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

Abstract

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.

Modeling of the Effect of Subperiosteal Hydrostatic Pressure Conductivity between Joints on Decreasing Contact Loads on Cartilage and of the Effect of Myofascial Relief in Treating Trigger Points: The Floating Skeleton Theory

“…One of the methods for decreasing stiffness is the injection of normal saline into a specific fascial layer of the myofascial unit under ultrasound control once the location of the painful zone has been identified with palpation [39]. Another quite popular one is the myofascial relief method patented by Joseph Jacobs [40].…”

Ultrasound Imaging and Guidance for Cervical Myofascial Pain: A Narrative Review

“…Considering the above-mentioned several pain generators that are potentially involved in cervical MPS, multiple US-guided interventions can be performed as well in clinical practice. In this regard, the authors suggest considering three main interventions: (i) injection and/or dry needling of the MTrPs, (ii) interfascial plane block, and (iii) fascial hydro-dissection [9,26,35].…”

“…As regards the technical tips and tricks, a long and flexible needle should be used to better "navigate" through the multiple layers of deep fascia. During both the advancement and retraction phases of the needle, the authors suggest slowly releasing the high-volume mixture to optimize the progressive detachment of the different layers of deep fascia-i.e., the seeding technique [35,48]. Last but not least, multiple back-andforward movements of the needle within the deep fascia should be performed to better release the intrafascial adhesions in between its multiple layers.…”

Efficacy of Extracorporeal Shockwave Therapy versus Corticosteroid Injection in Patients with Myofascial Pain Syndrome: A Prospective Study

“…The name "myofascial" was created since the pathophysiology of MPS includes various soft tissue components of the myofascial unit, such as the superficial fascia and deep fascia, in addition to its primary muscle origin (6) . Myofascial trigger points (MTrPs), which are described as hyperirritable sites inside a tight band of skeletal muscle or fascia, play a key role in the pathogenesis of MPS.…”