Fascial Tension Research Articles

Abdominal Wall Tension and Early Outcomes after Posterior Component Separation with Transversus Abdominis Release: Does a "Tension-Free" Closure Really Matter?

Ventral hernias result in fibrosis of the lateral abdominal wall muscles, increasing tension on fascial closure. Little is known about the effect of abdominal wall tension on outcomes after abdominal wall reconstruction. We aimed to identify an association between abdominal wall tension and early postoperative outcomes in patients who underwent posterior component separation (PCS) with transversus abdominis release (TAR). Using a proprietary, sterilizable tensiometer, the tension needed to bring the anterior fascial elements to the midline of the abdominal wall during PCS with TAR was recorded. Tensiometer measurements, in pounds (lb), were calibrated by accounting for the acceleration of Earth's gravity. Baseline fascial tension, change in fascial tension, and fascial tension at closure were evaluated with respect to 30-day outcomes, including wound morbidity, hospital readmission, reoperation, ileus, bleeding, and pulmonary complications. A total of 100 patients underwent bilateral abdominal wall tensiometry, for a total of 200 measurements (left and right side for each patient). Mean baseline anterior fascial tension was 6.78 lb (SD 4.55) on each side. At abdominal closure, the mean anterior fascial tension was 3.12 (SD 3.21) lb on each side. Baseline fascial tension and fascial tension after PCS with TAR at abdominal closure were not associated with surgical site infection, surgical site occurrence, readmission, ileus, and bleeding requiring transfusion. The event rates for all other complications were too infrequent for statistical analysis. Baseline and residual fascial tension of the anterior abdominal wall do not correlate with early postoperative morbidity in patients undergoing PCS with TAR. Further work is needed to determine if abdominal wall tension in this context is associated with long-term outcomes, such as hernia recurrence.

Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release

Posterior components separation (PCS) is a commonly used myofascial release technique in ventral hernia repairs. The contribution of each release with anterior and posterior fascial advancement has not yet been characterized in patients with ventral hernias. To quantitatively assess the changes in tension on the anterior and posterior fascial elements of the abdominal wall during PCS to inform surgeons regarding the technical contribution of each step with those changes, which may help to guide intraoperative decision-making. This case series enrolled patients from December 2, 2021, to August 2, 2022, and was conducted at the Cleveland Clinic Center for Abdominal Core Health. The participants included adult patients with European Hernia Society classification M1 to M5 ventral hernias undergoing abdominal wall reconstruction with PCS. A proprietary, sterilizable tensiometer measured the force needed to bring the fascial edge of the abdominal wall to the midline after each step of a PCS (retrorectus dissection, division of the posterior lamella of the internal oblique aponeurosis, and transversus abdominis muscle release [TAR]). The primary study outcome was the percentage change in tension on the anterior and posterior fascia associated with each step of PCS with TAR. The study included 100 patients (median [IQR] age, 60 [54-68] years; 52 [52%] male). The median (IQR) hernia width was 13.0 (10.0-15.2) cm. After complete PCS, the mean (SD) percentage changes in tension on the anterior and posterior fascia were -53.27% (0.53%) and -98.47% (0.08%), respectively. Of the total change in anterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -82.56% (0.68%), incision of the posterior lamella of the internal oblique with a change of -17.67% (0.41%), and TAR with no change. Of the total change in posterior fascial tension, retrorectus dissection was associated with a mean (SD) percentage change of -3.04% (2.42%), incision of the posterior lamella of the internal oblique with a change of -58.78% (0.39%), and TAR with a change of -38.17% (0.39%). In this case series, retrorectus dissection but not TAR was associated with reduced tension on the anterior fascia, suggesting that it should be performed if anterior fascial advancement is needed. Dividing the posterior lamella of the internal oblique aponeurosis and TAR was associated with reduced tension on the posterior fascia, suggesting that it should be performed for posterior fascial advancement.

Will Quantifying Fascial Tension Change the Practice of Component Separations in Complex Abdominal Wall Reconstruction?

Will Quantifying Fascial Tension Change the Practice of Component Separations in Complex Abdominal Wall Reconstruction?

Effects of Fascial Manipulative Treatment on Bone Tissue

The experimental research, presented in this study, focuses on athletic tests with the purpose to highlight the elastic deformations of the bones of the lower limbs, intending to verify whether the manually treated anatomical structure increases in elasticity, becoming able to accumulate more energy in the loading phase, to then release it in the final phase of the thrust. Introduction: Too often neglected, the bone tissue is capable of deforming. The deformation has a key role in the cushioning and dissipation of stress, a function that is hindered in the event of fascial tension, which will consequently fall on other structures used for the same purpose (Discs, menisci, cartilage, …). Structures that, in the event of increased mechanical stress, could undergo degeneration, inflammation, and injury. Materials and Method: Randomized double-blind selection of 38 people, 18 in the treatment group and 20 in the control group, men and women, aged between 16 and 35, who have been part, for at least one year, of a sports club, with a large space dedicated to jumping in its training program, have been divided into two groups: the treatment group, which was treated to increase the performance of the jump and the control group subjected to mild manual pressures, without any intention. Results: The treatment group had an increase in Standing Long Jump (SLJ) for 3.67% (p < 0.001) while the control group had a decrease in performance for 1.12% (p < 0.001). Conclusions: This study has shown that an osteopathic manipulative treatment, aimed at increasing jumping performance, can increase the performance of the SLJ.

Myofascial Release on Pain and Function in Adults with Low Back Pain: A systematic review

Poor posture in sitting and standing exerts stress on the spine muscle leading to non-specific low back pain (LBP). Myofascial release (MFR) on the back and leg muscles may reduce fascial tension in an individual with LBP is unclear. This review describes the effects of MFR on flexibility, pain, disability, and stress level among non-specific LBP individuals. The findings showed that the direct or indirect apply MFR on the back or lower limbs improve flexibility, pain, and disability. However, insufficient information on stress levels. The MFR therapy is recommended to enhance low back pain rehabilitation.

Minimally Invasive Tensiometry: A New Modality for Per-Operative Measurement of Medialization and Tension During Laparoscopic Hernia Surgery.

Background: Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction required to approximate these edges. This study presents minimally invasive tensiometry (MINT), a novel technology for measuring fascial tension, as well as initial experiences and results using it. Methods: The MINT device was designed using rapid prototyping principles. It was designed as an add-on tool for any existing laparoscopic instrument, enabling objective assessment of abdominal wall tension by the use of a manually operated linear spring. Pre-clinical measurements of medialization at 10 and 20N of tension during AWR were performed on fresh-frozen Post-Mortem Human Specimens (PMHS). Results: Three specimens were included, and a total number of 36 measurements of medialization at three different levels of the abdominal wall were performed under structured and similar circumstances. Median total medialization with 20 Newton (N) of applied tension was 25 mm (mm) cranially, 37.5mm at the umbilicus and 27.5mm at the caudal level. The highest rate of medialization was seen at the umbilical level (2.25mm/N). Conclusion: MINT is a novel non-invasive technique, which allows surgeons to intraoperatively measure fascial tension when performing AWR. The MINT device is easy to use and reproduce. The next step is to start performing clinical measurements applying MINT during AWR.

Intra-abdominal Pressure Monitoring During Negative Pressure Wound Therapy in the Open Abdomen

IntroductionNegative pressure wound therapy (NPWT) is commonly used in open abdomen management, where there may be a simultaneous need for prevention of abdominal hypertension, tamponade of hemorrhage, and continuous fascial tension. The regional pressure dynamics of vacuum dressings are poorly understood. MethodsThree duroc swine underwent mid-line laparotomy and application of vacuum open abdomen dressing, with and without sponge packing. Twenty-five catheters were placed throughout the abdomen to capture and record pressures in each quadrant as the vacuum system was ranged between (−75 mmHg to −200 mmHg pressure). Vital signs and ventilator pressures were measured and recorded concomitantly. ResultsNo variations in ventilatory pressures or vital signs were observed with any setting. NPWT changed pressure in seven of seventy-five catheters (9%), five of which were related to abdominal packing. When data were grouped into abdominal wall, perihepatic, perisplenic, and deep abdominal regions, there was no significant change in abdominal pressure when packing was absent. With packing, only the abdominal wall region showed a pressure change, reaching a maximum of 20% of the set vacuum pressure. ConclusionsNPWT does only little to change the intraabdominal pressure, except in superficial locations in packed abdomens and does not appear to cause hemodynamic changes in a porcine open abdomen model. While NPWT may play an important role in fluid scavenging and fascial tensioning, there are likely to be few benefits or drawbacks specifically related to negative abdominal pressure in the deep abdomen.

Efficacy of myofascial therapy and kinesitherapy in improving function in shoulder pathology with prolonged immobilization: A randomized, single-blind, controlled trial

BackgroundThe best physiotherapeutic approach in shoulder pathology that generates prolonged immobilization is still uncertain. Kinesitherapy remains the most widely used option. Myofascial therapy is a therapeutic approach in which the aim is to release fascial tension and regain mobility although its efficacy in shoulder pathology has not been sufficiently studied. This Prospective, single-blind randomized controlled trial in a university hospital setting aimed to compare the efficacy of myofascial therapy and kinesitherapy in improving function in shoulder pathology with prolonged immobilization. MethodsPatients were randomly assigned to a control group or to the intervention group.Both groups completed a therapeutic exercise program. Main Outcome Measures: The QuickDash questionnaire was the primary outcome, Pain Visual Analog Scale and the Range Of Motion of the shoulder were the secondary outcomes. The outcomes were evaluated at baseline (T0), at 4 (T2), 8 (T2), and 12 weeks (T3) Results44 participants were included. In the analysis of evolution over time, a significant improvement in functionality and range of motion measurements was observed in both groups (p < 0.05), although at 12 weeks only Myofasical Group achieved a clinically and statistically significant reduction in pain. Comparative analysis at 12 weeks revealed no statistically significant differences between the two therapies in the variables explored. ConclusionsBoth, myofascial therapy and kinesitherapy can improve function, mobility, and pain in patients with painful shoulder associated with prolonged immobilization, with no significant differences between therapies, although in the medium term only myofascial therapy achieves a clinically and statistically significant improvement in pain. Trial registrationTrial registration: ClinicalTrials.gov NCT04944446.

Update on surgical management of enteroatmospheric fistulae in intestinal failure patients.

The surgical management of enteroatmospheric fistula (EAF) in patients with intestinal failure represents a major challenge for a surgical team and requires proficiency in sepsis management, nutritional support and prehabilitation, beside expertise in visceral and abdominal wall surgery. This review provides an update on the current recommendations and evidence. Reconstructive surgery should be performed at a minimum of 6-12 months after last laparotomy. Isolation techniques and new occlusion devices may accelerate spontaneous EAF closure in selected cases. Chyme reinfusion supports enteral and parenteral nutrition. Stapler anastomosis and failure to close the fascia increase the risk of EAF recurrence. Posterior component separation, intraoperative fascial tension and biological meshes may be used to accommodate fascial closure. Timing of reconstructive surgery and previous optimal conservative treatment is vital for favorable outcomes. Wound conditions, nutritional support and general patient status should be optimal before attempting a definitive fistula takedown. Single stage procedures with autologous gut reconstruction and abdominal wall reconstruction can be complex but well tolerated.

Healthcare and Sports from the Perspective of Qi, Fascia, and Taijiquan

The slow-motion practice of Taijiquan, operationally, cultivates the cognitive perception of fascia tension as it is being harnessed to discipline body motion to be in accord with Yin-Yang Balance. The ideal motion that results, bestows liveliness of change and harmonizes body momentum,the hallmarks of maneuverability and force potential for performance. The paper puts forth the proposition that the manifestation of Qi in Taijiquan is primarily the cognitive perception of fascial tension in the functional efficacy of bipedal balance for performance. Though the cultivated cognition may be subjective, the process of Qi nurturing is grounded on the reduction of the errors of imbalances, which carves a practice path to balance with tangible effects. The force that arises from body motion so imbued with Yin-Yang Balance, is of the phenomenon of internal strength or neijin—consummate, of the right force vector in spontaneous response and rooted in balance. Taijiquan practice nurtures Qi for both health wellbeing and neijin as the body's core strength, depending on the practice efforts put in.

75 Years of Excellence: The Story of Reconstructive Surgery

75 Years of Excellence: The Story of Reconstructive Surgery

Body Balance after Fascial Therapy in Athletes with Soft Lower Limb Muscle Injuries

Background: Most injuries in competitive sports are due to overstrain and excessive muscular and fascial tension. This study aimed to assess the effects of a single session of fascial therapy on balance and lower limb weight-bearing in professional athletes following a lower limb soft-tissue injury. Methods: A pedobarographic platform was used to assess the weight-bearing on both lower limbs and corporal balance. A total of 41 athletes with an acute soft-tissue injury involving the quadriceps femoris muscle were included in the study. Each patient underwent myofascial therapy in the injured limb only. The therapy was intended to release tension and improve proprioception. Results: The injured and healthy limbs showed significant asymmetry in body weight distribution. Before treatment, the patients bore less weight on the injured limb than on the healthy limb. After fascial therapy, eyes-closed tests showed an improved weight distribution symmetry between the two lower limbs. There were no significant differences in the values of the evaluated balance parameters between those measured at baseline and those measured after the therapy, measured after the rehabilitation session. Conclusions: A single fascial therapy session has a beneficial effect on corporal balance in runners with an injured lower limb.

16 Preliminary investigation into the effects of McTimoney chiropractic treatment and combined with pulsed electromagnetic field therapy on mechanical nociceptive thresholds of horses

McTimoney chiropractic treatment(MCT), a high velocity low amplitude spinal manipulation therapy, produces profound but transient attenuation of motor neurone activity. Pulsed electromagnetic field therapy(PEMF) has perceived pain-relieving effects and improves the reduction in muscle and fascial tension. Both are used in therapeutic protocols. The study objectively assessed the influence of MCT and PEMF therapy on mechanical nociceptive thresholds(MNTs) at 3 specific muscular junction trigger points(TPs) of the thoracolumbar musculature. MNTs are a measure of sensitivity to musculoskeletal tenderness. A controlled randomized study using 12 sound cob-type horses from the same yard and training schedule randomly assigned into 3 groups of n = 4. Control group, no intervention; 2 treatment groups:(A) MCT only (10min assessment, 10min treatment by a qualified McTimoney animal practitioner) and (B) combined (MCT plus Biomag 2TM PEMF mat(200hz) placed cranial to T18, 5min per side). Stood square, triplicate MNTs were measured using pressure algometry on both sides at 3 muscle TPs[TP 45(junction of spinalis, longissimus thoracis and trapezius thoracis); 47 (longissimus thoracis et lumborum); and 62 (gluteus medius)] at 4 time points 0(pre-treatment), 30(post MCT), 60(post PEMF), 150min.Statistical tests: Shapiro-Wilk test, paired T- test compared left/right MNTs, ANOVA analyzed group data for each TP over time with Bonferroni post hoc analysis. There was no difference (P > 0.05) between left and right MNTs for all measurement sites. There was no changes in MNTs over time at all TPs for control group(P > 0.05). There was a significant increase in mean MNTs pre-treatment to 150min for both treatment groups (A:P = 0.03, B:P = 0.01). Significant changes in MNTs at each muscle TP shown in Table 1. This study provides positive evidence that chiropractic and when combined with PEMF treatment show a significant reduction in sensitivity to musculoskeletal tenderness (increased MNTs) over the time period compared with no treatment. Different muscle groups behave differently. Further research is required on difference in muscle tonicity effects and over a longer period.

“EFFECT OF MYOFASCIAL RELEASE ON SPASTIC MUSCLES AND FUNCTIONAL OUTCOME IN CHRONIC STROKE SUBJECT”- A RANDOMIZED CONTROL TRIAL

Background: Stroke is damage to the brain from interruption of blood supply causing altered sensations, reduced muscle power and tone, reduced joint mobility and stability, balance, gait impairment leading to plegia or paresis. Hemiplegia causes paralysis of one side of the body leading to inactivity, impaired movements, posture and gait pattern. Spasticity is increase in tonic stretch reexes with exaggerated tendon jerks. Myofascial release is a manipulative treatment that helps reduce fascial tension. Purpose:The aim of study was to nd out the effectiveness of Myofascial Release on spasticity of hamstrings, calf, adductors and biceps muscles in spastic hemiplegic subject. Methodology:Atotal 30 participants of middle aged group were diagnosed with chronic spastic hemiplegia. They were divided in two groups by randomized sampling, of which 15 (controlled group) and 15 (experimental group) who were treated with MFR and conventional treatment. Pre and Post treatment measures of Modied Ashworth Scale, Modied Tardieu Scale, Functional Independence Measure and Berg Balance Scale were evaluated. MFR was given to hamstrings, calf, adductors and biceps muscles for 5 days a week for 12 weeks. Result: MFR and conventional physiotherapy treatment had an excellent effect on the experimental group as compared to the controlled group. Conclusion: The current study concludes that MFR along with conventional treatment has signicant effect in reducing spasticity and improving the functional activities

Quantifying fascial tension in ventral hernia repair and component separation.

Excessive fascial tension is a major cause of ventral hernia recurrence. Although hernias are commonly characterized by area, the tension experienced by fascia is directly proportional to the surrounding tissue stiffness. We demonstrate an accurate and simple technique for intra-operative measurement of fascial closing tension and quantify the decrease in tension following Component Separation (CS). A tensiometer was created using a spring with a known recoil constant (k) and a surgical clamp. Using Hooke's law (Force = kX; X = spring displacement), fascial tension was calculated. This method was first validated on a bench-top model and then applied to the anterior fascia of 4 fresh cadavers (8 hemi-abdomens) over a range of simulated hernia defect sizes. When fascia could no longer reach midline, CS was performed and measures repeated. Tissue stiffness was calculated by plotting defect size versus resulting tension. Fascial defects ranged from 1- to 18-cm wide with average midline closing tension prior to release 36.1N (range 17-48) and 8.2N (range 5-11) after CS, a mean 76% decrease (range 70%-85%). Mean R2 values between defect size and tension for the synthetic and cadaver models were 0.99 (p < 0.01) and 0.91 (p = 0.01; all hemi-abdomen measurements significant). Inter-rater Pearson's correlation consistently found R2 values > 0.95 (p < 0.01) for each hemi-abdomen, showing high precision and reproducibility. We have applied a cheap, simple, and precise method to sterilely assess fascial tension during herniorrhaphy and also quantified the decrease in tension following component separation. This technique may be rapidly translated into the operating room with minimal equipment to provide objective data critical for intraoperative decision-making.

Simple and Reliable Method for Intraoperative Measurement of Fascial Tension: Implications for Complex Hernia Repair

Bernstein, Jaime L.; Levy, Adam S. MD; Celie, Karel-Bart; Spector, Jason A. MD, FACS Author Information

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Weighted abdominal traction for assistance in abdominal closure

Abstract Introduction Loss of abdominal domain is an unsolved problem in many complex abdominal procedures. We report three patients who underwent weighted traction and use of retention sutures to prevent fascial retraction. Cases Our first patient had esophageal metaplasia and a recalcitrant esophageal stricture after having esophageal atresia repair as an infant. Due to vascular congestion of his new conduit, his abdomen was left open. Respiratory compromise was noted on attempted closure, so the patient's abdominal fascia was placed on 20 pounds of traction to prevent fascial retraction. His abdomen was able to be closed after 7 days. Our second patient had a caustic ingestion and underwent a jejunal interposition. Due to the length of the procedure, the abdomen was left open. The fascia was sutured to a silastic silo and placed on 30 pounds of traction. After 8 days, the patient's abdomen was able to be closed primarily. Our third patient presented with persistent aspiration after esophageal atresia repair. Due to concern for her jejunal conduit, her abdomen was left open and placed on weighted traction. Once the abdomen was suitable for closure, an abdominal vac was placed, and continuous fascial tension was applied using #5 Ethibond sutures. Her abdomen was fully closed 10 days later. Discussion One of the concerns with temporary abdominal closure is retraction of the fascia. We report three cases where the fascia and abdominal wall were placed on weighted traction, which allowed for retention of abdominal domain and delayed primary closure without grafts or mesh. This approach adds to the options available to aid in closure of the complex abdomen.

요추부 안정화를 위한 흉요근막의 역할 분석

Spinal stability is controlled by two interrelated systems: the spinal column including ligaments and the muscular control system. In addition to these systems, the thoracolumbar fascia (TLF) also interacts with the muscular system to maintain the stability of the spine. The effects of the tensioning of TLF on the spinal stability was investigated using computational analysis. The stability of the spine was analyzed with a three-dimensional finite element model of musculoskeletal system including TLF. The paraspinal muscle activities were calculated based on a hypothesis: the intervertebral disc was assumed to have a transducer function and the muscle is activated according to a sensor driven control mechanism to maintain stability of the lumbar spine. Muscle forces were calculated in examining 40o isometric forward flexed and erect standing postures. As a result, the fascial tension induced a decrease in superficial muscle activity while maintaining the spinal stability.

Effect of lumbar fasciae on the stability of the lower lumbar spine

The biomechanical effect of tensioning the lumbar fasciae (LF) on the stability of the spine during sagittal plane motion was analysed using a validated finite element model of the normal lumbosacral spine (L4-S1). To apply the tension in the LF along the direction of the fibres, a local coordinate was allocated using dummy rigid beam elements that originated from the spinous process. Up to 10 Nm of flexion and 7.5 Nm of extension moment was applied with and without 20 N of lateral tension in the LF. A follower load of 400 N was additionally applied along the curvature of the spine. To identify how the magnitude of LF tension related to the stability of the spine, the tensioning on the fasciae was increased up to 40 N with an interval of 10 N under 7.5 Nm of flexion/extension moment. A fascial tension of 20 N produced a 59% decrease in angular motion at 2.5 Nm of flexion moment while there was a 12.3% decrease at 10 Nm in the L5-S1 segment. Its decrement was 53 and 9.6% at 2.5 Nm and 10 Nm, respectively, in the L4-L5 segment. Anterior translation was reduced by 12.1 and 39.0% at the L4-L5 and L5-S1 segments under 10 Nm of flexion moment, respectively. The flexion stiffness shows an almost linear increment with the increase in fascial tension. The results of this study showed that the effect of the LF on the stability of the spine is significant.