Fascial Manipulation Research Articles

Pilot Study of Sacroiliac Joint Dysfunction Treated with a Single Session of Fascial Manipulation® Method: Clinical Implications for Effective Pain Reduction

Background and Objectives: Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases. In literature, it emerges that the “fascia”, by its anatomical continuity, if altered or densified in different regions of the body with respect to the sacroiliac joint and its surroundings, may have a fundamental role in the genesis of SIJD and low back pain. The purpose of the present study is to evaluate the effectiveness of incorporating a single session of Fascial Manipulation®-Stecco method®, treating the muscular fasciae at distance from the painful region. Materials and Methods: Twenty patients with acute and chronic sacroiliac joint dysfunction (SIJD) were recruited (16 males and 4 females, mean age of 46.6 ± 12.98 years). Patients underwent a predefined assessment protocol, followed by an evaluation of myofascial pain and subsequent manipulation of the fascia at points at least 20 cm away from the posterior inferior iliac spines (PIIS). Each patient underwent three pain evaluations: pre-treatment (t0), post-treatment (t1), and at a 1-month follow-up (t2). For the evaluation in t0, t1 the numerical rating scale (NRS) for the intensity of pain and the algometer for the pain threshold at the PIIS were used; in t2 only the NRS scale. Results: The results obtained by comparing the algometer measurements with the NRS values between t0 and t1 were in both cases statistically significant (p < 0.0001), whereas the comparison between the NRS values at t1 and at t2 was not statistically significant (p > 0.05). Conclusions: A single Fascial Manipulation treatment, even when applied at least 20 cm from the PIIS, can potentially decrease pain around the SIJ. The inclusion of this type of approach in SIJD can allow for improved patient management, better tolerance for other treatments and a more rapid application of pain-free exercise programs.

The influence of fascial manipulation on function, ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability

BackgroundProprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear. ObjectiveThis study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI. DesignSingle group, pretest-posttest design. MethodsIndividuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance). ResultsThere was a significant improvement in the FADI scores (Z = −3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp 2 = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM. ConclusionSince fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.

Effects of Fascial Manipulation on patients with refractory painful external tibia

Effects of Fascial Manipulation on patients with refractory painful external tibia

Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain.

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.

Effect of Fascial Manipulation on Glenohumeral Internal Rotation Deficit in Overhead Athletes - A Randomized Controlled Trial

Background. Glenohumeral Internal Rotation Deficit (GIRD) is common among overhead athletes and is considered as one of the risk factors for upper extremity injuries.GIRD is usually managed by stretching and soft tissue release of the posterior shoulder capsule. Fascial manipulation is a manual therapy technique used in the management of musculoskeletal disorders. This study compared the efficacy of fascial manipulation (FM)with posterior capsular ball release and stretching on GIRD.Purpose. The purpose of this study is to determine the effect of Fascial Manipulation (FM) on the Internal Rotation Range of Motion (IRROM) in athletes with GIRD. Since studies have shown a possible association between GIRD and shoulder injuries, improving the IRROM in athletes with GIRD may help in reducing the risk of shoulder injuries. Thus,FM may be used as an effective strategy in increasing IRROM in overhead athletes with GIRD, thus preventing upper extremity injuries.Study Design. Randomized controlled trial.Methods. Asymptomatic overhead athletes with GIRD more than 20° when compared with the non-dominant shoulder were randomly assigned to two groups. The experimental group has received three sessions of FM treatment in two weeks. FM applied to densified Centre of Coordination (CC) points located on the myofascial sequences for 5 to 8 minutes at each CC point. The control group has received three sessions of posterior shoulder capsule release using a tennis ball under supervision. Along with the ball release, the therapist taught home-based, unsupervised sleeper, and cross-body adduction stretches, for the control group. A universal goniometer was used to measure the IRROM before and after all three treatment sessions in both groups. Results. There were no statistically significant differences between the control and experimental groups (p< 0.05). However, immediate improvement in the IRROM following FM was more substantial in the experimental group following each session.Conclusions. This study indicates that FM may be used as an adjunct to stretching in asymptomatic participants with GIRD to increase the IRROM. There is a scope for future studies to be done to investigate the effect of FM on symptomatic overhead athletes with GIRD

Effectiveness of Fascial Manipulation Method (FM®)

BackgroundFascial Manipulation® (FM®) is a manual method of treatment created by Luigi Stecco that centres on the muscular fascia. Fascia is a fibrous collagenous tissue which, with its wide strands, connects all the connective tissues in the body into a whole. Fascia can also cause restriction of motion of the organs as a result of an injury, inflammation or infection. FM® technique bases on identification and therapy of specific points, which are located at the point of convergence of the vectorial forces of the muscles involved in every movement. The aim of this literature review was to analyze publications on the use of FM® in treatment of pain and functional dysfunctions.Materials and methodsMaterial for this literature review was found by two independent authors using PubMed, Cochrane library, ScienceDirect and PEDro databases. In order to identify appropriate studies, a combination of keywords ,,fascial manipulation”, „pain”, „dysfunction” was used. Finally, 10 publications were qualified for a literature review.ResultsIn the analyzed ten publications, improvement after treatment, reduction of pain and better functional outcome in patients conditions were figured. Six authors had some similar conclusions which state that the positive results of treatment last over time. One study presented opposite findings and state that the treatment has not brought long-lasting effects. ConclusionsConsidering all the reports on this subject, it is suggested that FM® therapy is worth considering in treatment of pain disorders, orthopaedic dysfunctions and postural disabilities. Further research of the subject on whether the treatment results are sustainable is necessary.

Effect of fascial Manipulation® on reaction time

IntroductionThis study aimed to investigate the effects of fascial manipulation (FM) on muscle force and electrical activity. MethodsSixty healthy adult participants were randomly assigned to the FM intervention group (FM group; n = 20), static stretching intervention group (SS group; n = 20), and control group (C group; n = 20). The FM group underwent FM for the right brachial fascia (antecubitus) for 210 s. The SS group underwent static stretching of the right biceps brachii for 210 s. The C group was supine for 210 s. Participants were asked to flex the right elbow joint as quickly as possible after a light signal appeared during three sessions (before, immediately after, and 1 week after the intervention). During each session, the muscle activity of the right biceps brachii and bending force of the right elbow joint were measured. We calculated the reaction time (RT), pre-motor time (PMT), motor time (MT), time to peak force (TPF), and time to peak activity (TPA) from these measurements. ResultsThe RT, MT, TPA, and TPF of the FM group were significantly shorter immediately after or 1 week after the intervention compared with those before the intervention. The RT, MT, TPA, and TPF of the FM group were significantly shorter than those of the SS group or C group immediately after or 1 week after the intervention. ConclusionFM improved RT, MT, TPA, and TPA, and the effects lasted for 1 week. Both mechanical and neurological factors may contribute to improvements in motor performance after FM.

Progressive rehabilitation of the sprained ankle: A novel treatment method

ObjectivesThis randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma. MethodsMeasurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I–III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data. ResultsAfter one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p<0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion. ConclusionEarly fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs.

T1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation® in Subjects with Elbow Pain.

Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.

Manual Physiotherapy of Fascia - Introduction to Myofascial Release and Fascial Manipulation.

Abstract Fascia is formed from a superficial fascia, a deep fascia, a perimysium fascia, a perimysium fascia, a endomysium fascia. There are 6 Center of Coordination (CC) on a perimysium fascia. There are 8 Center of fusion (CF) on a deep fascia. When these abnormalities occur, fascia densification, substrate gelation, and hyaluronic acid aggregation occur. Fascial dysfunction spreads over a wide range through the deep fascia, and the past history often becomes a problem. Treatments for this fascial dysfunction include Muscle Pain Relief, Myofascial Release, and Facial Manipulation. This time, I will explain about Myofascial Release and Fascial Manipulation with case examples.

Inter and Intra Operator Reliability of Motor and Palpation Evaluation in Fascial Manipulation in individuals with coxarthrosis

ABSTRACT Objective An inter and intra rater reliability (INTERR and INTRAR) study was designed. Methods 71 subjects, with primary hip coxarthrosis, were included and randomly divided in a study group (SG= 36) and a control group (CG= 35) to assess the efficacy of the Fascial Manipulation® (FM®) method. The primary objective was the assessment of INTERR and INTRAR about movement verification (MV) and palpation verification (PV) of FM® performed by two physiotherapists (PtA and PtB). The secondary objective was evaluate the efficacy of FM® through MV, PV and pain score. Pain was assessed using the Numeric Rating Scale (NRS). SG received three weekly sessions of FM® byPtA. PtB re-evaluated all the subjects at the end of the study. Results Results of the INTERR analysis showed for SG: MV (ICC= 0.92, k= 72.7%); PV (ICC= 0.91, k= 75.7%). For CG : MV (ICC= 0.95, k= 84.2%); PV (ICC= 0.90, k= 75%). Results of the INTRAR analysis for SG reported: MV (ICC= 0.82, k= 74,8%); PV (ICC= 0.60, k= 46.8%); for CG: MV (ICC= 0.93, k= 78.7%); PV (ICC= 0.84, k= 53.3%). Statistical significance were reported in NRS (p = 0.001), MV (p = 0.0003) and PV (p < 0.0001) with better results for SG using “Intention To Treat” method. Discussion This study demonstrates that FM® assessment procedures have a high reliability even if applied by practitioners with basic experience. Furthermore FM® treatment can improve pain and ROM in individuals with primary coxarthrosis

Systematic review of treatment methods for the carpal tunnel syndrome

Abstract The carpal tunnel syndrome is a common condition, localized at the hand and knuckle level, caused by a compression of the median nerve as it travels the rigid structures of the carpal tunnel. This phenomenon is, essentially, a compressive neuropathy. Aim: The purpose of our research is to comparatively analyze the treatment methods of the carpal tunnel syndrome: treatment by acupuncture, fascial manipulation, low-level laser therapy, cupping treatment, kinesiotaping, surgical treatment, orthosis method, nerve and tendon gliding exercises, and ultrasound therapy, based on the review of specialized articles relevant for the last 10 years. Methods: The research method consisted of 3 steps. First, we analyzed and selected 160 specialized articles, based on titles and key words; in the second step, we analyzed the summaries of the articles, thus, reducing the number to 50 articles. The third step consisted of selecting 7 relevant articles based on an article content review. Results: The results of treatment comparisons have proved that non-invasive therapies are superior to surgical treatments, taking into consideration symptom improvement, the maximum period up to noticeable results, relapse situations, patients’ preferences, etc. Conclusions: The results of manual, traditional and non-invasive therapies are similar to those of surgical treatments, and even better in a very large number of cases.

Observation using thermography of post-operative reaction after fascial manipulation®.

Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points - coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body's temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. The average surface temperature of the treated area before mobilization was 33.4°C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p<0.001). However, the highest temperature was observed 24 hours after mobilization (increase of 2.4°C). The difference between the first and 7 other measurements was statistically relevant (p<0.001). The statistically relevant increase in temperature under the influence of fascial manipulation® in the treatment area can confirm the occurrence of inflammatory reaction.

Sport injury prevention in individuals with chronic ankle instability: Fascial Manipulation® versus control group: A randomized controlled trial

Chronic ankle instability (CAI) is one of the most common syndromes that occurs following an initial ankle sprain. Sprains are often correlated with recurrent sprains, loss of range of motion (ROM) and deficits in proprioception and postural control. The objectives were to evaluate the effectiveness of Fascial Manipulation® (FM) as a preventative measure in semi-professional athletes with CAI, and to monitor the symptomatology, equilibrium and ROM of the injured ankle.A single-blinded randomized controlled trial was conducted in the rehabilitation department of a medical centre. Twenty-nine semi-professional male footballers were recruited. Nine subjects with no previous symptomatology, were assigned to a baseline group, twenty symptomatic subjects were randomized into either the study or the control group. All three groups followed a specific training program. The control group followed normal training protocols and received standard medical care. The study group received an additional three FM treatment sessions.Symptomatology and ROM outcomes were recorded for all players at baseline, before each treatment for the treatment group, and at 1-, 3-, and 6-month follow-ups. At one year, an additional follow-up on was performed via phone.Four severe ankle traumas and one mild ankle trauma were reported in the control group during the trial period. The 6-month outcomes in the study group showed statistically significant improvements. The 1-year follow-up reported the absence of any reported trauma in the study group.FM was effective in improving ROM and symptomatology in footballers with CAI. FM intervention was effective in preventing injury in the study sample.

Investigation of fascial treatment effectiveness on pain, flexibility, functional level, and kinesiophobia in patients with chronic low back pain

IntroductionFascial manipulations have received attention in the treatment of chronic low back pain (CLBP). The purpose of this study is to investigate the effectiveness of fascial manipulation on pain, flexibility, functional level, and kinesiophobia in patients with CLBP.MethodsOverall, 55 individuals with a history of CLBP, without neurological deficits, lumbar disc herniation, lumbarization, spondylosis, or lumbar surgical history were included in the study. The participants were randomly divided into 2 groups depending on the patient protocol numbers. Subjects with odd protocol numbers were assigned to the study group (fascial manipulation) and those with even numbers to the control group (conventional physiotherapy). Both groups were assessed before and after the treatment in terms of pain, flexibility, functional level, and kinesiophobia.ResultsThere were significant differences after both treatment methods in terms of pain, functional level, and flexibility (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). However, pain levels decreased more statistically significantly in the fascial manipulation group than in the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). No significant difference was observed between the groups in terms of functional level, flexibility, or kinesiophobia after the treatment (&lt;i&gt;p&lt;/i&gt; &gt; 0.05).ConclusionsWe stated that fascial manipulation was more effective on pain than conventional physiotherapy methods (hot pack, microwave diathermy, interferential flow-vacuum applications, posterior pelvic tilt and abdominal exercises, stretching hip flexors and lumbar extensors) in patients with CLBP.

Fascial manipulation vs. standard physical therapy practice for low back pain diagnoses: A pragmatic study

BackgroundConnective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation® (FM®) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge. ObjectivesTo assess the effects of FM® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP). DesignSix-months controlled clinical trial. Method102 participants with LBP received SPT or FM®. Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress. ResultsThe FM® group had a significantly lower ODI (p < 0.009) and NPS scores (p < 0.0001) and significantly higher GROC scores (p < 0.003) once their means were adjusted for initial scores. When comparing the SPT to FM®, the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM® group (p = 0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM® group (p = 0.0001). The FM® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3 ± 2.2 to -1.5 ± 2.4, p=0.0001). ConclusionsFM® appears to improve NPRS, GROC, and ODI more than SPT. FM® may provide an effective treatment technique for LBP.

Does fascial manipulation and myofascial surgery reduce spasticity and improve function of upper limb in cerebral palsy?

Does fascial manipulation and myofascial surgery reduce spasticity and improve function of upper limb in cerebral palsy?

Efficacy of fascial manipulation and eccentric exercise for lateral elbow pain

Introduction: Lateral Elbow Pain (LEP) is a common painful condition affecting the working population, however, its aetiology and best treatments remain as yet unknown. Wrist extensor intratendinous modifications are commonly reported (Obuchowicz & Bonczar 2016), although changes in the innervation and vascularization of the fascial layers superficial to the tendon itself have been observed too (Spang & Alfredson 2017). Common treatment of LEP includes exercise therapy, targeting the wrist extensor’s tendinopathy (Cullinane et al 2014). Fascial Manipulation® (FM) is a manual method for the treatment of musculoskeletal painful conditions (Day et al 2009). Its purpose is to normalize restricted fascial gliding through deep friction over specific points of the deep fascia, thus restoring the physiological afference to the nervous system and the distribution of forces around the periarticular tissues. The objective of this research is to verify the efficacy of FM in addition to a program of eccentric exercise, compared with eccentric exercise only.

Fascial manipulation in the management of carpal tunnel syndrome

Fascial manipulation in the management of carpal tunnel syndrome

A case study of fascial manipulation method as a treatment for pain, atrophy, and skin depigmentation after pes anserine bursa corticosteroid injection

Introduction: Pain, atrophy, and skin depigmentation are known side effects of corticosteroid injection, which can result in dysfunction of the superficial and deep fascia. Increase of stiffness in the superficial fascia can generate an entrapment of the cutaneous nerves with consequential alteration of the fat and skin (Stecco et al 2016), while stiffness of the deep fascia can irritate the nociceptor and generate decrease of sliding with the underlying muscle (Stecco et al 2013). We describe a case study of Fascial Manipulation (FM) to the superficial and deep fascia, resulting in the resolution of soft tissue atrophy and skin depigmentation at the injection site as well as decreased pain after a steroid injection into the pes anserine bursa. A 23-year-old female presented with three years of left medial knee pain that started abruptly after a fall. The patient was treated with a pes anserine bursa injection of triamcinolone. Three months after the injection, the patient developed an indentation and discoloration on the medial aspect of the left knee. Fourteen months post-injection the patient began FM.