Faculty Bibliography

BACKGROUND:Pelvic floor dysfunction (PFD) is prevalent post-childbirth, with urinary incontinence (UI) affecting approximately 30 % of women. Although pelvic floor muscle training is widely recognized as the first-line treatment for UI, emerging research underscores the significance of fascial tissue on pelvic floor muscle function. The fascia surrounding the pelvic diaphragm shares an intrinsic relationship with the abdomen, pelvis, lumbar region, and lower limb. In this sense, fascial restrictions in any of these segments may contribute to the development of UI. Fascial Manipulation® (FM®), is a method targeting fascial restrictions across the body and has shown promise in treating musculoskeletal and pelvic conditions. Given the potential influence of fascial dysfunction in PFD, this case explores the application of FM® to address UI symptoms. CASE PRESENTATION/METHODS:A Japanese 36-year-old woman with UI symptoms that worsen six months post-partum. Two weeks after a vaginal delivery, she consulted a urologist due to increased urinary frequency and urgency, which was disrupting her sleep. At that time, she underwent a five-week program of pelvic floor muscle training, with no improvement in UI symptoms, prompting her to seek alternative treatment. A 72-h bladder diary was used to assess patient's voiding pattern, including daytime and nighttime urine frequency. Symptom severity and her distress symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS) and Core Lower Urinary Tract Symptom Score (CLSS) questionnaires, respectively. Pelvic floor displacement was measured via ultrasound imaging. Additionally, movement specific tests and palpation, based on Stecco's Fascial Manipulation® (FM®) method, identified points of tissue densification. Pain intensity was measured using the 10-point Visual Analogue Scale (VAS). During the specific movement tests assessment, the patient complained about right knee pain and restricted dorsiflexion of the right ankle. Palpation revealed tissue densifications in the medial ankle and knee, posterior knee, right hip, bilateral pelvic region, and the area of the lower abdominal muscles. The patient underwent a single session of the FM® method, involving deep friction of the identified densification points. Follow-up assessments included a reassessment of the 72-h bladder diary, OABSS, and CLSS questionnaires one month after the intervention. Ultrasound images and the specific movement tests, with VAS score, were performed immediately after intervention and one month later. RESULTS:One month after the treatment, the 72-h Bladder Diary indicated a reduction in urination frequency from 10 to 13 times/day to 6 times/day, and nighttime frequency from 2 to 3 times/night to 1 time/night. Questionnaire scores reflected significant improvement, with OABSS severity decreasing from 7 to 1, and CLSS distress reducing from 6 to 1. Immediately after the treatment the ultrasound imaging showed an increase in pelvic floor muscle elevation from 4 to 7 mm., which was maintained, at 7 mm., one month later. The patient reported an improvement in the specific movement tests, being able to squat without pain in the right knee, with zero on the VAS scale. One month later, the patient could sit upright without pain (VAS from 6 to 0) in the right knee. CONCLUSION/CONCLUSIONS:Fascial Manipulation may reduce urinary frequency and urgency by releasing abnormal tension on the bladder via the internal fascia. Recognizing fascial influences on the whole body could be an effective strategy for treating these symptoms.

The absence of a clear consensus on the definition and significance of fascia and the indiscriminate use of the term throughout the clinical and scientific literature has led to skepticism regarding its importance in the human body. To address this challenge, we propose that: (1) fasciae, and the fascial interstitia within them, constitute an anatomical system, defined as a layered body-wide multiscale network of connective tissue that allows tensional loading and shearing mobility along its interfaces; (2) the fascial system comprises four anatomical organs: the superficial fascia, musculoskeletal (deep) fascia, visceral fascia, and neural fascia; (3) these organs are further composed of anatomical structures, some of which are eponymous; (4) all these fascial organs and their structural components contain variable combinations and arrangements of the four classically defined tissues: epithelial, connective, muscle, and neural; (5) the overarching functions of the fascial system arise from the contrasting biomechanical properties of the two basic types of layers distributed throughout the system: one predominantly collagenous and relatively stiff, the other rich in hyaluronic acid and viscous, allowing for the free flow of fluid; (6) the topographical organization of these layers in different locations is related to local variations in function (e.g. unidirectional arrangements favor tensional loading, interwoven structures favor shear mobility) thereby accounting for both the system's universal functional aspects and the site-specific variations between them. A universal language related to fascia will break down linguistic barriers and facilitate cross-disciplinary cooperation, enabling scientists and practitioners from diverse backgrounds to contribute their expertise seamlessly.

This prospective study aimed to determine the impact of Fascial Manipulation^® by Stecco (FM) on the range of motion (ROM) of internal rotation (IR) and horizontal adduction (HADD) in asymptomatic handball players, representing significant risk factors for shoulder injuries. A randomized controlled trial was conducted, with participants randomly assigned to either the investigated group (N = 29) receiving a single session of FM or the control group (N = 27) receiving no treatment. The ROM for IR and HADD were measured before, immediately after, and one month after the FM session. The investigated group experienced a statistically significant acute increase in glenohumeral IR (14 degrees, p < 0.001) and HADD (14 degrees, p < 0.001) compared to the control group (p < 0.001). The positive effects of FM persisted one month post-treatment, with increased IR ROM by 12 degrees (p < 0.001) and HADD ROM by 11 degrees (p < 0.001). Participants in the investigated group reported lower subjective tightness/stiffness immediately after (p < 0.001) and one month after treatment (p = 0.002) compared to the control group. This study demonstrates that a single application of FM effectively improves glenohumeral ROM in the dominant throwing shoulder of asymptomatic handball players. It highlights the immediate and sustained positive effects of FM on IR and HADD. These findings support the use of FM as an effective method for enhancing shoulder ROM and reducing subjective tightness/stiffness. The study was registered at ClinicalTrials.gov (NCT06009367).

BACKGROUND:Retinacula of the ankle are thickening of the deep fascia of the leg (crural fascia) and foot i.e. inseparable structures. Recent studies report their crucial role in functional stability and proprioception of the ankle. CASE PRESENTATION:A 38-yr-old Caucasian man - with a history of lateral malleolus fracture 12 years ago, obesity and right ankle osteoarthritis - was referred to a physiatrist for a right ankle pain that had significantly worsened over the last year. During walking, the patient experienced stinging pain in the area of tibialis anterior and peroneus tertius muscles, and the superior extensor retinaculum. Magnetic resonance imaging and ultrasonography showed clear thicknening (2.05 mm) of the oblique superomedial band of the inferior extensor retinaculum. Sonopalpation was performed to precisely evaluate/confirm the site of maximum pain. Foot function index (FFI) score was 42. RESULTS:Subsequently, the patient was prescribed fascial manipulation, and he had clinical improvement after the first session (FFI: 21). At 1-month follow-up, the patient was still asymptomatic without any functional limitation (FFI: 24). US imaging confirmed the decreased thickness of the oblique superomedial band of the extensor retinaculum (1.35 mm). CONCLUSION:Fascial Manipulation® appears to be a useful tool to reduce thickness, stiffness, and pain in this case as displayed by the ultrasound Imaging.

The International Symposium on Myofascial Pain, Fibromyalgia, and Fascial Pain Disorders was held at the University of Padua, Padua, Italy in June of 2023. This report presents a summary of the presentations from scientists and clinicians from around the world who presented to the symposium. The purpose of this symposium and resultant paper is improve health professional's recognition and understanding of the clinical characteristics, co-morbidities, mechanisms, and treatment strategies for these common conditions to better understand and manage their pain, dysfunction, and quality life.

PURPOSE/OBJECTIVE:Fascial changes in hypermobile Ehlers-Danlos syndrome (hEDS), a heritable connective tissue disorder, can be used visualized with sonoelastography. The purpose of this study was to explore the inter-fascial gliding characteristics in hEDS. METHODS:In 9 subjects, the right iliotibial tract was examined with ultrasonography. Tissue displacements of the iliotibial tract were estimated from ultrasound data using cross-correlation techniques. RESULTS:In hEDS subjects, shear strain was 46.2%, lower than those with lower limb pain without hEDS (89.5%) and in control subjects without hEDS and without pain (121.1%). CONCLUSION/CONCLUSIONS:Extracellular matrix changes in hEDS may manifest as reduced inter-fascial plane gliding.

It is a common experience, reported by patients who have undergone manual therapy that uses deep friction, to perceive soreness in treatment areas; however, it is still not clear what causes it and if it is therapeutically useful or a simple side effect. The purpose of this narrative review is to determine whether manual and physical therapies can catalyze an inflammatory process driven by HA fragments. The literature supports the hypothesis that mechanical stress can depolymerize into small pieces at low molecular weight and have a high inflammatory capacity. Many of these pieces are then further degraded into small oligosaccharides. Recently, it has been demonstrated that oligosaccharides are able to stop this inflammatory process. These data support the hypothesis that manual therapy that uses deep friction could metabolize self-aggregated HA chains responsible for increasing loose connective tissue viscosity, catalyzing a local HA fragment cascade that will generate soreness but, at the same time, facilitate the reconstitution of the physiological loose connective tissue properties. This information can help to explain the meaning of the inflammatory process as well as the requirement for it for the long-lasting resolution of these alterations.

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/METHODS: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:< 0.001), but there were no significant differences in PSFS between the groups during the follow-up. CONCLUSION/CONCLUSIONS:FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

BACKGROUND:Myofascial Pain Syndrome (MPS) is a common pain disorder. Diagnostic criteria include physical findings which are often unreliable or not universally accepted. A precise biosignature may improve diagnosis and treatment effectiveness. The purpose of this study was to assess whether microanalytic assays significantly correlate with characteristic clinical findings in people with MPS. METHODS:This descriptive, prospective study included 38 participants (25 women) with greater than 3 months of myofascial pain in the upper trapezius. Assessments were performed at a university laboratory. The main outcome measures were the Beighton Index, shoulder range of motion, strength asymmetries and microanalytes: DHEA, Kynurenine, VEGF, interleukins (IL-1b, IL-2, IL-4, IL-5, IL-7, IL-8, IL-13), growth factors (IGF-1, IGF2, G-CSF, GM-CSF), MCP-1, MIP-1b, BDNF, Dopamine, Noradrenaline, NPY, and Acetylcholine. Mann-Whitney test and Spearman's multivariate correlation were applied for all variables. The Spearman's analysis results were used to generate a standard correlation matrix and heat map matrix. RESULTS:Mean age of participants was 32 years (20-61). Eight (21%) had widespread pain (Widespread Pain Index ≥ 7). Thirteen (34%) had MPS for 1-3 years, 14 (37%) 3-10 years, and 11 (29%) for > 10 years. The following showed strong correlations: IL1b,2,4,5,7,8; GM-CSF and IL 2,4,5,7; between DHEA and BDNF and between BDNF and Kynurenine, NPY and acetylcholine. The heat map analysis demonstrated strong correlations between the Beighton Index and IL 5,7, GM-CSF, DHEA. Asymmetries of shoulder and cervical spine motion and strength associated with select microanalytes. CONCLUSION/CONCLUSIONS:Cytokine levels significantly correlate with selected clinical assessments. This indirectly suggests possible biological relevance for understanding MPS. Correlations among some cytokine clusters; and DHEA, BDNF kynurenine, NPY, and acetylcholine may act together in MPS. These findings should be further investigated for confirmation that link these microanalytes with select clinical findings in people with MPS.