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Bali F, Bayram GA. Effects of myofascial release technique in patients with unilateral cervical radiculopathy: A single blind-randomized clinical trial. Explore (NY) 2024:S1550-8307(24)00007-7. [PMID: 38296722 DOI: 10.1016/j.explore.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/25/2023] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of the myofascial release technique in individuals diagnosed with unilateral cervical radiculopathy. MATERIALS AND METHODS Thirty-four cervical radiculopathy patients were randomly assigned to either the myofascial release group or the exercise group. Both groups received conventional treatment. Additionally, the exercise group performed stretching and strengthening exercises while the myofascial release group received the myofascial release technique. The pain pressure threshold, muscle strength, cervical range of motion, pain, and disability variables were assessed for all patients. RESULTS The myofascial release group demonstrated significantly larger improvements in flexion (p = 0.001), extension (p = 0.037), left rotation (p = 0.012), and left lateral flexion (p = 0.001) range of motions compared to the exercise group. Muscle strength in the wrist flexors (p < 0.001), wrist extensors (p < 0.010), biceps (p < 0.001) and triceps (p < 0.001) were significantly higher in the myofascial release group compared to the exercise group. And, again, the myofascial release group demonstrated significantly larger improvements in wrist flexors (p < 0.001), wrist extensors (p < 0.001), biceps (p < 0.001), triceps (p < 0.001), pectorals (p < 0.001), subscapularis (p < 0.001), upper trapezius (p = 0.002), and the pain pressure threshold. Finally, the myofascial release group demonstrated statistically significant improvements in pain (p < 0.001) and disability (p < 0.001) scales compared to the exercise group. CONCLUSION Evaluation of the arm muscle strength and pain pressure threshold variables in patients with cervical radiculopathy may benefit clinicians in the preparation of treatments. Cervical radiculopathy symptoms may improve after the application of myofascial release techniques. A customized cervical exercise program and conventional treatment could be added to the non-surgical treatment of cervical radiculopathy.
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Affiliation(s)
- Fatih Bali
- Department of Physical Therapy and Rehabilitation, Istanbul Kent University, Istanbul, Turkey.
| | - Gülay Aras Bayram
- Department of Physical Therapy and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey
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Raja G P, Bhat S, Gangavelli R, Prabhu A, Stecco A, Pirri C, Jaganathan V, Fernández-de-Las-Peñas C. Effectiveness of Deep Cervical Fascial Manipulation ® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial. Life (Basel) 2023; 13:2173. [PMID: 38004313 PMCID: PMC10672322 DOI: 10.3390/life13112173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP). METHOD Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken. RESULTS A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up. CONCLUSION FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.
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Affiliation(s)
- Prabu Raja G
- Department of Exercise and Sports Science, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - Shyamasunder Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal 576104, India
| | - Ranganath Gangavelli
- Department of Physiotherapy, GITAM School of Physiotherapy, GITAM University, Visakhapatnam 530045, India;
| | - Anupama Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - Antonio Stecco
- Department of Rehabilitation Medicine, New York University, New York, NY 10012, USA;
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy;
| | - Vennila Jaganathan
- Department of Statistics, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal 576104, India;
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28008 Madrid, Spain;
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Kondrup F, Gaudreault N, Venne G. The Deep Fascia and its Role in Chronic Pain & Pathological Conditions: A Review. Clin Anat 2022; 35:649-659. [PMID: 35417568 DOI: 10.1002/ca.23882] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. MATERIALS AND METHODS A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. RESULTS We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. CONCLUSIONS The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
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Affiliation(s)
- Flemming Kondrup
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nathaly Gaudreault
- School of rehabilitation, Faculty of medicine and health sciences, University of Sherbrooke, Sherbrooke, Canada
| | - Gabriel Venne
- Department of Anatomy & Cell Biology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.,Institute of Health Science Education, Faculty of Medicine, McGill University, Montreal, Canada
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Prabu Raja G, Shyamasunder Bhat N, Cruz A, Prabhu A, Fernandes S, Naaz N. The anatomical myofascial continuum between the neck and eyes. Clin Anat 2022; 35:340-346. [DOI: 10.1002/ca.23835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022]
Affiliation(s)
- G. Prabu Raja
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - N. Shyamasunder Bhat
- Department of Orthopedics Kasturba Medical College, Manipal Academy of Higher Education Manipal India
| | - Antony Cruz
- School of communication Manipal Academy of Higher Education Manipal Karnataka India
| | - Anupama Prabhu
- Department of Physiotherapy Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - Shifra Fernandes
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
| | - Nabeela Naaz
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research, Department of Exercise and Sports Science Manipal College of Health Professions, Manipal Academy of Higher Education Manipal Karnataka India
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Raja G P, Bhat N S, Fernández-de-Las-Peñas C, Gangavelli R, Davis F, Shankar R, Prabhu A. Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial. Trials 2021; 22:574. [PMID: 34454582 PMCID: PMC8399821 DOI: 10.1186/s13063-021-05533-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. METHODS This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. DISCUSSION If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. TRIAL REGISTRATION ClinicalTrials.gov CTRI/2020/01/022934 . Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry - India.
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Affiliation(s)
- Prabu Raja G
- Interdisciplinary Centre for Craniofacial and Orofacial pain Research, Department of Exercise and Sports Science, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576 104, India
| | - Shyamasunder Bhat N
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ranganath Gangavelli
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Fiddy Davis
- Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar
- Department of Data Science, Manipal Academy of Higher Education, Manipal, India
| | - Anupama Prabhu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Kamani NC, Poojari S, Prabu RG. The influence of fascial manipulation on function, ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability. J Bodyw Mov Ther 2021; 27:216-221. [PMID: 34391236 DOI: 10.1016/j.jbmt.2021.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Proprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear. OBJECTIVE This study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI. DESIGN Single group, pretest-posttest design. METHODS Individuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance). RESULTS There was a significant improvement in the FADI scores (Z = -3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp 2 = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM. CONCLUSION Since fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.
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Affiliation(s)
| | - Shruti Poojari
- Sports Scientist, Centre for Sports Medicine, Kokilabhen Dirubhai Ambani Hospital, Mumbai, India
| | - Raja G Prabu
- Interdisciplinary Center for Craniofacial and Orofacial Pain Research. Department of Exercise and Sports Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India, 576 104.
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