Quantifying thoracolumbar fascia deformation to discriminate acute low back pain patients and healthy individuals using ultrasound.

Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.

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.

The difference in the upper trapezius deep fascia slides between individuals with and without myofascial pain syndrome: A case-control study.

INTRODUCTION: MPS is a chronic disorder caused by myofascial trigger points, leading to pain and limited neck movements due to impacted fascia. Studies have reported reduced fascia slides in chronic low back pain, but limited fascia slides in MPS patients are still unreported. AIM: We determined differences in upper trapezius' deep fascia slides between MPS and non-MPS participants. METHODS: Between January-August 2019, participants from diverse work sectors were recruited in Manila. An expert physiotherapist diagnosed MPS, while non-MPS participants performed full painless cervical movements. Participants underwent upper trapezius deep fascia scans on both shoulders while performing six cervical movements. An HS1 Konica Minolta ultrasound recorded the data. Two blinded physiotherapists used Tracker 5.0 © 2018 to analyze videos and quantify deep fascia slides by measuring the distance between two x-axis points. The Multivariate analysis of variance (MANOVA) assessed deep fascia slide differences in six active cervical movements. Pillai's Trace, with a range of 0-1 and a p-value of <0.05, was set. Effect sizes in individuals with and without MPS were calculated using Hedges' g and Cohen's d. RESULTS: Of the 327 participants (136 non-MPS, 191 MPS), 101 MPS participants had shoulder pain for <1 year and 103 experienced unilateral pain. The study examined 3800 ultrasound videos but found no significant difference in deep fascia slides across cervical movements between MPS and non-MPS groups (Pillai's Trace = 0.004, p = 0.94). Minor differences in deep fascia displacement were observed, with small effect sizes (g = 0.02-0.08). CONCLUSION: A limited deep fascia slide does not characterize MPS participants from non-MPS participants.

Superficial fascia displacement in cervical flexion: differentiating myofascial pain syndrome, a cross-sectional study.

CONTEXT: Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial flexibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM). OBJECTIVES: This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of superficial fascial displacement during active cervical flexion with the clinical diagnosis of MPS. METHODS: A cross-sectional study selectively included MPS and non-MPS participants from different workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a sonographer recorded superficial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized. RESULTS: In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found significant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically significant (p>0.05). Also, the type of work, the direction of fascial displacement, and the difference in superficial fascial displacement during cervical flexion did not show a significant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a specificity of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS. CONCLUSIONS: We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as significant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.

Pain improvement after three weeks of daily self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain: a case report.

BACKGROUND: Plantar heel pain is described as sharp pain at the medial plantar aspect of the calcaneus and medial longitudinal arch of the foot. There are various treatment options that usually need a clinician or a therapist for application. The present case report aimed to describe the outcomes of self-executed cross-friction massage using a fascia ball in a patient with recent-onset plantar heel pain. CASE DESCRIPTION: The patient was a 42-year-old man who reported plantar heel pain during the first steps in the morning along with decreased function of the foot and ankle lasting about three months. He was instructed to self-execute cross-friction massage using a fascia ball daily in the evening at home for six weeks. OUTCOMES: Pain during treatment decreased from a Numeric Pain Rating Scale (NPRS)-score of 8/10 and from a Short-Form McGill Pain Questionnaire (SF-MPQ)-score of 34/60 at initial treatment to NPRS- and SF-MPQ-scores of 0/10 and 0/60, respectively, after about three weeks. The patient reported no pain and restored function after six weeks of treatment, and in the follow-up measurements. DISCUSSION: Daily self-executed cross-friction massage using a fascia ball may be a useful alternative intervention for treating recent-onset plantar heel pain.

Immediate effects of myofascial release to the pectoral fascia on posture, range of motion, and muscle excitation: a crossover randomized clinical trial.

CONTEXT: Forward shoulder posture (FSP) is a risk factor for shoulder pathology. Manual therapists often use myofascial release (MFR) to elongate restricted pectoral fascia to reduce FSP and improve shoulder function; however, the effects of this treatment approach remain anecdotal. OBJECTIVE: Determine the acute effects of 4-min of MFR, compared to a soft-touch control (CON), to the pectoral fascia on: 1) FSP, 2) shoulder horizontal abduction ROM (HA-ROM), and 3) muscle excitation of the trapezius (upper, middle, lower [UT, MT, LT]) and pectoralis major (PEC). METHODS: Fifty-nine right-handed participants (27 ± 9 years, 30 female) with FSP, but otherwise asymptomatic shoulders participated in a randomized crossover clinical trial by attending two experimental sessions: one MFR and one CON treatment, each administered by a Registered Massage Therapist. FSP, HA-ROM, and muscle excitation during a reaching task, were measured before and after each treatment. RESULTS: There was a significant interaction between treatment and time for FSP (p = .018, ηp = .093) with FSP decreasing from PRE MFR (128 ± 19 mm) to POST MFR (123 ± 19 mm; p < .001, ηp = .420) and PRE CON (126 ± 19 mm) to POST CON (124 ± 18 mm; p < .001, ηp = .191) interventions. There were no significant differences in HA-ROM or muscle excitation. CONCLUSION: Four minutes of MFR or CON to the pectoral fascia acutely reduces FSP.

Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen: a randomized controlled trial.

BACKGROUND: Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore, we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients. METHODS: A pragmatic, prospective, randomized, observer-blind, single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 days of ICU management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC, postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 days after OA. The Kaplan-Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built. RESULTS: A total of 134 patients completed the trial (BIA, n = 66; TRD, n = 68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33% vs. 55.88%, P < 0.001). In the BIA group, the time to PFC occurred earlier than that of the TRD group by an average of 3.66 days (P < 0.001). Additionally, the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (P < 0.001) and fewer complications. CONCLUSION: Among postinjury OA patients in the ICU, the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.

Pes Cavus Deformity: Anatomic, Functional Considerations, and Surgical Implications.

Pes cavus is a complicated, multiplanar deformity that requires a thorough understanding in order to provide the appropriate level of care. The foot and ankle surgeon should perform a comprehensive examination, including a neurologic evaluation, in the workup of this patient population. Understanding the cause of the patient's deformity is a critical step in predicting the disease course as well as the most acceptable form of treatment. The surgical correlation with the patient's pathologic anatomy requires an in-depth clinical evaluation, in addition to the radiographic findings, as the radiographic findings do not necessarily correlate with the patient's discomfort.

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.

Analysis of resorbable mesh implants in short-term human muscular fascia cultures: a pilot study.

PURPOSE: Alteration in fascial tissue collagen composition represents a key factor in hernia etiology and recurrence. Both resorbable and non-resorbable meshes for hernia repair are currently used in the surgical setting. However, no study has investigated so far the role of different implant materials on collagen deposition and tissue remodeling in human fascia. The aim of the present study was to develop a novel ex vivo model of human soft tissue repair mesh implant, and to test its suitability to investigate the effects of different materials on tissue remodeling and collagen composition. METHODS: Resorbable poly-4-hydroxybutyrate and non-resorbable polypropylene mesh implants were embedded in human abdominal fascia samples, mimicking common surgical procedures. Calcein-AM/Propidium Iodide vital staining was used to assess tissue vitality. Tissue morphology was evaluated using Mallory trichrome and hematoxylin and eosin staining. Collagen type I and III expression was determined through immunostaining semi-quantification by color deconvolution. All analyses were performed after 54 days of culture. RESULTS: The established ex vivo model showed good viability at 54 days of culture, confirming both culture method feasibility and implants biocompatibility. Both mesh implants induced a disorganization of collagen fibers pattern. A statistically significantly higher collagen I/III ratio was detected in fascial tissue samples cultured with resorbable implants compared to either non-resorbable implants or meshes-free controls. CONCLUSION: We developed a novel ex vivo model and provided evidence that resorbable polyhydroxybutyrate meshes display better biomechanical properties suitable for proper restoration in surgical hernia repair.

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.

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.

Sonoelastographic evaluation of plantar fascia after shock wave therapy for recalcitrant plantar fasciitis: A 12-month longitudinal follow-up study.

Extracorporeal shockwave therapy (ESWT) is proposed to be effective in reducing pain and improving functional outcome in chronic plantar fasciitis. However, no long-term reports exist on the changes in plantar fascia (PF) elasticity after ESWT. We aimed to evaluate the changes in PF stiffness in patients with plantar fasciitis undergoing ESWT. The visual analogue scale (VAS, 0-100) was used for evaluating heel pain severity. B-mode sonography and strain sonoelastography were used for evaluating the PF thickness and stiffness. The sonoelastogram was analyzed using hue histogram analysis (value: 0-255, from stiffer to softer). All evaluations were recorded before ESWT, and 1 week, 1 month, 3 months, 6 months, and 12 months after ESWT. Repeated measures ANOVA was used to compare pain VAS, PF thickness, and PF hue value at different follow-up time-points. Twenty-two participants (8 men, 14 women) completed all measurements for 12 months. The VAS of heel pain, PF thickness, and PF hue values at pre-ESWT, and 1-week, 1-month, 3-month, 6-month, and 12-month evaluations after ESWT were 62.4 ± 4.2, 49.3 ± 5.8, 38.3 ± 5.7, 27.9 ± 5.3, 18.9 ± 4.7, and 13.2 ± 3.0 (p < 0.01 in all measurements post ESWT versus pre-ESWT); 5.57 ± 0.22 mm, 5.64 ± 0.18 mm, 5.45 ± 0.24 mm, 5.37 ± 0.20 mm, 5.08 ± 0.20 mm, and 4.62 ± 0.15 mm (p < 0.01 at 6-month; otherwise p > 0.05); and 24.5 ± 2.4, 35.2 ± 3.1, 31.0 ± 4.1, 30.5 ± 3.9, 21.4 ± 2.1, and 15.9 ± 1.6 (p < 0.01 at 1-week and 6-month; otherwise p > 0.05), respectively. In conclusion, the heel pain intensity and PF thickness reduced gradually over 12 months after ESWT. The PF stiffness decreased during the first week and increased thereafter; at the 12-month follow-up, stiffness was more than at pre-ESWT.

Local heating of trigger points reduces neck and plantar fascia pain.

BACKGROUND: Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow. OBJECTIVE: The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia. METHODS: Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area. RESULTS: Subjective pain significantly decreased in both sham and heat group patients with neck pain (p< 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups (p= 0.002, d= 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain. CONCLUSION: The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.

Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: A randomized controlled trial.

BACKGROUND: Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS: A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS: Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION: The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.

Relationship of the lobular branch of the great auricular nerve to the tympanoparotid fascia: Spatial anatomy for salvage during face and neck lift.

To enable selection of a safer suspension site to use in face and neck lifting procedures, the spatial relationship between the tympanoparotid fascia and the great auricular nerve should be clarified. In this study, we aimed to elucidate the position of the tympanoparotid fascia and the pathway of the lobular branch of the great auricular nerve traversing the tympanoparotid fascia. Twenty hemifaces from non-preserved bequeathed Korean cadavers (5 males, 7 females; mean age, 77.0 years) were dissected to determine the great auricular nerve distribution close to the tympanoparotid fascia of clinical significance for face and neck lift procedures. We observed the tympanoparotid fascia in all specimens (20 hemifaces). The tympanoparotid fascia was located anteriorly between the tragus and intertragic notch. Regarding the spatial relationship between the tympanoparotid fascia and the great auricular nerve, we found the sensory nerve entering the tympanoparotid fascia in all specimens (100%), and the depth from the skin was approximately 4.5 mm; in 65% of the specimens, the lobular branch was found to run close to the tympanoparotid fascia before going into the earlobe. Provided with relatively safer surface mapping to access the tympanoparotid fascia free of the lobular branch of the great auricular nerve, surgeons may better protect the lobular branch by anchoring the SMAS-platysma flap and thread to the deeper superior and anterior portions of the expected tympanoparotid fascia.

A pilot study of fascia Bowen therapy for 8-11 year-old boys with developmental coordination disorder.

BACKGROUND: Developmental coordination disorder (DCD), also known as dyspraxia, is a disorder emerging in childhood characterised by motor skill impairments. The motor difficulties often produce negative effects in other areas of life, such as poor self-esteem and reduced social interactions. One treatment used for DCD is fascia Bowen therapy, which involves stimulating the fascia tissues of the body using finger and thumb rolling movements over the skin to improve overall muscle movement. However, no studies to date have been reported testing the effectiveness of fascia Bowen in DCD. METHODS: The present pilot study tested the effectiveness of 6 weeks of fascia Bowen in 10 boys aged 8-11 years with DCD. None of the boys had ever received treatment in any form before this study. Motor skills were assessed using the Movement Assessment Battery for Children-2 (MABC-2) and the DCD questionnaire, and psycho-social functioning was measured using the Self-Perception Profile, Spence Social Skills Questionnaire, and Strengths and Difficulties Questionnaire. All measures of interest were assessed before and after the therapy. RESULTS: Results showed significant improvement in motor function post-intervention, with 60% of the children no longer clinically being classified as having a movement difficulty on the MABC-2. However, no significant improvements were seen in psycho-social measures, at least within the short time-frame of the therapy in the current study. CONCLUSIONS: The current pilot study revealed improvements in motor functioning after fascia Bowen therapy, across both performance and questionnaire measures, but that these improvements did not extend to wider areas of life. Further research in DCD is needed to test the effectiveness of fascia Bowen in larger studies with expanded ages and both genders over longer periods, including the generalisation of results of these longer interventions to different areas of life beyond motor ability.

Observation using thermography of post-operative reaction after fascial manipulation®.

INTRODUCTION AND OBJECTIVE: Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points - coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. MATERIAL AND METHODS: For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body's temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. RESULTS: The average surface temperature of the treated area before mobilization was 33.4°C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p<0.001). However, the highest temperature was observed 24 hours after mobilization (increase of 2.4°C). The difference between the first and 7 other measurements was statistically relevant (p<0.001). CONCLUSIONS: The statistically relevant increase in temperature under the influence of fascial manipulation® in the treatment area can confirm the occurrence of inflammatory reaction.