Abstract
Background and objectives: The aims of this study were to delineate the contribution of specific fascial layers of the myofascial unit to myofascial pain and introduce the use of ultrasound-guided fascial layer-specific hydromanipulation (FLuSH) as a novel technique in the treatment of myofascial pain. Materials and Methods: The clinical data of 20 consecutive adult patients who underwent myofascial injections using FLuSH technique for the treatment of myofascial pain were reviewed. The FLuSH technique involved measuring the pain pressure threshold using an analog algometer initially and after each ultrasound guided injection of normal saline into the specific layers of the myofascial unit (superficial fascia, deep fascia, or muscle) in myofascial points corresponding with Centers of Coordination/Fusion (Fascial Manipulation®). The outcome measured was the change in pain pressure threshold after injection of each specific fascial layer. Results: Deep fascia was involved in 73%, superficial fascia in 55%, and muscle in 43% of points. A non-response to treatment of all three layers occurred in 10% of all injected points. The most common combinations of fascial layer involvement were deep fascia alone in 23%, deep fascia and superficial fascia in 22%, and deep fascia and muscle in 18% of injected points. Each individual had on average of 3.0 ± 1.2 different combinations of fascial layers contributing to myofascial pain. Conclusions: The data support the hypothesis that multiple fascial layers are responsible for myofascial pain. In particular, for a given patient, pain may develop from discrete combinations of fascial layers unique to each myofascial point. Non-response to treatment of the myofascial unit may represent a centralized pain process. Adequate treatment of myofascial pain may require treatment of each point as a distinct pathologic entity rather than uniformly in a given patient or across patients.
Highlights
Myofascial pain is a common clinical entity with a high prevalence, ranging from 30% to 85% [1,2].Myofascial pain may be involved in a variety of pain syndromes [3], including tension headaches [4], lower back syndromes [5], neck pain [6], and pelvic pain [7]
The objectives of this study were to delineate the contribution of specific fascial layers of the myofascial unit to myofascial pain and introduce the use of fascial layer-specific hydromanipulation (FLuSH) as a novel technique in the diagnosis and treatment of specific fascial layers contributing to myofascial pain
A total of 20 patients who underwent myofascial injections were included in this analysis
Summary
Myofascial pain is a common clinical entity with a high prevalence, ranging from 30% to 85% [1,2].Myofascial pain may be involved in a variety of pain syndromes [3], including tension headaches [4], lower back syndromes [5], neck pain [6], and pelvic pain [7]. Several small studies and case reports elucidated the pathophysiology of myofascial pain beyond a purely muscle origin to include other soft tissue structures of the myofascial unit with its discrete layers: superficial fascia, deep fascia and muscle (epimysium, perimysium, endomysium) [8,9,10,11]. The FLuSH technique involved measuring the pain pressure threshold using an analog algometer initially and after each ultrasound guided injection of normal saline into the specific layers of the myofascial unit (superficial fascia, deep fascia, or muscle) in myofascial points corresponding with. The most common combinations of fascial layer involvement were deep fascia alone in 23%, deep fascia and superficial fascia in 22%, and deep fascia and muscle in 18% of injected points. Non-response to treatment of the myofascial unit may represent a centralized pain process
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