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.
Strenuous and unaccustomed exercise frequently lead to what has been coined “delayed onset muscle soreness” (DOMS). As implied by this term, it has been proposed that the associated pain and ...stiffness stem from micro-lesions, inflammation, or metabolite accumulation within the skeletal muscle. However, recent research points towards a strong involvement of the connective tissue. First, according to anatomical studies, the deep fascia displays an intimate structural relationship with the underlying skeletal muscle and may therefore be damaged during excessive loading. Second, histological and experimental studies suggest a rich supply of algogenic nociceptors whose stimulation evokes stronger pain responses than muscle irritation. Taken together, the findings support the hypothesis that DOMS originates in the muscle-associated connective tissue rather than in the muscle itself. Sports and fitness professionals designing exercise programs should hence consider fascia-oriented methods and techniques (e.g., foam rolling, collagen supplementation) when aiming to treat or prevent DOMS.
High-intensity functional training (HIFT) has become a popular method in the sports and fitness sector. In contrast to unimodal approaches such as strength or endurance training, it has been ...hypothesized to induce concurrent adaptations in multiple markers of motor function. However, to date, the effectiveness of HIFT in this regard has not been studied. The present systematic review quantified the chronic effects of HIFT on motor function in healthy individuals. A multilevel meta-analysis with a robust random effects meta-regession model was used to pool the standardized mean differences (SMD) between (a) HIFT and (b) no-exercise (NEX) as well as conventional endurance, resistance and balance training for outcomes of muscle strength, endurance capacity and balance. The influence of possible effect modifiers such as program duration, session duration, age or sex was examined in a moderator analysis. Seventeen papers with moderate to high methodological quality (PEDro scale) were identified. Compared to NEX, HIFT had small to moderate positive effects on endurance capacity (SMD: 0.42, 95% CI 0.07-0.78, p = 0.03) and strength (0.60, 95% CI 0.02-1.18, p = 0.04) but no effect on balance (SMD: - 0.10, 95% CI - 1.13 to 0.92, p = 0.42). Regarding endurance, HIFT showed similar effectiveness as moderate-intensity endurance training (SMD: - 0.11, 95% CI - 1.17 to 0.95, p = 0.75) and high-intensity interval endurance training (SMD: - 0.15, 95% CI - 1.4 to 1.1, p = 0.66). No comparisons of HIFT vs. classical resistance or balance training were found. Moderator analyses revealed no influence of most effect modifiers. However, regarding endurance, females seemed to respond more strongly to HIFT in the comparison to NEX (p < .05). HIFT appears to represent an appropriate method to induce chronic improvements in motor function. While being superior to NEX and non-inferior to endurance training, current evidence does not allow a comparison against resistance and balance training. The impact of possible effect moderators should be further elucidated in future research.
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.
A media‐based collection and further analysis of relative return to play (RTP) rates and the corresponding quality of play after anterior cruciate ligament (ACL) rupture in top‐level football was the ...aim of our study. In the 5‐year case–control study, male players from the first two leagues of the five top leagues in Europe, who sustained a total ACL rupture during the season 2010/11 and/or 2011/12, were included. For them and a matched control sample (ratio 1:2), data were retrieved from the publicly available and validated media‐based platforms (transfermarkt.de & whoscored.com) until the end of season 2016/17. Injury and return to play‐specific data were calculated as rate ratios (RR) to compare the injured and matched control athletes rates and as a survival analysis (log‐rank test; career duration). Overall, 132 ACL‐injuries in 125 players occurred. The RTP rate was 98.2%, and the RTP to the same level was 59.4%. Five years post‐RTP, 69.9% of the ACL group were still engaged in football (RR = 87%), 40.9% at the same level (RR = 72%). Survival analysis revealed a systematic group difference in career duration compared to controls (Cox‐Mantel's χ2 = 5.8; P = 0.016). Game performance (scoring points, P < 0.001; rates/number of completed passes, P = 0.048; and minutes played, P < 0.001) was lower in the ACL athletes than in the matching group in the RTP and post‐RTP seasons. Although absolute and relative RTP rates after ACL reconstruction are high in professional football, career duration and game performance are lower than in the reference group.
Stretching is performed with numerous purposes in multiple settings such as prevention, rehabilitation, fitness training and sports. Its patterns of use substantially depend on the education and ...beliefs of health care and exercise professionals as they represent the multiplicators recommending and prescribing interventions to clients, patients and athletes. This study investigated movement experts' knowledge about the scientific evidence on stretching effects.
Survey study.
A total of 117 exercise and health professionals (physiotherapists, sports scientists, coaches) attending a training convention in Austria (male: n = 44, female: n = 73, 36±11 years) completed a digital survey. With its 22 items, the questionnaire addressed the movement experts' awareness of the evidence on stretching effects regarding a variety of related topics selected based on the findings of topical systematic reviews.
The majority of the individuals (57-88%) assumed positive effects of stretching on recovery, prevention of muscle injury, range of motion, muscular imbalance and artery elasticity. No or adverse effects were mostly claimed on bone injury prevention, maximal/explosive strength, and delayed-onset muscle soreness. In only 10 of 22 items, participants' classifications were in accord with the scientific evidence.
The awareness of research findings on stretching effects among exercise and health professionals is alarmingly low. Future studies may hence be geared to improve implementation and science communication.
The lumbodorsal fascia (LF) has been proposed to represent a possible source of idiopathic low back pain. In fact, histological studies have demonstrated the presence of nociceptive free nerve ...endings within the LF, which, furthermore, appear to exhibit morphological changes in patients with chronic low back pain. However, it is unclear how these characteristics relate to the aetiology of the pain. In vivo elicitation of back pain via experimental stimulation of the LF suggests that dorsal horn neurons react by increasing their excitability. Such sensitization of fascia-related dorsal horn neurons, in turn, could be related to microinjuries and/or inflammation in the LF. Despite available data point towards a significant role of the LF in low back pain, further studies are needed to better understand the involved neurophysiological dynamics.
Connective tissue links the skeletal muscles, creating a body-wide network of continuity. A recent in-vivo experiment demonstrated that passive elongation of the calf caused a caudal displacement of ...the semimembranosus muscle, indicating force transmission across the dorsal knee joint. However, it remains unclear as to whether this observation is dependent on the joint angle. If force would not be transmitted at flexed knees, this would reduce the number of postures and movements where force transmission is of relevance. Our trial, therefore, aims to investigate the influence of passive calf stretching with the knee in extended and flexed position on dorsal thigh soft tissue displacement. Understanding myofascial force transmission under in-vivo conditions is a pre-requisite for the development of exercise interventions specifically targeting the fascial connective tissue. Our study may thus provide health and fitness professional with the anatomical and functional basis for program design.
A large body of evidence suggests that the 11+ warm-up programme is effective in preventing football-related musculoskeletal injuries. However, despite considerable efforts to promote and disseminate ...the programme, it is unclear as to whether team head coaches are familiar with the 11+ and how they rate its feasibility. The present study aimed to gather information on awareness and usage among German amateur level football coaches. A questionnaire was administered to 7893 individuals who were in charge of youth and adult non-professional teams. Descriptive and inferential statistics were used to analyse the obtained data. A total of 1223 coaches (16%) returned the questionnaire. There was no risk of a non-response bias (p>.05). At the time of the survey, nearly half of the participants (42.6%) knew the 11+. Among the coaches who were familiar with the programme, three of four reported applying it regularly (at least once per week). Holding a license (φ = .28, p < .0001), high competitive level (Cramer-V = .13, p = .007), and coaching a youth team (φ = .1, p = .001) were associated with usage of 11+. Feasibility and suitability of the 11+ were rated similarly by aware and unaware coaches. Although a substantial share of German amateur level coaches is familiar with the 11+, more than half of the surveyed participants did not know the programme. As the non-usage does not appear to stem from a lack of rated feasibility and suitability, existing communication strategies might need to be revised.
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