[Cause-effect chains after distal radius fracture from an osteopathic perspective]

Osteopathy as a manual procedure is an important therapeutic tool in postoperative care. The essence of diagnostic and manual medical procedures in osteopathy is explained. The clinical procedure of osteopathic work is presented on the basis of a case study of a distal radius fracture and cause-effect chains are dealt with in depth. Pain can have its origin in another region of the body than where it occurs. The functional significance of the fasciae and myofascial chains is examined in more detail. Finally, the range of applications and effects of osteopathy in postoperative care are presented.

Role of fascial connectivity in musculoskeletal dysfunctions: A narrative review

INTRODUCTION

Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of 'fascial connectivity' evolved two decades ago from a simple anatomical hypothesis called 'myofascial meridians'. Since then it has been widely researched, as conceptually it makes more sense for functional movements than 'single-muscle' theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field.

METHODS

A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine's scoring).

RESULTS

Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment.

CONCLUSION

Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial

Lower limb stretching based on myofascial chains has been demonstrated to increase cervical range of motion (ROM) in the sagittal plane. It is, however, unknown whether such remote exercise is as effective as local stretching. To resolve this research deficit, 63 healthy participants (36 ± 13 years, ♂32) were randomly assigned to one of three groups: remote stretching of the lower limb (LLS), local stretching of the cervical spine (CSS) or inactive control (CON). Prior (M1), immediately post (M2) and 5 min following intervention (M3), maximal cervical ROM was assessed. Non-parametric data analysis (Kruskal-Wallis tests and adjusted post hoc Dunn tests) revealed significant differences between the disposed conditions. With one exception (cervical spine rotation after CSS at M2, P > .05), both LLS and CSS increased cervical ROM compared to the control group in all movement planes and at all measurements (P < .05). Between LLS and CSS, no statistical differences were found (P > .05). Lower limb stretching based on myofascial chains induces similar acute improvements in cervical ROM as local exercise. Therapists might consequently consider its use in programme design. However, as the attained effects do not seem to be direction-specific, further research is warranted in order to provide evidence-based recommendations.

Remote effects of lower limb stretching: preliminary evidence for myofascial connectivity?

The skeletal muscles and the fibrous connective tissue form an extensive, body-wide network of myofascial chains. As fascia can modify its stiffness, strain transmission along these meridians is supposable. The goal of this trial therefore was to collect pilot data for potential remote effects of lower limb stretching on cervical range of motion (ROM). Twenty-six healthy participants (30 ± 6 years) were included in the matched-pairs intervention study. One group (n = 13) performed three 30 s bouts of static stretching for the gastrocnemius and the hamstrings, respectively. An age- and sex-matched control group (CG; n = 13) remained inactive. Pre- and post-intervention, maximal cervical ROM in flexion/extension was assessed. A repeated measures ANOVA revealed systematic differences between groups (P < .05). ROM increased following stretching (143.3 ± 13.9 to 148.2 ± 14°; P < .05) but remained unchanged in the CG (144.6 ± 16.8 to 143.3 ± 16.8°; P > .05). Our data point towards existence of a strain transfer along myofascial meridians. Further randomised controlled studies on conditions, factors and magnitude of tensile transmission are warranted.