Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over decades, however these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting low back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies were: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in low back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Greater knowledge of fascial neurological components could impact LBP treatment.

Despite more than hundred years of research since Sir Sherrington’s studies on reflexes, his questions are still somehow unanswered. On what anatomical stage do the play of spinal reflex interaction take place? What are the physiological properties of this anatomical substrate? In this paper, we address these questions in light of the most advanced theory of motor control and the anatomical discoveries on the fascia that are changing how we think about control of action and perception. There are two sides of the problem: the neurological (reflex) connections that are at the base of movement, and the anatomical substrate that regulates and coordinates the movement. We recently advanced a hypothesis on how these two elements are connected and how they interplay. Here we further explain the concept of the somatic equilibrium point – SEP – and its central role in movement control and coordination. It is our belief that the concept of SEP explains how the neuro-mechanical control of movement is organized at peripheral level. At this level, intrafusal and extrafusal muscle fibres are combined in myofascial units, organized in anatomical directions. Myofascial units are closed systems whose behaviour can be affected by neural (voluntary) control or changes in external forces. SEPs represent the intrinsic equilibrium of the myofascial units, and are connected through the continuum of the fascia so that mechanical transfer of tension from segment to segment pre-adjust muscle fibers length and hence their excitation level. This is how coordination between segments is achieved. Finally, we suggest SEPs create the neurological representation of the referent configuration for action, and configurations are linked to the architecture of the fascial system.

(1) Background: Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study aimed to investigate whether a single session of a specific technique reduces pain and disability. (2) Methods: This was a crossover clinical trial in which 41 participants over 18 years old with CLBP were randomly enrolled into 3 situations - experimental, placebo, control, in a balanced and cross-over manner. The subjects underwent a single session of myofascial release on thoracolumbar fascia and compare it with the control and placebo. Outcome were pain and functionality, evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT) and Oswestry (ODI). (3) Results: There was no effects between-, within-tests, and interaction for all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η 2 = 0.02, F = 0.02, p = 0.97). (4) Conclusion: A single trial of thoracolumbar myofascial release technique was not enough to reduce pain and disability in subjects with CLBP.

Background: The fascial system provides an environment that enables all body systems to operate in an integrated manner and is capable of modifying its tensional state in response to the stress applied to it. Recent in vitro, animal and cadaveric studies have shown that “myofascial force transfer” (MFT) has the potential to play a major role in musculoskeletal function and dysfunction.Objective: Human evidence for the existence of invivo MFT is scarce. This scoping review attempts to gather and analyse the available evidence of the in-vivo human MFT studies in order to sustain and facilitate further research and evidence based practice in this field.Methods: A search of most major databases was conducted with relevant keywords that yielded 238 articles as of August 2020. A qualitative analysis of the studies was conducted after rating it with Oxford’s Center for Evidence –based Medicine (CEBM) scale.Result: Nineteen studies ranging from randomized controlled trials to case studies covering 540 patients were included in this review. The analysed studies were highly heterogeneous and of lower methodological quality meddling with the quantitative analysis. Ten studies are confirming a ‘most likely’ existence of MFT, eight studies confirming it as ‘likely’ and one study couldn’t confirm any MFT existence in this review.Conclusion: Findings from in vivo human studies supports the animal and cadaveric studies claiming the existence of MFT which need to be corroborated by the future high quality studies. Forthcoming studies on MFT may give answers and solutions to many of the human musculoskeletal mysteries or dysfunctions.

Introduction: Musculoskeletal dysfunctions happen to be the most common reason for referral to physiotherapy and manual therapy services. Therapists may use several articular and/or soft tissue concepts/approaches to evaluate and treat such dysfunctions that may include integration of myofascial system. Despite the research in this area spanning more than three decades, the role played by fascia has not received its duly deserved attention, owing to the lack of definitive research evidence. The concept of ‘fascial connectivity’ evolved two decades ago from a simple anatomical hypothesis called ‘myofascial meridians’. Since then it has been widely researched, as conceptually it makes more sense for functional movements than ‘single-muscle’ theory. Researchers have been exploring its existence and role in musculoskeletal dysfunctions and clinicians continue to practice based on anecdotal evidence. This narrative review attempts to gather available evidence, in order to support and facilitate further research that can enhance evidence based practice in this field. Methods: A search of most major databases was conducted with relevant keywords that yielded 272 articles as of December 2019. Thirty five articles were included for final review with level of evidence ranging from 3b to 2a (as per Center of Evidence Based Medicine’s scoring). Results: Findings from cadaveric, animal and human studies supports the claim of fascial connectivity to neighboring structures in the course of specific muscle-fascia chains that may have significant clinical implications. Current research (level 2) supports the existence of certain myofascial connections and their potential role in the manifestation of musculoskeletal dysfunctions and their treatment. Conclusion: Although these reviews and trials yield positive evidence for the objective reality/existence of fascial connectivity and continuity, several aspects need further exploration and in-depth analysis, which could not be evidenced entirely in this review. Manual and physical therapists may utilize the concept of fascial connectivity as a convincing justification to deal with clinical problems, but need to remain vigilant that functional implications are still being investigated.

Cardiovascular diseases (CVDs) are the leading cause of death in the globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery, but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was approached with an osteopathic technique, working the pericardial area. To the knowledge of the Authors, it is the first case report where osteopathy is associated with a gentle treatment on the pericardial area to resolve a NNP.

Background: Recent work has investigated significant force transmission between the compo-nents of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause-effect pathology, a comprehensive neuro-musculoskeletal therapy such as the Rolf Meth-od of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retro-spectively screened from the medical records of an SI practice over a 23-year period. 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flex-ion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001), but were not affected by age. Conclusions: SI intervention produces multiple changes in the components of myofascial chains that could help maintain upright pos-ture in humans and reduce inadequate compensatory patterns. SI affects differently the outcome of some AROM parameters in women and men.

Background: Instrument-assisted soft tissue mobilization (IASTM) is thought to alter fluid dynamics in human soft tissue. The aim of this study was to investigate the influence of IASTM on the thoracolumbar fascia (TLF) on the water content of the lumbar myofascial tissue. Methods: 21 healthy volunteers were treated with IASTM. Before and after the procedure and 5 and 10 minutes later, lumbar bioimpedance was measured by bioimpedance analysis (BIA) and TLF stiffness by indentometry. Tissue temperature was recorded at the measurement time points using an infrared thermometer. Results: Bioimpedance increased significantly from 58.3 to 60.4 Ω (p < 0.001) at 10-minute follow-up after the treatment. Temperature increased significantly from 36.3 to 36.6° Celsius from 5 to 10 minutes after treatment (p = 0.029), while lumbar myofascial stiffness did not change significantly (p = 0.84). Conclusions: After the IASTM intervention, there was a significant increase in bioimpedance, likely due to a decrease in water content in myofascial lumbar tissue. Further studies in a randomized control trial design are needed to extrapolate the results in healthy subjects to a symptomatic population as well and to confirm the reliability of BIA in myofascial tissue.

Accumulating reports have suggested that an inability to clear dead cells is a cause of inflammation and cancer and that the fascia is associated with cancer metastasis. Novel corpuscle-connected filiform structures (CCFSs) entangled on the fascia of the internal organs of rats were selectively visualized with high repeatability (93%) under vital staining with Janus Green B (JGB). Serial sections of CCFSs stained with haematoxylin and eosin and with Mattson Trichrome were microscopically examined. In parallel, the immunohistochemistry with CD31, Lyve 1, scanning electron microscopy, and transmission electron microscopy (TEM) were also used to investigate the novel properties of the CCFSs. All of the CCFSs enclosed JGB-stained granules, which was verified by the impromptu coupling of stereo and light microscopes and fluorescence-activated cell sorting. The functions of the CCFSs were discovered under fluorescence microscopy and confocal laser scanning microscopy to be implicated in cell death: fragmented DNAs and f-actins with extracellular DNAs. The dead cells in the CCFSs were verified by using terminal deoxynucleotidyl transferase dUTP nick end labelling and TEM. Moreover, the CCFS had a relatively-high concentration of calcium, a main element for cell death in tissue, which was measured in 2-dimensionally images using time-of-flight secondary ion mass spectrometry. Taken these results, we report for the first time that novel reticular CCFSs are widely entangled on the fascia of the internal organs of rats with the implication for cell death.

Background: Spine shape parameters, such as leg length, kyphotic or lordotic angle, are influenced by low back pain. There is also evidence that the thoracolumbar fascia plays a role in such pa-thologies. This study examined the immediate effects of a myofascial release technique (MFR) on the thoracolumbar fascia and of an osteopathic treatment (OMT) on postural parameters in pa-tients with acute low back pain (aLBP). Methods: This study was a single-blind randomized pla-cebo-controlled trial. Seventy-one subjects (43.8 ± 10.5 years) suffering from aLBP were randomly and blinded assigned to three groups to be treated with MFR, OMT or a placebo intervention. Spinal shape parameters (functional leg length discrepancy (fLLD), kyphotic angle, lordotic an-gle) were measured before and after the intervention using video raster stereography. Results: Within the MFR group, fLLD reduced by 5.2 mm, p < 0.001 and kyphotic angle by 8.2 degrees, p < 0.001. Within the OMT group, fLLD reduced by 4.5 mm, p < 0.001 and kyphotic angle by 8.4 °, p = 0.007. Conclusion: MFR and OMT have an influence on fLLD and the kyphotic angle in aLBP patients. The interventions could have a regulating effect on the impaired neuromotor control of the lumbar muscles.

Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae muscle (ES) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). Granger causality (GC) showed a direct effect of TLF deformation on ES activation only in the aLBP group (p &lt; 0.03). Conclusions: The results suggest that in aLBP, ES activity is significantly affected by TLF, whereas this relation-ship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.

The research methods were used to investigate the following questions: Does a mobility training intervention change tissue stiffness, joint range of motion, and compensate for possible imbalances? Do the interventions influence the pressure pain threshold and the overall well-being?