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3 authors, including:
Journal of
Bodywork and
Movement Therapies
www.intl.elsevierhealth.com/journals/jbmt
PILOT STUDY
a
Centro Socio Sanitario dei Colli, Physiotherapy, Azienda Ulss 16, Via dei Colli 4, Padova, Italy
b
Section of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Italy
c
Physical Medicine and Rehabilitation Clinic, University of Padova, Italy
Received 28 March 2008; received in revised form 10 April 2008; accepted 21 April 2008
KEYWORDS Summary Classical anatomy still relegates muscular fascia to a role of contention.
Fascia; Nonetheless, different hypotheses concerning the function of this resilient tissue
Musculoskeletal have led to the formulation of numerous soft tissue techniques for the treatment of
dysfunction; musculoskeletal pain. This paper presents a pilot study concerning the application of
Manual technique; one such manual technique, Fascial Manipulation&, in 28 subjects suffering from
Chronic shoulder pain; chronic posterior brachial pain. This method involves a deep kneading of muscular
Fascial Manipulation fascia at specific points, termed centres of coordination (cc) and centres of fusion
(cf), along myofascial sequences, diagonals, and spirals. Visual Analogue Scale (VAS)
measurement of pain administered prior to the first session, and after the third
session was compared with a follow-up evaluation at 3 months. Results suggest that
the application of Fascial Manipulation& technique may be effective in reducing
pain in chronic shoulder dysfunctions. The anatomical substratum of the myofascial
continuity has been documented by dissections and the biomechanical model
is discussed.
& 2008 Elsevier Ltd. All rights reserved.
1360-8592/$ - see front matter & 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbmt.2008.04.044
ARTICLE IN PRESS
Application of Fascial Manipulation& technique in chronic shoulder pain 129
Anatomical study
Table 3 Results of +ve movement tests on three planes in segments examined at the first visit in 28 subjects.
LA ME RE AN ER IR
Scapula 3 3 1 2 1 2 1 2 1 1
Humerus 3 6 5 1 1 5 1 4 3 7 2 3 1 1 2 2
Elbow 1 1 1
Wrist 1 2
Digits 2 1
Neck 1 2 1 4 1 1 1 2 2 1 1
Thorax 3 1 2
Lumbar 1 2 1 1 1
Pelvis 1 2
Hip 1 1
Knee 1
Total ¼ 112 8 12 6 2 1 4 27 4 7 8 9 5 8 2 1 3 4
10
8
VAS
0
SUBJECTS
After the three treatments a mean pain reduction Fascial Manipulation&, has the following structure.
of 57% was recorded (mean value of VAS prior to Beginning at the hand, we have seen that the fascia
treatment: 77 mm; mean value after three treat- of extensor digiti minimi and abductor digiti minimi
ments: 32.8 mm) (po0.0001) together with a good is continuous with the deep muscular fascia of the
recovery of movement. The initial benefit was posterior region of the forearm. Some of the fibres
generally maintained (mean value of VAS: 38.2 mm, of abductor digiti minimi originate directly from
p40.05) at a short-term follow-up. In eight cases, the fascia, therefore, when these muscles contract
there was a partial increase in reported pain after they can transmit tension directly to the posterior
the suspension of treatment, and in three cases, antebrachial fascia. This fascia is tensioned distally
pain had returned to its initial level (Table 4). also due to its insertions onto the flexor retinacu-
lum, pisiform and pisohamate ligaments. The
extensor carpi ulnaris extends a tendinous expan-
Anatomical study sion onto the deep fascia of extensor digiti minimi
and abductor digiti minimi (Figure 3). More
From our anatomical dissections, we have seen that proximally, some fibres of the proximal part of
the posterior region of the upper limb, in corre- extensor carpi ulnaris and extensor digiti minimi
spondence to the retromotion sequence from originate from the antebrachial fascia. Fibrous
ARTICLE IN PRESS
Application of Fascial Manipulation& technique in chronic shoulder pain 133
Concerning alterations in afferent signals, any Green, S., Buchbinder, R., Hetrick, S., 2003. Physiotherapy
incorrect activation of receptors embedded in the interventions for shoulder pain. Cochrane Database Systema-
impeded fascia could result in inaccurate proprio- tic Reviews, CD004258.
Huijing, P., Baan, G., 2003. Myofascial force transmission:
ceptive afferents. Consequent incoherent muscle
muscle relative position and length determine agonist and
recruitment would produce repercussions on joint synergist muscle force. Journal of Applied Physiology 94,
movement (e.g. impingement) and poorly coordi- 1092–1107.
nated joint movement can cause periarticular Kitaoka, H.B., Luo, Z.P., An, K.N., 1997. Mechanical behavior of
inflammation, resulting in activation of nociceptors the foot and ankle after plantar fascia release in the unstable
around the joint. foot. Foot & Ankle International 18, 8–15.
Langevin, H., 2006. Connective tissue: a body-wide signalling
The biomechanical model proposed by the
network? Medical Hypotheses 66, 1074–1077.
Fascial Manipulation& technique offers interesting Loukas, M., Shoja, M.M., Thurston, T., Jones, V.L., Linganna, S.,
possibilities for more in-depth studies. Tubbs, R.S., 2007. Anatomy and biomechanics of the
vertebral aponeurosis part of the posterior layer of the
thoracolumbar fascia. Surgical and Radiologic Anatomy 30,
125–129.
Conclusion Myers, T.W., 2001. Anatomy Trains. Churchill Livingstone,
New York, NY.
In conclusion, this study suggests that fascial Paoletti, S., 2002. Les Fascias: Role des Tissus dans la Mecanique
anatomy can provide a biomechanical explanation Humaine. Vannes, Sully.
for the effectiveness of myofascial treatments in Picavet, H.S.J., Schouten, J.S.A.G., 2003. Musculoskeletal pain
musculoskeletal dysfunctions. Fascial anatomy can in the Netherlands: prevalences, consequences and risk
groups, the DMC (3)-study. Pain 102, 167–178.
also serve as a guide to interpreting pain distribu-
Rolf, I.P., 1997. Rolfing. Mediterranee, Roma.
tion and a topographical map for identifying Schleip, R., Lehmann-Horn, F., Klingler, W., 2006. Fascia is able
specific, key areas for effective treatment. to contract in a smooth muscle-like manner and thereby
influence musculoskeletal mechanics. In: Liepsch, D. (Ed.),
Proceedings of the Fifth World Congress of Biomechanics,
Munich, Germany, 2006, pp. 51–54, ISBN 88-7587-270-8.
References Stecco, L., 2004. Fascial Manipulation. Piccin, Padova.
Stecco, C., Porzionato, A., Macchi, V., Tiengo, C., Parenti III, A.,
Baldry, P., 2001. Myofascial Pain and Fibromyalgia Syndromes.
Aldegheri, R., Delma, V., De Caro, R., 2006. A histological
Churchill Livingstone, New York, NY.
study of the deep fascia of the upper limb. Italian Journal of
Barker, D., 1974. The morphology of muscle receptors. In: Hunt,
Anatomy and Embryology 111 (2), 105–110.
C.C. (Ed.), Handbook of Sensory Physiology. Springer, Berlin,
Stecco, C., Gagey, O., Macchi, V., Porzionato, A., De Caro, R.,
pp. 1–190.
Aldighieri, R., Delmas, V., 2007. Tendinous muscular inser-
Birnbaum, K., Siebert, C.H., Pandorf, T., Schopphoff, E.,
tions onto the deep fascia of the upper limb. First part:
Prescher, A., Niethard, F.U., 2004. Anatomical and biome-
chanical investigations of the iliotibial tract. Surgical and anatomical study. Morphologie 91 (292), 29–37 http://
Radiologic Anatomy 26, 433–446. www.ncbi.nlm.nih.gov/sites/entrez?Db ¼ pubmed&Cmd ¼
Busquet, L., 1995. Les chaines musculaires. Tome II. Frison Search&Term ¼ %22GageyO%22%5BAuthor%5D&itool ¼
Roche, Paris. EntrezSystem2.PEntrez.Pubmed.Pubmed_
Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., ResultsPanel.Pubmed_RVAbstractPlusDrugs1.
Phillips, N., Best, T.M., Benjamin, M., 2006. The functional Vleeming, A., Stoeckart, R., Snijders, C.J., 1995. The posterior
anatomy of the iliotibial band during flexion and extension of layer of the thoracolumbar fascia. Spine 20, 753–758.
the knee: implications for understanding iliotibial band Yahia, H., Rhalmi, S., Newman, N., 1992. Sensory innervation of
syndrome. Journal of Anatomy 208, 309–316. human thoracolumbar fascia, an immunohistochemical study.
Godelieve, Denys-S., 1996. Il manuale del Mézièrista vols. I Acta Orthopaedica Scandinavica 63, 195–197.
and II. Marrapese, Roma. Yu, J.S., 2000. Pathologic and post-operative conditions of the
Gracovetsky, S., Farfan, H., Helleur, C., 1985. The abdominal plantar fascia: review of MR imaging appearances. Skeletal
mechanism. Spine 10, 317–324. Radiology 29, 491–501.