The morphological and microscopical characteristics of posterior layer of human thoracolumbar fascia; A potential source of low back pain

Marpalli, Sapna; Rao, K. G. Mohandas; Venkatesan, P; George, B

doi:10.1016/j.morpho.2021.01.001

Cited by 7 publications

(12 citation statements)

References 18 publications

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“…Of the 23 total studies, five studies were performed in rats [ 7 , 8 , 9 , 10 , 11 ], four in mice [ 7 , 8 , 9 , 10 ], two in horses [ 11 , 12 ], ten in humans, among which there were six in human cadavers [ 13 , 14 , 15 , 16 , 17 , 18 ], two in live humans [ 19 ], and two in human cadavers and live humans [ 20 , 21 ]. Two studies were made both in humans and rats [ 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Also, Marpalli et al [ 18 ] studied the TLF and noted that the number of free nerve endings in the right sacral level, 12.762 ± 0.42, is bigger than in the right thoracic vertebral level (10.210 ± 0.374). Many authors [ 8 , 10 , 18 , 22 , 23 , 24 , 25 ] agree that the free nerve endings have the features of nociceptors. Nobody has found Pacini, Ruffini or Golgi-Mazzini corpuscles in the TLF samples.…”

Section: Resultsmentioning

confidence: 99%

“…Nobody has found Pacini, Ruffini or Golgi-Mazzini corpuscles in the TLF samples. Mense and Hoheisel [ 23 , 24 , 25 ] in their studies described an increase of nociceptors (SP-IR), both in the density and in the length, in inflamed TLF, passing from a density of 2.0 per 1000 µm 2 in health to 2.5 in inflamed one [ 23 , 24 ]. They observed the same effect in rats and humans.…”

Section: Resultsmentioning

confidence: 99%

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Fascial Innervation: A Systematic Review of the Literature

Suárez-Rodríguez

Fede

Pirri

et al. 2022

IJMS

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Currently, myofascial pain has become one of the main problems in healthcare systems. Research into its causes and the structures related to it may help to improve its management. Until some years ago, all the studies were focused on muscle alterations, as trigger points, but recently, fasciae are starting to be considered a new, possible source of pain. This systematic review has been conducted for the purpose of analyze the current evidence of the muscular/deep fasciae innervation from a histological and/or immunohistochemical point of view. A literature search published between 2000 and 2021 was made in PubMed and Google Scholar. Search terms included a combination of fascia, innervation, immunohistochemical, and different immunohistochemical markers. Of the 23 total studies included in the review, five studies were performed in rats, four in mice, two in horses, ten in humans, and two in both humans and rats. There were a great variety of immunohistochemical markers used to detect the innervation of the fasciae; the most used were Protein Gene Marker 9.5 (used in twelve studies), Calcitonin Gene-Related Peptide (ten studies), S100 (ten studies), substance P (seven studies), and tyrosine hydroxylase (six studies). Various areas have been studied, with the thoracolumbar fascia being the most observed. Besides, the papers highlighted diversity in the density and type of innervation in the various fasciae, going from free nerve endings to Pacini and Ruffini corpuscles. Finally, it has been observed that the innervation is increased in the pathological fasciae. From this review, it is evident that fasciae are well innerved, their innervation have a particular distribution and precise localization and is composed especially by proprioceptors and nociceptors, the latter being more numerous in pathological situations. This could contribute to a better comprehension and management of pain.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Fascial Innervation: A Systematic Review of the Literature

Suárez-Rodríguez

Fede

Pirri

et al. 2022

IJMS

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“…A total of seven studies characterized the distribution of the nociceptive nerve fibers terminating within the TLF [ 39 , 50 , 55 , 56 , 57 , 58 , 59 ]. All these studies investigated whether fasciae associated with muscle are also innervated by peptidergic nociceptive sensory fibers.…”

Section: Resultsmentioning

confidence: 99%

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Sinhorim

Amorim

Ortiz

et al. 2021

JCM

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Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few 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 lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (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, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower 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. Additional knowledge of fascial neurological components could impact LBP treatment.

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“…Another recent study performed on twenty formalin embalmed human cadavers documented the occurrence of peripheral nerve endings and nociceptors within the posterior layer of the thoracolumbar fascia (PTLF). Morphometrical analysis demonstrated that these nerve fibers are more abundant in the sacral region than at thoracic vertebral levels of the human PTLF [ 103 ].…”

Section: A Brief Overview Of the Human Fascial System And Its Role As...mentioning

confidence: 99%

Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors

Ryskalin

Morucci

Natale

et al. 2022

Life

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In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.

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The morphological and microscopical characteristics of posterior layer of human thoracolumbar fascia; A potential source of low back pain

Cited by 7 publications

References 18 publications

Fascial Innervation: A Systematic Review of the Literature

Fascial Innervation: A Systematic Review of the Literature

Potential Nociceptive Role of the Thoracolumbar Fascia: A Scope Review Involving In Vivo and Ex Vivo Studies

Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors

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