Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis

Abstract

Context: Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). Objective: To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. Evidence Acquisition: In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. Evidence Synthesis: Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22–36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; −0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. Conclusions: Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.

Selective Effects of Manual Massage and Foam Rolling on Perceived Recovery and Performance: Current Knowledge and Future Directions Toward Robotic Massages

“…Commonly used to improve ROM, FR has also been tested during warm-up to improve the physical qualities of athletes such as muscle power, strength or agility. However, unlike ROM, performance results obtained were not always clearly established (Burk et al, 2019;Hughes and Ramer, 2019;Skinner et al, 2020). Some studies recorded improvements in muscle power, strength or agility, after a single session of FR (D'Andrea, 2016;Sagiroglu, 2017;Stroiney et al, 2020).…”

“…Other came to different conclusions. For example, FR was not shown to bring any significant improvement in performance (Burk et al, 2019). Few protocols have been tested and replicated enough to lead to real consensus.…”

“…Few protocols have been tested and replicated enough to lead to real consensus. Indeed, between the protocols, many parameters differed such as outcome measures, FR tool, target muscles, type of population, participants' FR experience, and FR instructions (e.g., pressure level, duration and rate of treatment) (Burk et al, 2019;Dębski et al, 2019). It is likely that this experimental disparity justifies the heterogeneity of the results reported in the literature.…”

Effect of Myofascial Therapy on Pain and Functionality of the Upper Extremities in Breast Cancer Survivors: A Systematic Review and Meta-Analysis

“…In 2016, Webb and colleagues [ 48 ] did not find conclusive results after their meta-analysis about the efficacy of myofascial therapy on joint range of motion and perceived pain. A recently-published article also obtained outcomes that tend towards the statistical significance of myofascial techniques for the improvement of joint range of motion, without these generating a clinically relevant change [ 49 ]. Our article correlates with this article, as obtaining statistical significance in the improvement of the range of motion in shoulder abduction reaffirms myofascial therapy as an effective technique in the improvement of this specific variable.…”

A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains

“…From a macroscopic point of view, revision and cadaver studies (with mechanical or manual traction) have highlighted and demonstrated the existence of some myofascial lines [39][40][41]. To give an example, stretching, with healthy people, of the lower limbs improves the range of motion of the cervical tract in flexion/extension ( Figure 6) [42][43].…”