hence undertreated. Traditional medical training and management of musculoskeletal pain have focused much attention on bones, joints and nerves. This review will focus on muscles, myofascial pain and dysfunction. During history taking and physical examination, precipitating and perpetuating factors, taut bands, trigger points, tender spots and sensitised spinal segments have to be accurately located and correctly identified for effective needling treatment. There is also a high recurrence rate unless appropriate exercises are prescribed, with active participation from the patient, to restore flexibility and balance to the muscles. With rehabilitation, many patients do not have to continue to suffer unnecessary pain that affects their daily activities and quality of life. Early diagnosis and management may also help reduce psychosocial complications and financial burden of chronic pain syndrome.
PMID: 17285185 [PubMed – indexed for MEDLINE]
Phys Ther. 2006 Feb;86(2):254-68.

Differential diagnosis and treatment in a patient with posterior upper thoracic pain.

Fruth SJ.
Krannert School of Physical Therapy, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227-3697, USA. fruths@uindy.edu

therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities. DISCUSSION BACKGROUND AND PURPOSE: Determining the source of a patient’s pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. CASE DESCRIPTION: The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV/CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV/CT joint mobilizations, TrP release, and flexibility and postural exercises. OUTCOMES: The patient reported intermittent mild discomfort after 7 physical: This case suggests that CV/CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient.
PMID: 16445339 [PubMed – indexed for MEDLINE]
Australas Chiropr Osteopathy. 2000 Mar;9(1):13-6.

Integrative fascial release and functional testing.

Hammer W.
Soft tissue techniques, including Integrative Myofascial Release (IFR) can be more effective if the area of treatment can be determined by functional testing. The patient’s source of pain may not necessarily be located at the area of complaint and functional testing helps in pinpointing the source. Post-treatment functional testing will provide feedback to both the patient and the doctor as to whether the technique was effective. This paper will describe some typical functional tests and treatment using IFR of the posterior cervical/thoracolumbar fascia.
PMID: 17987166 [PubMed]
J Bodyw Mov Ther. 2008 Jul;12(3):274-80. Epub 2008 Mar 5.

Efficacy of myofascial release techniques in the treatment of primary Raynaud’s phenomenon.
Walton A.
Kiné-Concept Institute Ontario, Ontario, Canada. awalton@hotmail.com

OBJECTIVE: This study investigated whether myofascial release techniques performed on upper body connective tissue could mitigate the frequency, duration or pain intensity associated with primary Raynaud’s phenomenon. METHODS: Five treatments were administered over a 3-week treatment period on a 35-year-old female experiencing primary Raynaud’s phenomenon for the past 12 years. A log was kept documenting frequency, duration and severity of pain. The myofascial work targeted the upper back, neck and arms according to hypothetical fascial meridian lines. RESULTS: Symptom duration was the one characteristic that showed improvement. After the first treatment, the duration of the subject’s vasospastic episodes was reduced by almost half and continued to decrease throughout the 3 weeks of treatments. Neither the frequency or number of affected digits varied significantly from the pre-treatment weeks. CONCLUSIONS: The results suggest that by releasing restricted fascia, myofascial techniques may influence the duration and severity of the vasospastic episodes experienced in primary Raynaud’s phenomenon.
PMID: 19083682 [PubMed – indexed for MEDLINE]
J Sport Rehabil. 2008 Nov;17(4):432-42.

A comparison of the pressure exerted on soft tissue by 2 myofascial rollers.
Curran PF, Fiore RD, Crisco JJ.
Dept of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI 02903, USA.

CONTEXT: Self-myofascial release (SMR) is a technique used to treat myofascial restrictions and restore soft-tissue extensibility. PURPOSE: To determine whether the pressure and contact area on the lateral thigh differ between a Multilevel rigid roller (MRR) and a Bio-Foam roller (BFR) for participants performing SMR. PARTICIPANTS: Ten healthy young men and women. METHODS: Participants performed an SMR technique on the lateral thigh using both myofascial rollers. Thin-film pressure sensels recorded pressure and contact area during each SMR trial. RESULTS: Mean sensel pressure exerted on the soft tissue of the lateral thigh by the MRR (51.8 +/- 10.7 kPa) was significantly (P < .001) greater than that of the conventional BFR (33.4 +/- 6.4 kPa). Mean contact area of the MRR (47.0 +/- 16.1 cm2) was significantly (P < .005) less than that of the BFR (68.4 +/- 25.3 cm2). CONCLUSION: The significantly higher pressure and isolated contact area with the MRR suggest a potential benefit in SMR.

PMID: 19160916 [PubMed – indexed for MEDLINE
Techniques in Orthopaedics:
March 2003 – Volume 18 – Issue 1 – pp 67-73

Bioelectric Responsiveness of Fascia: A Model for Understanding the Effects of Manipulation
O’Connell, Judith A. D.O., F.A.A.O.

Abstract

Summary: Embryologically, the largest mesodermal derivative is connective tissue encompassing blood, cartilage, bone, and connective tissue proper. Collagen is a major component of connective tissue proper and more specifically white fibrous tissue. Fascia, the largest component of white fibrous tissue, contains linear sheets of collagen found in superficial, deep, and subserous layers. Collagen is piezoelectric, functioning as a transducer of mechanical and electrical energy. Electrical impulses are generated in the collagen by compressive and distraction forces within the musculoskeletal system. These impulses trigger a cascade of cellular, biomechanical, neural, and extracellular events as the body adapts to external stress. In response to internal stress, components of the extracellular fluid change in polarity and charge affecting fascial motion. This somatic dysfunction, whether caused by internal or external stress, is identified as tenderness, asymmetry, altered motion, and tissue texture changes. Somatic dysfunction is also caused by visceral somatic relationships mediated at the level of the spinal cord. Specific patterns of somatic dysfunction in the paraspinal connective tissue are related to specific organs and act as diagnostic markers. Osteopathic manipulative treatment is a manually applied procedure used to treat somatic dysfunction. Through the application of compressive and distraction forces, the physician identifies altered patterns of motion in the fascia. Physicians trained in osteopathic manipulative techniques are able to normalize the somatic dysfunction and in so doing encourage healing. Physicians able to integrate osteopathic manipulative treatment into standard medical and surgical care have an advantage in meeting the needs of their patients.

Phys Ther. 1992 Dec;72(12):893-902.

 

The effects of manual therapy on connective tissue.

Threlkeld AJ.
Department of Physical Therapy, Creighton University, Omaha, NE 68178.

The purpose of this manuscript is to examine the known and theoretical mechanical effects of therapeutic manual techniques on the connective tissue (CT) of joints and fasciae. Typical CT structures that could be influenced by manual techniques will be discussed. The behavior of CT under loading and the influence of immobilization on CT will be examined. The forces developed during manual techniques will be described, and their potential effects on the physical properties of CT will be discussed. Research priorities regarding the effects of manual therapy on CT will be outlined.

PMID: 1454865 [PubMed – indexed for MEDLINE]

Phys Ther. 1992 Dec;72(12):885-92.

A rationale for the treatment of back pain and joint pain by manual therapy.

Twomey LT.
Division of Academic Affairs, Curtin University of Technology, Western Australia.

Manual therapy, with its emphasis on joint movement and exercise, has become increasingly important for the treatment of pain and dysfunction of the musculoskeletal system. The rationale used to explain the success of manual therapy has changed radically in recent years. Early explanations, which included concepts such as adjusting joint subluxations, restoring bony alignment, and reducing nuclear protrusion, have been shown to have no basis in fact. Current biological research shows the value of movement in maintaining the health and strength of collagenous, muscular, and bony tissues and emphasizes the need for joint movement and for relatively high levels of activity throughout the life cycle. The musculoskeletal system thrives on stress and movement and reacts adversely to prolonged rest or immobilization. The problems associated with working or recreational postures involving prolonged loading at or near the limit of joint range of motion are considered together with a rationale for appropriate therapeutic management. Explanations are provided to enable an understanding of the success of intensive physical therapy for chronic back pain and for manipulation in the treatment of the acute painful locked back.

PMID: 1454864 [PubMed – indexed for MEDLINE]