Abstract: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 … Show more
“…Manipulation was performed by deep manual friction using elbows or knuckles for 5–8 min at each CC point, as shown in Figure 2 . During the treatment session, the patient was asked to stay relaxed and attain the required position of supine, side, or prone lying as per the application of technique [ 18 , 28 , 29 ]. Figure 2 Application of FM on CC point (LA-CL) [ 8 ].…”
Section: Case Descriptionmentioning
confidence: 99%
“…FM is considered to restore the restricted movement of collagen and elastin fibers within the ground substance through heat generated from manipulation of the densified CC points [ 18 ]. The manual friction (tangential oscillation) might modulate the state of hyaluronan from gel to fluid, thereby improving the fascial mobility and thus reducing pain [ 19 , 20 ].…”
Background
The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration.
Objective
We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation).
Methods
This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed.
Results
Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI).
Conclusion
This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.
“…Manipulation was performed by deep manual friction using elbows or knuckles for 5–8 min at each CC point, as shown in Figure 2 . During the treatment session, the patient was asked to stay relaxed and attain the required position of supine, side, or prone lying as per the application of technique [ 18 , 28 , 29 ]. Figure 2 Application of FM on CC point (LA-CL) [ 8 ].…”
Section: Case Descriptionmentioning
confidence: 99%
“…FM is considered to restore the restricted movement of collagen and elastin fibers within the ground substance through heat generated from manipulation of the densified CC points [ 18 ]. The manual friction (tangential oscillation) might modulate the state of hyaluronan from gel to fluid, thereby improving the fascial mobility and thus reducing pain [ 19 , 20 ].…”
Background
The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration.
Objective
We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation).
Methods
This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed.
Results
Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI).
Conclusion
This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.
“…The anatomical link between the CT of the orbits, skull, and neck forms the proximal part of the SBL. Alterations in the ground substance of the deep muscular fascia and their myofascial continuum (MC) can cause musculoskeletal dysfunction (Mathew et al, 2020). Also, the DF is vital for improving muscle function by transmitting the contraction force in all directions (Kamani et al, 2021; Shah et al, 2019).…”
The posterior myofascial chain (PMC) or superficial back line encompasses a series of muscles interlinked by the deep fascia, extending from the foot to the fascial sheath of the eyeball. The deep cervical fascia of the neck, the epicranial aponeurosis of the head, and the fascial sheath of eyeball, form the proximal PMC. Although the literature has reported an anatomical myofascial continuum between the neck, head, and eyes, the anatomical descriptions vary substantially. Moreover, there is still no plausible functional interrelationship between the proximal structural myofascial links. Chronic neck pain is usually associated with a plethora of symptoms including craniofacial pain and oculomotor disorders. Understanding the anatomy of the proximal myofascial chain could help clinicians improvise treatment strategies for managing such painful head and neck disorders.
“…The increased viscosity of hyaluronan leads to the formation of adhesions and the generation of tensional forces. The adhesions alter the activation of mechanoreceptors, leads to the non-physiologic movement of the joints, resulting in pain and dysfunctions [ 28 – 31 ].…”
Section: Introductionmentioning
confidence: 99%
“…Fascial manipulation (FM) is hypothesized to restore the restricted movement of collagen and elastin fibers within the ground substance. The manipulation of the densified center of coordination (CC) and center of fusion (CF) points might improve the flexibility of the myofascial structures, thereby improving the fascial mobility and the associated symptoms [ 17 , 28 , 31 ]. Besides FM, sequential yoga poses (SYP) also focus on the myofascial lines.…”
Introduction
Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP.
Methods
This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1.
Discussion
If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial.
Trial registration
ClinicalTrials.gov CTRI/2020/01/022934. Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry – India.
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