Active contractile properties of fascia

Acute Effects of Local High-Frequency Percussive Massage on Deep Fascial and Muscular Stiffness and Joint Range of Motion in Young Adult Men

BACKGROUND

Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM.

METHOD

The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power.

RESULTS

Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes.

CONCLUSIONS

HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently.

Fascia Promotes Adipose Tissue Regeneration by Improving Early Macrophage Infiltration after Fat Grafting in a Mouse Model

BACKGROUND

Low early macrophage fat graft infiltration (within a week of surgery) hinders tissue regeneration, suggesting that macrophages play a vital role in early angiogenesis and adipogenesis. However, the source of macrophages during this period is unclear.

METHOD

C57BL/6 mice were split into fascial removal (FR) group and control groups (CG). Mice had a piece of back fascia removed in the FR group, which was immediately replaced in the CG, and inguinal fat injected into the transplantation site of both groups. Separately, fascia was harvested from green fluorescent protein-expressing mice and transplanted into C57BL/6 mice for tracing macrophage infiltration after fat grafting.

RESULTS

The number of capillaries in the FR group was lower than that in the CG at days 3 ( P < 0.01) and 7 ( P < 0.05). Moreover, the number of small adipocytes in the FR group was lower than in the CG on days 3, 7, and 14 (all P < 0.05), and the relative expression of several adipogenic proteins was significantly lower in the FR group than in the CG on days 14 and 30. The timeline of macrophage infiltration was consistent with angiogenesis and adipogenesis. The number of macrophages in the FR group was significantly lower than in the CG at days 3 and 7 ( P < 0.05), and there were more fascia-derived macrophages than circulation-derived macrophages infiltrated into fat grafts within 7 days. Finally, the graft retention was lower in the FR group than the CG at day 90 ( P < 0.05).

CONCLUSION

In the early stage after fat grafting, fascial macrophage infiltration initiates tissue regeneration, thereby improving graft retention by promoting angiogenesis and adipogenesis.

CLINICAL RELEVANCE STATEMENT

In the clinic, injecting fat close to the fascia may increase fat retention. Fascia is widespread and self-regenerating, which may be a promising alternative source of local macrophages, with implications for tissue-engineering therapies such as correction of soft-tissue defects and breast reconstruction.

The Effects of Pre-conditioning on Exercise-Induced Muscle Damage: A Systematic Review and Meta-analysis

BACKGROUND

Several studies have utilised isometric, eccentric and downhill walking pre-conditioning as a strategy for alleviating the signs and symptoms of exercise-induced muscle damage (EIMD) following a bout of damaging physical activity.

OBJECTIVES

This systematic review and meta-analysis examined the effects of pre-conditioning strategies on indices of muscle damage and physical performance measures following a second bout of strenuous physical activity.

DATA SOURCES

PubMed, CINAHL and Scopus.

ELIGIBILITY CRITERIA

Studies meeting the PICO (population, intervention/exposure, comparison, and outcome) criteria were included in this review: (1) general population or "untrained" participants with no contraindications affecting physical performance; (2) studies with a parallel design to examine the prevention and severity of muscle-damaging contractions; (3) outcome measures were compared using baseline and post-intervention measures; and (4) outcome measures included any markers of indirect muscle damage and muscular contractility measures.

PARTICIPANTS

Individuals with no resistance training experiences in the previous 6 or more months.

INTERVENTIONS

A single bout of pre-conditioning exercises consisting of eccentric or isometric contractions performed a minimum of 24 h prior to a bout of damaging physical activity were compared to control interventions that did not perform pre-conditioning prior to damaging physical activity.

STUDY APPRAISAL

Kmet appraisal system.

SYNTHESIS METHODS

Quantitative analysis was conducted using forest plots to examine standardised mean differences (SMD, i.e. effect size), test statistics for statistical significance (i.e. Z-values) and between-study heterogeneity by inspecting I2.

RESULTS

Following abstract and full-text screening, 23 articles were included in this paper. Based on the meta-analysis, the pre-conditioning group exhibited lower levels of creatine kinase at 24 h (SMD =  - 1.64; Z = 8.39; p = 0.00001), 48 h (SMD =  - 2.65; Z = 7.78; p = 0.00001), 72 h (SMD =  - 2.39; Z = 5.71; p = 0.00001) and 96 h post-exercise (SMD =  - 3.52; Z = 7.39; p = 0.00001) than the control group. Delayed-onset muscle soreness was also lower for the pre-conditioning group at 24 h (SMD =  - 1.89; Z = 6.17; p = 0.00001), 48 h (SMD =  - 2.50; Z = 7.99; p = 0.00001), 72 h (SMD =  - 2.73; Z = 7.86; p = 0.00001) and 96 h post-exercise (SMD =  - 3.30; Z = 8.47; p = 0.00001). Maximal voluntary contraction force was maintained and returned to normal sooner in the pre-conditioning group than in the control group, 24 h (SMD = 1.46; Z = 5.49; p = 0.00001), 48 h (SMD = 1.59; Z = 6.04; p = 0.00001), 72 h (SMD = 2.02; Z = 6.09; p = 0.00001) and 96 h post-exercise (SMD = 2.16; Z = 5.69; p = 0.00001). Range of motion was better maintained by the pre-conditioning group compared with the control group at 24 h (SMD = 1.48; Z = 4.30; p = 0.00001), 48 h (SMD = 2.20; Z = 5.64; p = 0.00001), 72 h (SMD = 2.66; Z = 5.42; p = 0.00001) and 96 h post-exercise (SMD = 2.5; Z = 5.46; p = 0.00001). Based on qualitative analyses, pre-conditioning activities were more effective when performed at 2-4 days before the muscle-damaging protocol compared with immediately prior to the muscle-damaging protocol, or 1-3 weeks prior to the muscle-damaging protocol. Furthermore, pre-conditioning activities performed using eccentric contractions over isometric contractions, with higher volumes, greater intensity and more lengthened muscle contractions provided greater protection from EIMD.

LIMITATIONS

Several outcome measures showed high inter-study heterogeneity. The inability to account for differences in durations between pre-conditioning and the second bout of damaging physical activity was also limiting.

CONCLUSIONS

Pre-conditioning significantly reduced the severity of creatine kinase release, delayed-onset muscle soreness, loss of maximal voluntary contraction force and the range of motion decrease. Pre-conditioning may prevent severe EIMD and accelerate recovery of muscle force generation capacity.

“Long COVID-19” and viral “fibromyalgia-ness”: Suggesting a mechanistic role for fascial myofibroblasts (Nineveh, the shadow is in the fascia)

The coronavirus pandemic has led to a wave of chronic disease cases; “Long COVID-19” is recognized as a new medical entity and resembles “fibromyalgia” which, likewise, lacks a clear mechanism. Observational studies indicate that up to 30%–40% of convalescent COVID-19 patients develop chronic widespread pain and fatigue and fulfill the 2016 diagnostic criteria for “fibromyalgia.” A recent study suggested a theoretical neuro-biomechanical model (coined “Fascial Armoring”) to help explain the pathogenesis and cellular pathway of fibromyalgia, pointing toward mechanical abnormalities in connective tissue and fascia, driven by contractile myo/fibroblasts and altered extracellular matrix remodeling with downstream corresponding neurophysiological aberrations. This may help explain several of fibromyalgia’s manifestations such as pain, distribution of pain, trigger points/tender spots, hyperalgesia, chronic fatigue, cardiovascular abnormalities, metabolic abnormalities, autonomic abnormalities, small fiber neuropathy, various psychosomatic symptoms, lack of obvious inflammation, and silent imaging investigations. Pro-inflammatory and pro-fibrotic pathways provide input into this mechanism via stimulation of proto/myofibroblasts. In this hypothesis and theory paper the theoretical model of Fascial Armoring is presented to help explain the pathogenesis and manifestations of “long COVID-19” as a disease of immuno-rheumo-psycho-neurology. The model is also used to make testable experimental predictions on investigations and predict risk and relieving factors.

Suggesting a mechanism for acupuncture as a global percutaneous needle fasciotomy that respects tensegrity principles for treating fibromyalgia

Acupuncture is a minimally invasive therapeutic method that uses small caliber needles while inserting them through the skin into various areas of the body. Some empirical studies find evidence to support the use of acupuncture as a treatment for certain medical conditions, however, this peculiar practice is widely considered as the domain of alternative and non-evidence-based medicine. Several mechanisms have been suggested in an attempt to explain the therapeutic action of acupuncture, but the way in which acupuncture alleviates chronic non-cancer pain or psychosomatic and psychiatric disorders is not fully understood. A recent study suggested a theoretical model (coined "Fascial Armoring") with a cellular pathway to help explain the pathogenesis of myofascial pain/fibromyalgia syndrome and functional psychosomatic syndromes. It proposes that these syndromes are a spectrum of a single medical entity that involves myofibroblasts with contractile activity in fascia and aberrant extracellular matrix (ECM) remodeling, which may lead to widespread mechanical tension and compression. This can help explain diverse psycho-somatic manifestations of fibromyalgia-like syndromes. Fascia is a continuous interconnected tissue network that extends throughout the body and has qualities of bio-tensegrity. Previous studies show that a mechanical action by needling induces soft tissue changes and lowers the shear modulus and stiffness in myofascial tissue. This hypothesis and theory paper offers a new mechanism for acupuncture therapy as a global percutaneous needle fasciotomy that respects tensegrity principles (tensegrity-based needling), in light of the theoretical model of "Fascial Armoring." The translation of this model to other medical conditions carries potential to advance therapies. These days opioid overuse and over-prescription are ubiquitous, as well as chronic pain and suffering.

Acute Effects of Percussive Massage Therapy on Thoracolumbar Fascia Thickness and Ultrasound Echo Intensity in Healthy Male Individuals: A Randomized Controlled Trial

Percussive massage therapy (PT) has been widely used by therapists and the fitness population to treat myofascial-related conditions. However, there is no evidence to confirm the effects of PT on the fascia. This study aimed to investigate the effects of PT on thoracolumbar fascia (TLF) morphology and other related outcomes.

METHODS

Sixty-six healthy males participated and were randomly allocated into a percussive massage group (PT group) and a control group. The PT group received 15 min of back percussion massage, while the control group rested prone lying in the same environment for 15 min. Thoracolumbar fascia (TLF) thickness and echo intensity, perceived stiffness, lumbar flexibility, and skin temperature were measured in both groups before and immediately after the intervention.

RESULT

TLF thickness and lumbar flexibility did not change when compared in the two groups. However, the echo intensity (left side, difference -3.36, 95% CI -5.1 to -1.6; right side, difference -4.39, 95% CI -6.1 to -2.7) and perceived stiffness (difference, -1.18, 95% CI -1.84 to -0.52) in the TLF region were significantly lower in the PT group than in the control group and were accompanied by increased skin temperature (difference 0.29, 95% CI 0.11 to 0.48).

CONCLUSION

We suggest that a 15 min PT with 30 Hz on the back region could reduce TLF echo intensity and perceived stiffness and increase skin temperature in healthy men individual.

Tissutal and Fluidic Aspects in Osteopathic Manual Therapy: A Narrative Review

Over the years, several authors have discussed the possibility of considering somatic dysfunction (SD) as a “nosological element” detectable on palpation. There are many aspects to consider regarding the etiology and diagnosis of SD, and the literature on osteopathic issues provides details on physiological signs that characterize it, including tissue texture changes. Recent knowledge suggests that how tissue and, in particular, connective tissue, responds to osteopathic treatment may depend on the modulation of the inflammation degree. Low-grade inflammation (LGI) may act on the extracellular matrix (ECM) and on cellular elements; and these mechanisms may be mediated by biological water. With its molecules organized in structures called exclusion zones (EZ), water could explain the functioning of both healthy and injured tissues, and how they can respond to osteopathic treatment with possible EZ normalization as a result. The relationship between inflammation and DS and the mechanisms involved are described by several authors; however, this review suggests a new model relating to the characteristics of DS and to its clinical implications by linking to LGI. Tissue alterations detectable by osteopathic palpation would be mediated by body fluids and in particular by biological water which has well-defined biophysical characteristics. Research in this area is certainly still to be explored, but our suggestion seems plausible to explain many dynamics related to osteopathic treatment. We believe that this could open up a fascinating scenario of therapeutic possibilities and knowledge in the future.

Myofascial Tissue and Depression

Background

The myofascial system plays a fundamental role in the mechanics of the body, in body tension regulation and the etiology of pathological states like chronic pain. Moreover, it contains contractile elements and preliminary evidence suggests that its properties are linked to psychological factors. The aim of the present research was to investigate characteristics of the myofascial tissue in patients with Major Depressive Disorder (MDD) and to examine whether the state of the myofascial tissue causally affects pathopsychological processes in MDD.

Methods

In Study 1, stiffness and elasticity of the myofascial tissue of 40 inpatients suffering from MDD measured with a tissue compliance meter were compared with those of 40 matched never-depressed participants. In Study 2, 69 MDD patients were randomly assigned to single-session self-myofascial release intervention (SMRI) or a placebo intervention. Effects on memory bias and affect were investigated.

Results

Results showed that MDD patients displayed heightened stiffness and reduced elasticity of the myofascial tissue and that patients in the SMRI group showed a reduced negative memory bias and more positive affect compared to patients in the placebo condition.

Conclusions

The preliminary results of our studies indicate that the myofascial tissue might be part of a dysfunctional body-mind dynamic that maintains MDD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-021-10282-w.

Acute Effects of Static Self-Stretching Exercises and Foam Roller Self-Massaging on the Trunk Range of Motions and Strength of the Trunk Extensors

Although the effectiveness of static self-stretching exercises (SSSEs) and foam roller self-massaging (FRSM) in joint range of motion and muscle strength of the lower limbs has been extensively investigated, little is known about their effectiveness on the posterior trunk muscles. The present study aimed to investigate the acute effects of two 7-min SSSEs and FRSM intervention protocols on the range of trunk movements and the strength of the trunk extensors. Twenty-five healthy active males (n = 14) and females (n = 11) performed each intervention separately, one week apart. The range of motion (ROM) of the trunk-hip flexion (T-HF), the ROM of the trunk side-flexion (TSF) and rotation (TR) bilaterally, as well as the isometric maximum strength (TESmax) and endurance (TESend) of the trunk extensors were measured before and after each intervention. The ROMs of T-HF, TSF, and TR were significantly increased following both SSSEs and FRSM. The TESmax and TESend were also significantly increased after FRSM, but decreased following SSSEs. While both interventions were effective in increasing the range of motion of the trunk, a single 7-min session of FRSM presented more advantages over a similar duration SSSEs protocol due to the increase in the strength of the trunk extensors it induced.

Finding Solutions for Fibrosis: Understanding the Innate Mechanisms Used by Super-Regenerator Vertebrates to Combat Scarring

Soft tissue fibrosis and cutaneous scarring represent massive clinical burdens to millions of patients per year and the therapeutic options available are currently quite limited. Despite what is known about the process of fibrosis in mammals, novel approaches for combating fibrosis and scarring are necessary. It is hypothesized that scarring has evolved as a solution to maximize healing speed to reduce fluid loss and infection. This hypothesis, however, is complicated by regenerative animals, which have arguably the most remarkable healing abilities and are capable of scar-free healing. This review explores the differences observed between adult mammalian healing that typically results in fibrosis versus healing in regenerative animals that heal scarlessly. Each stage of wound healing is surveyed in depth from the perspective of many regenerative and fibrotic healers so as to identify the most important molecular and physiological variances along the way to disparate injury repair outcomes. Understanding how these powerful model systems accomplish the feat of scar-free healing may provide critical therapeutic approaches to the treatment or prevention of fibrosis.

A Closer Look at the Cellular and Molecular Components of the Deep/Muscular Fasciae

The fascia can be defined as a dynamic highly complex connective tissue network composed of different types of cells embedded in the extracellular matrix and nervous fibers: each component plays a specific role in the fascial system changing and responding to stimuli in different ways. This review intends to discuss the various components of the fascia and their specific roles; this will be carried out in the effort to shed light on the mechanisms by which they affect the entire network and all body systems. A clear understanding of fascial anatomy from a microscopic viewpoint can further elucidate its physiological and pathological characteristics and facilitate the identification of appropriate treatment strategies.

The Rolf Method of Structural Integration on Fascial Tissue Stiffness, Elasticity, and Superficial Blood Perfusion in Healthy Individuals: The Prospective, Interventional Study

Introduction: There are multiple theories surrounding the physiological impact of structural integration (SI) with little evidence or research corroborating any of these. The aim of the study was to assess the effectiveness of 10 sessions of SI on fascial tissue (FT) superficial blood perfusion, stiffness, and elasticity in 13 healthy women.

Methods: This was a prospective, interventional study. The primary outcome measures were FTs’ superficial blood perfusion, stiffness, and elasticity of bilateral selected FT points on the body. Data were collected before and after 10 sessions of SI intervention. Statistical analysis was performed using the non-parametric Wilcoxon test (intragroup comparison).

Results: The superficial blood perfusion increased significantly in the most selected FT points on the body (p < 0.05). SI interventions produced significant decreases in selected points (brachioradialis, biceps brachii, and trapezius; p < 0.05) of FT stiffness and significant increases in elasticity (brachioradialis, biceps brachii, triceps surae, and trapezius; p < 0.05), especially in the FT of the right (dominant) upper limb.

Conclusion: A 10-session of SI demonstrated positive effects on increasing superficial blood perfusion contributed to a decrease in FT stiffness and an increase in elasticity properties in the dominant upper limb. Data collection for this study is currently underway, and the trial is registered at ISRCTN.com with the identifier: ISRCTN46707309.

Embryology of the Fascial System

The fascial system is a link between the various body systems. Understanding the embryonic formation of the fascial system contributes to understanding the development of the whole body, helping to understand clinical phenomena. The text presents the concept of the fascial system and its interactions with the neural system. We describe the formation of musculoskeletal fascia from somites and mesenchymal cells of the cranial neural crest. Differences in the formation of the head, neck, trunk, and limbs and their respective embryonic relationships are presented. We detail the formation of visceral fascia and their corresponding innervations, from the tongue to the final portion of the digestive tract; the development of the genitourinary system that occurs later in the celomic cavity; and the formation of the cardiocirculatory and respiratory systems, with the development of their respective envelopes, associated with the corresponding innervation. The text covers the embryology of neural fasciae, both at the level of the central and peripheral nervous system. Finally, the development of derme and pannicular fascia is presented.

Pressure and Traction Technique Improves Postural Control More Than Tactile Stimulation in Foot Plantar Fascia: A Randomized Single-Blind Trial

OBJECTIVE

To check the acute effects of manual pressure and traction technique on balance and plantar footprint variables.

DESIGN

A single-blind clinical study with 2 groups.

SETTING

Private practice.

PARTICIPANTS

Healthy participants (N=40; 28 female and 12 male) were recruited to carry out a single-blind study.

INTERVENTIONS

Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist, and the time of application of the techniques (5min) were the same for both interventions.

MAIN OUTCOME MEASURES

We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle, and front foot areas.

RESULTS

Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (P=.014) and surface eyes closed (P=.046) variables.

CONCLUSIONS

After technique the experimental group improved the stabilometry variables, specifically surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared with the control group.