To provide evidence for the existence of 6 myofascial meridians proposed by Myers based on anatomic dissection studies.
Relevant articles published between 1900 and December 2014 were searched in ...MEDLINE (PubMed), ScienceDirect, and Google Scholar.
Peer-reviewed human anatomic dissection studies reporting morphologic continuity between the muscular constituents of the examined meridians were included. If no study demonstrating a structural connection between 2 muscles was found, articles on general anatomy of the corresponding body region were targeted.
Continuity between 2 muscles was documented if 2 independent investigators agreed that it was reported clearly. Also, 2 independent investigators rated methodologic quality of included studies by means of a validated assessment tool (Quality Appraisal for Cadaveric Studies).
The literature search identified 6589 articles. Of these, 62 article met the inclusion criteria. The studies reviewed suggest strong evidence for the existence of 3 myofascial meridians: the superficial back line (all 3 transitions verified, based on 14 studies), the back functional line (all 3 transitions verified, based on 8 studies) and the front functional line (both transitions verified, based on 6 studies). Moderate-to-strong evidence is available for parts of the spiral line (5 of 9 verified transitions, based on 21 studies) and the lateral line (2 of 5 verified transitions, based on 10 studies). No evidence exists for the superficial front line (no verified transition, based on 7 studies).
The present systematic review suggests that most skeletal muscles of the human body are directly linked by connective tissue. Examining the functional relevance of these myofascial chains is the most urgent task of future research. Strain transmission along meridians would both open a new frontier for the understanding of referred pain and provide a rationale for the development of more holistic treatment approaches.
The present review aims to provide a systematic overview on tensile transmission along myofascial chains based on anatomical dissection studies and in vivo experiments. Evidence for the existence of ...myofascial chains is growing, and the capability of force transmission via myofascial chains has been hypothesized. However, there is still a lack of evidence concerning the functional significance and capability for force transfer. A systematic literature research was conducted using MEDLINE (Pubmed), ScienceDirect and Google Scholar. Studied myofascial chains encompassed the superficial backline (SBL), the back functional line (BFL) and the front functional line (FFL). Peer‐reviewed human dissection studies as well as in vivo experiments reporting intermuscular tension transfer between the constituents of a myofascial chain were included. To assess methodic quality, two independent investigators rated studies by means of validated assessment tools (QUACS and PEDro Scale). The literature research identified 1022 articles. Nine studies (moderate to excellent methodological quality) were included. Concerning the SBL and the BFL, there is moderate evidence for force transfer at all three transitions (based on six studies), and one of two transitions (three studies). One study yields moderate evidence for a slight, but not significant force transfer at one transition in the FFL. The findings of the present study indicate that tension can be transferred between some of the examined adjacent structures. Force transfer might have an impact in overuse conditions as well as on sports performance. However, different methods of force application and measurement hinder the comparability of results. Considering anatomical variations in the degree of continuity and histological differences of the linking structures is crucial for interpretation. Future studies should focus on the in vivo function of myofascial continuity during isolated active or passive tissue tensioning.
•FR and static stretching led to equal changes in ROM.•Acute changes in ROM are driven by neurophysiological and morphological factors.•Stretch sensation seems to be altered by both FR and static ...stretching.•Passive stiffness does not seem to be affected by FR or static stretching.•Sliding of fascial layers was only altered after FR.•Mechanisms for altered ROM after FR or static stretching seem to differ.
Foam Rolling (FR), aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are poorly understood. The aim of the present study was to further elucidate the acute, systemic and tissue-specific responses evoked by FR.
In a crossover study, 16 (34 ± 6y, 6f) participants received all of the following interventions in a random order: a) 2 × 60 seconds of FR at the anterior thigh, b) 2 × 60 seconds of passive static stretching of the anterior thigh (SS), and c) no intervention (CON). Maximal active and passive knee flexion range of motion (ROM), passive stiffness, sliding of fascial layers, as well as knee flexion angle of first subjectively perceived stretch sensation (FSS) were evaluated before and directly after each intervention.
Flexibility increased only after, FR (active (+1.8 ± 1.9%) and passive ROM (+3.4 ± 2.7%), p = .006, respectively) and SS (passive ROM (+3.2 ± 3.5%), p = .002). Angle of FSS was altered following FR (+4.3° (95% CI: 1.4°–7.2°)) and SS (+6.7° (3.7°–9.6°)), while tissue stiffness remained unchanged after any intervention compared to baseline. Movement of the deepest layer (−5.7 mm (−11.3 mm to −0.1 mm)) as well as intrafascial sliding between deep and superficial layer (−4.9 mm (−9.mm to −0.7 mm)) decreased only after FR.
FR improved knee flexion ROM without altering passive stiffness, but modified the perception of stretch as well as the mobility of the deep layer of the fascia lata. The mechanisms leading to altered fascial sliding merit further investigation.
Individuals afflicted with nonspecific chronic low back pain (CLBP) exhibit altered fundamental movement patterns. However, there is a lack of validated analysis tools. The present study aimed to ...elucidate the measurement properties of a functional movement analysis (FMA) in patients with CLBP.
In this validation (cross-sectional) study, patients with CLPB completed the FMA. The FMA consists of 11 standardised motor tasks mimicking activities of daily living. Four investigators (two experts and two novices) evaluated each item using an ordinal scale (0-5 points, one live and three video ratings). Interrater reliability was computed for the total score (maximum 55 points) using intra class correlation and for the individual items using Cohen's weighted Kappa and free-marginal Kappa. Validity was estimated by calculating Spearman's Rho correlations to compare the results of the movement analysis and the participants' self-reported disability, and fear of movement.
Twenty-one participants (12 females, 9 males; 42.7 ± 14.3 years) were included. The reliability analysis for the sum score yielded ICC values between .92 and.94 (p < .05). The classification of individual scores are categorised 'slight' to 'almost perfect' agreement (.10-.91). No significant associations between disability or fear of movement with the overall score were found (p > .05). The study population showed comparably low pain levels, low scores of kinesiophobia and disability.
The functional movement analysis displays excellent reliability for both, live and video rating. Due to the low levels of disability and pain in the present sample, further research is necessary to conclusively judge validity.
Self-myofascial release (SMR) aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in ...flexibility, but the underlying mechanisms are still poorly understood. In addition to neuronal mechanisms, improved flexibility may be driven by acute morphological adaptations, such as a reduction in passive tissue stiffness or improved movement between fascial layers. The aim of the intended study is to evaluate the acute effects of SMR on the passive tissue stiffness of the anterior thigh muscles and the sliding properties of the associated fasciae.
In a crossover study design, 16 participants will receive all of the following interventions in a permutated random order: (1) one session of 2 × 60 s of SMR at the anterior thigh, (2) one session of 2 × 60 s of passive static stretching of the anterior thigh and (3) no intervention. Passive tissue stiffness, connective tissue sliding, angle of first stretch sensation, as well as maximal active and passive knee flexion angle, will be evaluated before and directly after each intervention.
The results of the intended study will allow a better understanding of, and provide further evidence on, the local effects of SMR techniques and the underlying mechanisms for flexibility improvements.
ClinicalTrials.gov, identifier: NCT02919527 . Registered on 27 September 2016.
A considerable part of patients with non-specific low back pain (LBP) suffer from a recurrence of symptoms after therapy cessation.
The aim of this cohort study was to evaluate the predictive value ...of active and passive treatments and treatment modalities on a recurrence of low back pain after cessation of medically prescribed therapy.
Patients with non-specific LBP from a health- and therapy-center were included. Treatments were monitored and categorized as active or passive. During one year after therapy cessation, patients were monitored to retrieve information about recurrence of symptoms. Patients were dichotomized (recurrence versus no recurrence). An ROC-Analysis was used to determine optimal cut-offs for relevant treatment characteristics' (passive versus active; frequency) impact on recurrence risk. The relative risk for a recurrence was calculated based on Chi2-test.
Data from 96 participants (56 females, 40 males, mean age 49 years, standard deviation 11 years) were analysed. A total of 34 participants had recurring LBP. The frequency of active treatment differed significantly between groups with or without recurrence (p< 0.05). A therapy frequency of 1.45 active treatments/week was a sensitive cut-off (sensitivity: 0.73) to discriminate the recurrence groups. Participants with an active therapy frequency of less than 1.45 treatments per week showed an 82% increased relative recurrence risk (RR: 1.824 (95%-CI: 1.077-3.087)).
The results empathize the importance of active treatments (i.e. exercise) in the therapy and (secondary) prevention of non-specific LBP. Less than 1.45 active treatment sessions/week increases the 1-year-risk of a recurrence by 82%. Performing at least two treatments sessions per week is therefore recommended.
Motor function, such as strength asymmetries of the lower extremities and impaired dynamic stability, have a predictive value for the risk of injury. The present study aimed to reveal potential ...associations between injury and motor performance.
Two hundred and five male youth elite (association) football (soccer) players (mean: 13.5±4.5 years, 57.2±30.2 kg, 168±35 cm) were included. A test battery was conducted twice per season, over two consecutive seasons (four times). Mobility (Sit and Reach Test, SnR), dynamic stability (Single Leg Hop for Distance, SLHD), linear sprinting speed (10 m, 30 m s), agility (Zig-Zag test with and without dribbling a ball s), jump performance (countermovement jump (CMJ) and drop jump (DJ), in cm) and maximal isometric voluntary force (MIVF, in N) of the knee extensors and flexors were assessed. All injuries occurring over the two-year period, as well as training and competition exposure time, were collected and used as grouping variables for statistical difference testing.
One hundred and twenty-five injuries in 93 players occurred (an injury incidence of 2.7/1000 hours of exposure). Age was associated with injury incidence (r=0.191; P=0.006). Neither DJ, CMJ, SnR nor agility performance were statistically different between injured and non-injured participants (P>0.05). Group differences did occur for sprint and strength (P=0.011; P=0.016), but these lapsed after the inclusion of age as a covariate. Only for SLHD symmetry was a non-significant trend evident after the correction for age (P=0.08).
The occurrence of musculoskeletal injuries in junior football players are, probably, not related to baseline motor function. Group differences between injured and non-injured youth elite football players are mostly explained by age. Only the symmetry in SLHD could be a potential risk factor for injuries and merits further investigation.
Fatigue protocols have been used over the years to examine muscular exhaustion. As an alternative to approaches in laboratory settings, functional agility protocols claiming to mimic the multifaceted ...loads of athletic activity have been proposed. This study aimed to examine the effects of a functional agility short-term fatigue protocol (FAST-FP) on neuromuscular function. Twenty-eight healthy sports students (15 males, aged 24.3 ± 2.4 years) completed the FAST-FP, which consists of four components: three counter-movement jumps (90% of individual maximum), a 20-s bout of step-ups, three bodyweight squats and an agility run. Tasks were repeated until the participants no longer achieved the required jump height in two consecutive sets. Outcomes (pre-post) encompassed subjective exhaustion (visual analogue scale VAS), maximum isometric voluntary force of the knee extensors (MIVF), reactive strength index (RSI), mean power frequency (MPF, measured using surface electromyography) and maximum knee range of motion (ROM). Post-intervention, VAS (+54 mm) increased significantly, while MIVF (-6.1%), RSI (-10.7%) and MPF (-4.1%) were reduced (p < 0.05). No changes were observed for ROM (p > 0.05). The FAST-FP induces small-to-moderate impairments in neuromuscular function and considerable self-perceived fatigue. Current evidence on exhaustion developing in team sports suggests that this magnitude of fatigue is similar. The protocol might thus be valuable in the evaluation of treatments counteracting post-match fatigue in team sports.
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