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During pregnancy, fetal growth could lead to changes in human biomechanics. If postpartum recovery was not properly managed, it could be exacerbated, resulting in myofascial system disorders and various functional impairments. Among them, pain-related functional disorders were an important issue affecting quality of life in postpartum women. The pathogenesis of these disorders remained unclear but it was primarily associated with changes in biomechanics, the endocrine system, and nervous function. However, postpartum pain-related dysfunction had been considered a normal physiological response to childbirth, leading to a lack of attention. Therefore, many postpartum women failed to receive timely, effective, and standardized treatment, hindering their ability to reintegrate into family and society, and causing severe damage to their physical and mental health. In clinical practice, myofascial therapy could effectively alleviate postpartum pain and muscle spasms, improve excessive tension injuries in myofascial, and had a good therapeutic effect on postpartum pain-related functional disorders. The mechanism of myofascial therapy involved improving core muscle strength, restoring normal body alignment, and promoting the remodeling of myofascial mechanical structures. This article explored the positive effects of myofascial therapy on postpartum pain-related functional disorders from a biomechanical perspective, aiming to provide diverse treatment approaches for clinical practitioners., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Computer professionals often develop a forward head posture due to prolonged hours of computer use, leading to neck pain. Instrument-assisted soft tissue mobilization (IASTM), an advanced technique for treating myofascial trigger points, has become increasingly popular for addressing these musculoskeletal issues., Objectives: The study aimed to compare the effectiveness of IASTM mobilization on SBAL (superficial back arm line) and SM(specific muscles-upper trapezius, levator scapulae, and sternocleidomastoid) in managing chronic neck pain among computer professionals., Participants & Methods: The study involved 62 computer professionals, randomly divided into two groups. Group A received IASTM on SBAL and group B received IASTM on SM for neck pain each receiving three sessions weekly for four weeks. Outcome variables like Neck Disability Index (NDI), NPRS(Neck Pain Rating Scale), Craniovertebral angle (CVA), and range of motion (ROM) for flexion, and side flexion (right & left side) were evaluated at baseline, 2 weeks and 4 weeks., Results: Significant improvement in NPRS were observed in both the SBAL and SM groups after 2 weeks of IASTM, wth the SBAL group demonstrating greater improvement. At 4 weeks, IASTM on SBAL showed significantly higher improvements in NPRS, CVA, NDI, and flexion compared to the SM group. The repeated measures ANOVA indicated a significant main effect of both time and group, along with a significant interaction between time and group for all outcome variables, except for CVA., Conclusion: The study indicates that IASTM on SBAL may offer a more effective treatment for chronic neck pain in computer professionals compared to targeting specific muscles., Competing Interests: Declaration of competing interest “No financial, legal, or political conflicts involving third parties (government, corporations, private foundations, etc.) have been declared for any aspect of the submitted work (including, but not limited to grants and funding, advisory board participation, study design, preparation of the manuscript, statistical analysis, etc.)”. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2024. Published by Elsevier Ltd.)

Although there are studies showing that myofascial release will increase muscle force production, the contribution of its application alone to muscle force production has not been examined. Aim of the study is to investigate the effect of instrument-assisted soft tissue mobilization (IASTM) on eccentric strength, frontal plane projection angle (FPPA), dynamic (DPS), and static postural stability (SPS), femoral internal rotation (FIR) angle in females with dynamic knee valgus (DKV). A total of 44 recreationally active females with asymptomatic DKV (age: 21,39 ± 1,79, body mass index: 20,09 ± 2,45) participated and were randomly assigned to either control group (CG) or IASTM group (IASTMG). Participants' eccentric contraction strength, FPPA, DPS, SPS, and FIR on the involved leg were measured pre- and post. IASTM application was applied to IASTMG for 6 weeks, twice a week, for 5 min, using Graston Technique® instruments on gluteus medius. CG received no intervention. In comparison of ECS difference values, change in IASTMG was found to be statistically significantly higher than CG (p = .004; p < .01). There was no statistical difference in comparison of FIR and FPPA values (respectively p = .213, p = .360; p < .05). In SPS and DPS evaluation, a statistically significant improvement was observed in favor of IASTMG in comparison of both intergroup and difference values (p < .05 for all). Strength gain without exercise can increase postural stability, but it isn't sufficient to correct faulty movement patterns. We recommend adding IASTM to injury prevention programs, but there is a need to investigate the effect of IASTM with technique correction feedback., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Myofascial trigger point therapy (MTrP) is a widely used therapeutic approach, although the underlying mechanisms remain unclear. Mechanisms discussed include peripheral involvement of muscles as well as central pain modulating processes such as the conditioned pain modulation (CPM). The aim of this study was to investigate whether the analgesic response of MTrP and the analgesic response of CPM correlate in asymptomatic participants in order to identify shared underlying mechanisms of MTrP and CPM., Method: Both, CPM and MTrP protocols consisted of heat-based test stimuli (heat pain thresholds before and after the intervention) and pressure-based (conditioning) stimuli. Asymptomatic participants (n = 94) were randomly assigned to receive either mild, intense or no pressure stimuli (between-group design) to both the fingernail and the MTrP of the infraspinatus muscle (within-group design). Pressure stimuli at both locations (fingernail, MTrP) were applied with a pressure algometer for 120 s and continuously adjusted to maintain a constant pain intensity of mild or intense pain. All thermal stimuli were applied on the lower leg with a thermal stimulator., Results: A significant correlation was shown between the analgesic effect of CPM and MTrP therapy for mild (r = 0.53, p = 0.002) and intensive stimuli (r = 0.73, p < 0.001). 17.3% of the variance of the MTrP effect were explained by CPM after mild stimulation, and 47.1% after intense stimulation. Pain-related characteristics did not explain the variance within the analgesic response using a regression analysis., Conclusions: Between the analgesic responses following MTrP and CPM paradigms, a moderate to strong correlation was observed, suggesting shared underlying mechanisms., Competing Interests: Declaration of competing interest All authors declare they have no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background/aim: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) used in myofascial pain syndrome (MPS) and to determine whether they are superior to conservative treatment (CT)., Materials and Methods: A total of 42 female patients (aged 18-60 years) diagnosed with MPS were enrolled and randomly assigned to either the CT (n = 14), CT+IASTM (n = 14), or CT+ESWT group (n = 14). All of the groups received treatment for 3 weeks (CT: 5 sessions per week, 15 sessions in total, ESWT and IASTM: 2 sessions per week, 6 sessions in total). Neck stretching exercises were given to all of the patients as a home program. The pain intensity of the patients was determined using the visual analog scale (VAS). The pressure pain threshold (PPT) was measured with an algometer. Cervical joint range of motion (ROM) was measured with a cervical ROM (CROM) device. Pain, cervical disability, quality of life, and sleep disturbances were evaluated with the Neck Outcome Score (NOOS). Depression and anxiety parameters were evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were made before treatment and 3 days after the last treatment session., Results: The CT+IASTM group was more successful than the other groups in terms of pain intensity, PPT, and improvements in the ROM parameters (p < 0.05). No significant difference was found between the NOOS and HADS scores of the groups when the posttreatment changes were compared to pretreatment (p > 0.05)., Conclusions: All 3 of these treatments can be used to alleviate the negative effects of MPS. IASTM treatment can be preferred primarily in the creation of combined treatment programs for patients with ROM limitations and low PPTs., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare., (© TÜBİTAK.)

Background: The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy., Material and Methods: The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping., Results: Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed., Conclusion: To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities., (© 2022 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

Objective: People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies., Methods: This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention., Results: The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2-37.7); an increase of 1.0 point (95% CI = 0.7-1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5-9.2)., Conclusion: Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF., Impact: This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Context: Limited dorsiflexion (DF) range of motion (ROM) is commonly observed in both the athletic and general populations and is a predisposing factor for lower extremity injury. Graston Technique® (GT) is a form of instrument-assisted soft tissue mobilization (IASTM), used commonly to increase ROM. Evidence of the long-term effects of GT on ROM is lacking, particularly comparing the full GT protocol versus IASTM alone., Objective: To evaluate the effectiveness of 6 sessions of the GT or IASTM compared with a control (CON) group for increasing closed-chain DF ROM., Design: Cohort design with randomization., Setting: Athletic training clinic., Patients or Other Participants: A total of 23 physically active participants (37 limbs) with <34° of DF. Participants' limbs were randomly allocated to the GT, IASTM, or CON group., Intervention: Participants' closed-chain DF ROM (standing and kneeling) were assessed at baseline and 24-48 hours following their sixth treatment. Participants in the CON group were measured at baseline and 3 weeks later. The intervention groups received 6 treatments during a 3-week period, whereas the CON group received no treatment. The GT group received a warm-up, instrument application, stretching, and strengthening of the triceps surae. The IASTM group received a warm-up and instrument application., Main Outcome Measures: Closed-chain DF was assessed with a digital inclinometer in standing and kneeling., Results: A significant difference between groups was found in the standing position (P = .03) but not in kneeling (P = .15). Post hoc testing showed significant improvements in DF in standing following the GT compared with the control (P = .02)., Conclusions: The GT significantly increases ankle DF following 6 treatments in participants with DF ROM deficits; however, no differences were found between GT and IASTM. The GT may be an effective intervention for clinicians to consider when treating patients with DF deficits.

Clinical Scenario: Dynamic stretching and foam rolling are commonly used by athletes to reduce injury and enhance recovery, thereby improving athletic performance. In contrast to dynamic stretching, little research has been conducted on the acute effects of foam rolling as part of the preexercise warm-up routine. Previously, when researchers implemented foam rolling with static stretching as a warm-up, some found that foam rolling slightly improved flexibility and performance outcomes. More recent research has shown that dynamic stretching is favorable to static stretching when used as a warm-up strategy. Therefore, adding foam rolling to dynamic stretching is hypothesized to create more significant improvements in flexibility and performance compared with adding foam rolling to static stretching. Focused Clinical Question: In active individuals, does foam rolling in addition to dynamic stretching lead to enhanced performance compared with dynamic stretching alone? Summary of Key Findings: Four randomized controlled trials were included. Two studies concluded that the addition of foam rolling to dynamic stretching increased vertical jump height more than dynamic stretching alone, while 2 studies found no difference between these treatment groups. Two studies concluded that the addition of foam rolling increased agility performance compared with dynamic stretching alone, while one study found no difference between treatment groups and one study did not measure agility. All 4 studies reviewed concluded that foam rolling did not improve flexibility more than dynamic stretching alone. Clinical Bottom Line: Foam rolling in conjunction with dynamic stretching may further improve an athlete's agility and power output; however, little improvement has been observed with foam rolling in regard to athlete flexibility when compared with completing dynamic stretching programs alone. Strength of Recommendation: Inconsistent findings from 4 randomized controlled trials suggest there is Grade C evidence to support the inclusion of foam rolling in a dynamic warm-up.

Objectives: This study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain., Methods: A randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up., Results: Although both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion., Discussion: Vacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Context: Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown., Objective: To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction., Design: Randomized controlled clinical trial., Setting: Mid-Atlantic University., Participants: Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM., Interventions: All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time., Main Outcome Measures: Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction., Results: Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied., Conclusions: As both groups improved pretest to posttest, either treatment could be used.

Percutaneous devices are prone to epidermal downgrowth and sinus tract formation, which can serve as a nidus for bacterial colonization and increase the risk of peri-prosthetic infection. A laser microgrooved topography has been shown to limit gingival epidermal downgrowth around dental implants. However, the efficacy of this laser microgrooved topography to limit epidermal downgrowth around nongingival percutaneous devices is yet to be investigated. In this study, devices with a porous-coated subdermal component and a percutaneous post were designed and manufactured. The proximal 2 mm section of the percutaneous post were left smooth, or were textured with either a porous coating, or with the laser microgrooved topography. The smooth and porous topographies served as controls. The devices were tested in a hairless guinea pig back model, where 18 animals were randomly assigned into three groups, with each group receiving one implant type (n = 6/group). Four weeks postimplantation, the devices with surrounding soft-tissues were harvested and processed for histological analyses. Results indicated that the laser microgrooved topography failed to prevent epidermal downgrowth (23 ± 4%) around percutaneous posts in this model. Furthermore, no significant differences (p = 0.70) in epidermal downgrowth were present between the three topographies, with all the groups exhibiting similar measures of downgrowth. Overall, these findings suggest that the laser microgrooved topography may not halt downgrowth around percutaneous devices for dermal applications., (Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)

Objective: To study the effects of the three methods and three-acupoint technique on DRG gene expression in SNI model rats and to elucidate the molecular mechanism of the three methods and three-acupoint technique on promoting recovery in peripheral nerve injury., Methods: 27 male SD rats were randomly divided into three groups: a Sham group, the SNI group, and the Tuina group. The Tuina group was treated with a tuina manipulation simulator to simulate massage on points, controlling for both quality and quantity. Point-pressing, plucking, and kneading methods were administered quantitatively at Yinmen (BL37), Chengshan (BL57), and Yanglingquan (GB34) points on the affected side once a day, beginning 7 days after modeling. Intervention was applied once a day for 10 days, then 1 day of rest, followed by 10 more days of intervention, totally equaling 20 times of intervention. The effect of the three methods and three-point technique on the recovery of injured rats was evaluated using behavior analysis. RNA sequencing (RNA-Seq) analysis of differentially expressed genes in DRGs of the three groups of rats was also performed. GO and KEGG enrichment was analyzed and verified using real-time PCR., Results: RNA-Seq combined with database information showed that the number of differentially expressed genes in DRG was the largest in the Tuina group compared with the SNI group, totaling 226. GO function is enriched in the positive regulation of cell processes, ion binding, protein binding, neuron, response to pressure, response to metal ions, neuron projection, and other biological processes. GO function is also enriched in the Wnt, IL-17, and MAPK signaling pathways in the KEGG database. PCR results were consistent with those of RNA sequencing, suggesting that the results of transcriptome sequencing were reliable., Conclusion: The three methods and three-acupoint technique can promote the recovery of SNI model rats by altering the gene sequence in DRGs., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2020 Tao-tao Lv et al.)

Objective: The purpose of this study was to evaluate the effects of plantar myofascial mobilization (PMM) on the plantar area, balance, and functional mobility of elderly women., Methods: In this randomized, single-blind, placebo-controlled clinical trial, elderly women with maintained independent orthostatism were recruited from the community and randomly separated into a PMM group (MG = 15), a placebo group (PG = 13), or a control group (control group = 14). Vigorous PMM and soft PMM were performed in the MG and PG, respectively, for 5 days with a rest day between each. The measures of plantar area, single leg stance test with open eye and closed eye, and timed up-and-go test were performed pre-PMM, immediately post-PMM, and on the last day of the protocol. The control group only underwent evaluation before and on the last day of the protocol. The sample size was calculated, and, for quantitative variables, a mixed analysis of variance was used for repeated measurements (split plot), followed by the Bonferroni post hoc test. The results were analyzed in 2 ways: 3 groups at 2 moments (pre, last day), and 2 groups at 3 moments (pre, post, last day)., Results: Forty-two elderly women with mean age of 69.03 ± 3.32 years were included in the study. The vigorous MMP showed a statistically significant increase in the plantar area of the right foot (3 groups: P = .49) and single leg stance test with open eye time (2 groups: P = .002; 3 groups: P = .001), and a decrease in the timed up-and-go time (2 groups: P = .04; 3 groups: P = .0001)., Conclusion: The vigorous PMM showed increases of the plantar area and promoted beneficial effects on functional mobility and body balance., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone, in individuals with chronic non-specific low back pain (CNLBP)., Design: Randomized controlled trial with three months follow-up., Setting: Rehabilitation clinic., Participants: Seventy-two individuals (between 18 and 50 years of age; CNLBP ≥12 consecutive weeks) were enrolled and randomly allocated to one of two groups: (1) Spinal manipulation and myofascial release - SMMRG; n=36) or (2) Spinal manipulation alone (SMG; n=36)., Interventions: Combined spinal manipulation (characterized by high velocity/low amplitude thrusts) of the sacroiliac and lumbar spine and myofascial release of lumbar and sacroiliac muscles vs manipulation of the sacroiliac and lumbar spine alone, twice a week, for three weeks., Main Outcome Measures: Assessments were performed at baseline, three weeks post intervention and three months follow-up. Primary outcomes were pain intensity and disability. Secondary outcomes were quality of life, pressure pain-threshold and dynamic balance., Results: No significant differences were found between SMMRG vs SMG in pain intensity and disability post intervention and at follow-up. We found an overall significant difference between-groups for CNLBP disability (SMG-SMMRG: mean difference of 5.0; 95% confidence interval of difference 9.9; -0.1), though this effect was not clinically important and was not sustained at follow-up., Conclusions: We demonstrated that spinal manipulation combined with myofascial release was not more effective compared to spinal manipulation alone for patients with CNLBP., Clinical Trial Registration Number: NCT03113292., (Copyright © 2019 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to investigate the short-term effects of myofascial induction on mechanosensitivity of upper limb nerves., Methods: In this secondary analysis of a randomized, single-blind, placebo-controlled crossover study, 21 breast cancer survivors with stage I-IIIA cancer were randomly allocated to an experimental group (30 minutes of myofascial induction session) or placebo control group (unplugged pulsed 30 minutes of shortwave therapy), with a 4-week washout period between sessions that occurred in a physical therapy laboratory in the Health Science Faculty (University of Granada, Spain). Range of motion (universal goniometry), structural differentiation, symptoms (yes/no), and pressure pain thresholds (electronic algometry) were assessed during neurodynamic tests and attitude toward massage scale as covariate., Results: An analysis of covariance revealed significant time × group interactions for range of motion in affected upper limb nerves (median, P < .001; radial, P = .036; ulnar, P = .002), but not for nonaffected upper limb nerves (median, P = .083; radial, P = .072; ulnar, P = .796). A χ 2 or Fisher exact test, as appropriate, also revealed a significant difference (P = .044) in sensitivity for the affected upper limb ulnar nerve in the experimental group, whereas the rest of the assessed nerves (affected and nonaffected upper limb nerves) showed no significant changes in either the experimental or control groups (P > .05). An analysis of covariance revealed no significant interactions on pressure pain thresholds over the nerves for affected (all P > .05) and nonaffected (all P > .05) upper limb nerves., Conclusion: A single myofascial induction session may partially improve mechanosensitivity of median, radial, and ulnar nerves and yield positive effects on symptom mechanosensitivity, especially regarding the ulnar nerve in breast cancer survivors., (Copyright © 2020. Published by Elsevier Inc.)

Soft tissue defects in the oral maxillofacial area are critical problems for many patients and, in some cases, patients require an operation coupled with a performance scaffold substitution. In this research, mimicked anatomical scaffolds were constructed using gelatin- and chitosan-coated woven silk fibroin fabric. The morphologies, crystals, and structures were observed and then characterized using scanning electron microscopy, X-ray diffraction, and differential scanning calorimetry, respectively. Physical performance was evaluated from the swelling behavior, mechanical properties, and biodegradation, while the biological performance was tested with fibroblasts and keratinocytes, after which cell proliferation, viability, and histology were evaluated. The results revealed that a coated woven silk fibroin fabric displayed a crystal structure of silk fibroin with amorphous gelatin and chitosan layers. Also, the coated fabrics contained residual water within their structure. The physical performance of the coated woven silk fibroin fabric with gelatin showed suitable swelling behavior and mechanical properties along with acceptable biodegradation for insertion at a defect site. The biological performances including cell proliferation, viability, and histology were suitable for soft tissue reconstruction at the defect sites. Finally, the results demonstrated that mimicked anatomical scaffolds based on a gelatin layer on woven silk fibroin fabric had the functionality that was promising for soft tissue construction in oral maxillofacial defect.

Objective: The aim of this study was to evaluate the effect of adding the integrated neuromuscular inhibition technique (INIT) to therapeutic exercise (TE) in individuals with chronic mechanical neck pain (CMNP)., Methods: In this 34-week, assessor-blind randomized controlled trial, 40 participants (men and women) with CMNP with active or latent myofascial trigger points on the neck muscles were divided into 2 groups. The participants followed 4 treatments per week for 10 weeks. The intervention group followed a TE program in combination with the INIT, whereas the control group followed the same program without the INIT. Both protocols were applied by physiotherapists. Pain, disability, pressure pain threshold, active range of motion, and health-related quality of life were evaluated before, during, and after the intervention, whereas patients were followed for 6 months after completion of treatment. Repeated-measures ANOVA was applied., Results: Both groups showed a significant improvement in all dependent measures after the intervention (P < .05). However, the intervention group showed greater improvement in the visual analog scale and neck disability index score, in the neck muscles pressure pain threshold, in the range of motion, and in the 36-Item Short Form Health Survey score, than the control group. In many of the above variables this improvement was seen from the second week and was maintained for 6 months after the intervention., Conclusion: The results of this preliminary study suggest that the addition of the INIT to a TE program had a positive effect on pain, functionality, and the quality of life in individuals with CMNP., (Copyright © 2020. Published by Elsevier Inc.)

When immobile or neuropathic patients are supported by beds or chairs, their soft tissues undergo deformations that can cause pressure ulcers. Current support surfaces that redistribute under-body pressures at vulnerable body sites have not succeeded in reducing pressure ulcer prevalence. Here we show that adding a supporting lateral pressure can counter-act the deformations induced by under-body pressure, and that this 'pressure equalisation' approach is a more effective way to reduce ulcer-inducing deformations than current approaches based on redistributing under-body pressure. A finite element model of the seated pelvis predicts that applying a lateral pressure to the soft tissue reduces peak von Mises stress in the deep tissue by a factor of 2.4 relative to a standard cushion (from 113 kPa to 47 kPa)-a greater effect than that achieved by using a more conformable cushion, which reduced von Mises stress to 75 kPa. Combining both a conformable cushion and lateral pressure reduced peak von Mises stresses to 25 kPa. The ratio of peak lateral pressure to peak under-body pressure was shown to regulate deep tissue stress better than under-body pressure alone. By optimising the magnitude and position of lateral pressure, tissue deformations can be reduced to that induced when suspended in a fluid. Our results explain the lack of efficacy in current support surfaces and suggest a new approach to designing and evaluating support surfaces: ensuring sufficient lateral pressure is applied to counter-act under-body pressure., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: CB and SM have filed a patent (application number 1814813.0) for a support surface device based on the principle described in this paper. Imperial Innovations Ltd and Imperial College London partly funded this work through a Proof of Concept grant to SDM and CJB. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Drawing from this work, CJB and SDM have applied for a patent (GB1814813.0 “Device for supporting a body part”). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background : In general, chronic problems of soft tissues (muscles, tendons, ligaments) are due to scarring or degeneration. Astym therapy (Performance Dynamics, Inc. Muncie, Indiana) has been reported to address tendinopathy by stimulating regeneration in soft tissues (muscles, tendons, ligaments) and the resorption of unwanted scar tissue that causes pain and limits mobility. Purpose : To analyze the effectiveness of Astym therapy in the treatment of musculoskeletal problems Methods : A narrative review of the literature on the topic was carried out. A Cochrane Library and PubMed (MEDLINE) search related to the role of Astym therapy was analyzed. The only language searched was English. Scientific meeting abstracts and other sources of evidence were not considered. The main criteria for selection were articles that were focused on the role of Astym therapy. Results : Astym therapy seems to be useful for the treatment of chronic ankle sprains, Achilles tendon tendinopathy, hamstring tendinopathy, elbow tendinopathy, and the stiff total knee arthroplasty. Astym therapy also appears to be useful to gain range of motion, muscle strength, and function in patients with cerebral palsy, and after mastectomy. Conclusions : Astym therapy seems to activate a regenerative response in degenerative tendinopathy and eliminate or reduce the scar tissue/fibrosis that causes pain and limitation of mobility. Based on the positive findings of the emerging published research further study is warranted to confirm the benefits of Astym therapy on a variety of musculoskeletal disorders.

Background: Shoulder pain is among the most common musculoskeletal pain syndromes. This study aimed to compare the effectiveness of the worldwide renowned Kaltenborn and Evjenth manual therapy and the innovative concept of Fascial Distortion Model (FDM) in the treatment of patients suffering from shoulder pain., Material and Method: The study group consisted of 100 patients treated for shoulder pain (SP), who were randomly assigned to two groups: Group A, whose therapy involved FDM (51), and Group B, treated with Kaltenborn and Evjenth method (49). Exclusion criteria comprised age &lt; 30 years, low threshold of sensitivity to pain, participation in another rehabilitation programme, uncontrolled arterial hypertension, neurological conditions associated with sensory impairment, connective tissue conditions and presence of 'red flags'. The tools used in the study included a digital inclinometer to measure the range of joint mobility and a NeuroTrack device to assess neuromuscular conductivity. Statistical analysis used the non-parametric Mann-Whitney U test and non-parametric Wilcoxon signed rank test. The significance threshold was accepted as p ≤ 0.05., Results: Both groups showed significant improvement (p&lt;0.05) in the range of motion in the upper limb in all direc-tions (flexion, abduction and external rotation) and change in the function of the infraspinous muscle. The only significant difference between the groups was found for external rotation (p&lt;0.05), with Group A displaying a superior range of motion., Conclusions: 1. A single session of the Kaltenborn and Evjenth method and FDM in patients suffering from shoulder pain may increase their range of motion in the shoulder as well as improve the function of the infraspinous muscle. 2. Cur-rently there is insufficient evidence to warrant stronger recommendation of one of the study therapies over the other. 3. There is a need for further prospective randomised studies involving larger groups of patients and assessing long-term effec-tiveness of the therapies.

Introduction: Roughly 17 million abdominal surgeries are performed annually in the U.S. Up to 17% of those may be readmitted for adhesion related problems. This study evaluated the effectiveness of soft tissue mobilization (STM) techniques at improving chronic pain, mobility restrictions and functional deficits following complex abdominal surgery., Methods: Subjects Two females aged 51 and 65., Design: Single subject quasi-experimental A-B-A., Intervention: Four 30-min treatment sessions of abdominal tissue mobilizations. Outcome measures Pain pressure threshold (PPT) and average scar mobility (ASM), Numeric Pain Rating Scale (NPRS), and the Oswestry Disability Index (ODI)., Results: Subject 1 ASM and PPT of the abdomen improved significantly and exceeded the established standard error of measurement (SEM). PPT of the scar decreased during the second baseline. This decrease exceeded the SEM for PPT but was not statistically significant. The changes in NPRS did not reach the minimal clinically important difference (MCID). Subject 2 abdominal PPT and ASM showed statistically significant improvements that exceeded their SEMs. Scar PPT showed improvement during the repeat baseline, however, this reached neither statistical significance nor the SEM., Conclusions: Scar mobility and abdominal PPT improved both statistically and clinically in both subjects after only 4 sessions of STM. Scar pain measured by NPRS and PPT did not show significant improvement. This study demonstrated that STM can be an effective way to treat chronic abdominal scars by increasing scar mobility and reducing abdominal sensitivity to pressure. It is non-invasive, and is a less costly alternative to laparoscopic adhesiolysis., (Copyright © 2019. Published by Elsevier Ltd.)

Purpose of Review: Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points., Recent Findings: The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated., Summary: The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.

Purpose of Review: Pain is one of the most feared and most common symptoms of cancer, experienced by 38-85% of patients. Pain in terminally ill cancer patients is a multidimensional experience caused by a diverse array of factors - cancer itself, its treatment or other causes. Studies have shown a high incidence of myofascial pain syndrome (MPS) in patients with cancer and the knowledge of myofascial trigger points (MTrPs) is important to address and manage existing pain, and to prevent the recurrence of pain. This review aims to summarize recent advances in interventions for managing MPS in patients with cancer., Recent Findings: Database searches were conducted on MEDLINE, CINAHL, and Google Scholar to locate all studies published from inception until April 2019 using the keywords cancer pain, myofascial pain, TrPs with emphasis of any methodological quality that included interventions for MPS. MPS in advanced cancer patients are more commonly observed along with other cancer pains rather than independently with a prevalence of 11.9-48% in those patients diagnosed with cancer of head and neck and breast cancer., Summary: Interventional therapies employing ultrasound guided injection of the MTrPs is gaining popularity in the management of MPS in cancer pain and may be a better alternative than the use of opioid analgesics in the multidisciplinary management.

Objectives : To evaluate the clinical effect of sciatic neural mobilization in combination with the treatment of surrounding structures for sciatica patients. Secondly, we were also interested in identifying possible baseline characteristics that may be associated with improvements in pain and disability for sciatica patients. Methods : Twenty-eight patients with a clinical diagnosis of sciatica were treated with neural mobilization, joint mobilization and soft tissue techniques. Pain intensity and lumbar disability were assessed at baseline and after treatment using a Numerical Rating Scale (0-10) and the Oswestry Disability Index (0-100), respectively. The pre- and post-intervention data were compared. The research protocol was registered under the number NCT03663842. Results : Participants attended an average of 16 (SD±5.6) treatment
sessions over an average of 12 weeks. Decrease in pain scores (before median = 8, after median = 2; p < 0.001) and improvement in lumbar disability scores (before median = 33.3%, after median = 15.6%; p < 0.001) were observed. A multiple linear regression analysis showed that duration of pain and age of the patient predicted the disability improvement: F (2, 24) = 4.084, p < 0.030, R 2  = 0.254. Discussion : Patients with sciatica may benefit from neural mobilization in combination with manual therapy for pain and lumbar disability. Longer pain duration and younger age had a negative influence on lumbar disability improvement.

The meninges are involved in various pathologies and are often directly or indirectly severed during surgical procedures, especially the dura mater. This can pose a real challenge for the surgeon, as a proper reconstruction of the meninges is important to prevent complications such as cerebrospinal fluid leak (CSF). A variety of techniques for dural reconstruction have been described, employing natural and artificial materials. A novel technique for dural reconstruction involves soft tissue grafts in the form of fibrous or fibromuscular flaps, which are placed on the dural defects to seal the gaps. These soft tissue grafts represent an appropriate scaffold for cell ingrowth and fibrosis, thus preventing CSF. In this pilot study, we described the application of soft tissue grafts for dural reconstruction in 10 patients who underwent convexity meningioma surgery.

Rey, E, Padrón-Cabo, A, Costa, PB, and Barcala-Furelos, R. Effects of foam rolling as a recovery tool in professional soccer players. J Strength Cond Res 33(8): 2194-2201, 2019-Foam rolling (FR) is a common strategy used after training and competition by players. However, no previous studies have assessed the effectiveness of FR as a recovery tool in sports populations. The aim of this study was to examine the effectiveness of FR (20 minutes of FR exercises on quadriceps, hamstrings, adductors, gluteals, and gastrocnemius) and passive recovery (20 minutes sit on a bench) interventions performed immediately after a training session on Total Quality Recovery (TQR), perceived muscle soreness, jump performance, agility, sprint, and flexibility 24 hours after the training. During 2 experimental sessions, 18 professional soccer players (age 26.6 ± 3.3 years; height: 180.2 ± 4.5 cm; body mass: 75.8 ± 4.7 kg) participated in a randomized fully controlled trial design. The first session was designed to collect the pretest values of each variable. After baseline measurements, the players performed a standardized soccer training. At the end of training unit, all the players were randomly assigned to the FR recovery group and the passive recovery group. A second experimental session was conducted to obtain the posttest values. Results from the between-group analyses showed that FR had a large effect on the recovery in agility (effect sizes [ES] = 1.06), TQR (ES = 1.08), and perceived muscle soreness (ES = 1.02) in comparison with the passive recovery group at 24 hours after training. Thus, it is recommended that soccer coaches and physical trainers working with high-level players use a structured recovery session lasting from 15 to 20 minutes based on FR exercises that could be implemented at the end of a training session to enhance recovery between training loads.

Objective: To investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain., Methods: Seventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days., Results: Current VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556)., Conclusion: Adding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Developmental coordination disorder (DCD), also known as dyspraxia, is a disorder emerging in childhood characterised by motor skill impairments. The motor difficulties often produce negative effects in other areas of life, such as poor self-esteem and reduced social interactions. One treatment used for DCD is fascia Bowen therapy, which involves stimulating the fascia tissues of the body using finger and thumb rolling movements over the skin to improve overall muscle movement. However, no studies to date have been reported testing the effectiveness of fascia Bowen in DCD., Methods: The present pilot study tested the effectiveness of 6 weeks of fascia Bowen in 10 boys aged 8-11 years with DCD. None of the boys had ever received treatment in any form before this study. Motor skills were assessed using the Movement Assessment Battery for Children-2 (MABC-2) and the DCD questionnaire, and psycho-social functioning was measured using the Self-Perception Profile, Spence Social Skills Questionnaire, and Strengths and Difficulties Questionnaire. All measures of interest were assessed before and after the therapy., Results: Results showed significant improvement in motor function post-intervention, with 60% of the children no longer clinically being classified as having a movement difficulty on the MABC-2. However, no significant improvements were seen in psycho-social measures, at least within the short time-frame of the therapy in the current study., Conclusions: The current pilot study revealed improvements in motor functioning after fascia Bowen therapy, across both performance and questionnaire measures, but that these improvements did not extend to wider areas of life. Further research in DCD is needed to test the effectiveness of fascia Bowen in larger studies with expanded ages and both genders over longer periods, including the generalisation of results of these longer interventions to different areas of life beyond motor ability., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to investigate whether the application of the integrated neuromuscular inhibition technique (INIT) combined with therapeutic exercise (TE) can provide faster and greater improvement in maximum isometric strength and isometric endurance of the neck muscles in patients with chronic mechanical neck pain (CMNP)., Methods: In this 10-week, single-blind clinical trial, 40 participants (men and women) with CMNP were divided into two groups. The intervention group (IG) followed a TE program in combination with the INIT, while the control group (CG) followed the same TE program without the INIT technique. Changes in maximum isometric strength and isometric endurance of the neck muscles were evaluated before, during, and after the intervention, with follow-up measurements taken at 1, 3, and 6 months after the intervention. Analysis of variance with repeated measures was applied., Results: Both groups showed a significant improvement in all dependent measures after the intervention (p < .05). These changes were maintained for both groups 6 months after the intervention. However, the IG showed a greater improvement in the maximum isometric strength of neck flexion and an improved craniocervical flexion test score compared with the CG., Conclusion: The combination of TE and INIT had a positive effect on neck muscle strength and endurance in individuals suffering from CMNP as compared with TE alone., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Myofascial release (MFR) is a form of manual therapy that involves the application of a low load, long duration stretch to the myofascial complex intended to restore optimal length, decrease pain and improve function. MFR is being used to treat patients with a wide variety of conditions, with favourable evidence supporting its efficacy. Critical appraisal of the recent research trials or reviews aims to improve the quality and reliability of future works in this field., Objective: This work attempts to examine and categorize the strength and limitations of current MFR research by critically appraising recent systematic reviews (SRs) to synthesise recommendations for improving quality and reliability of future clinical trials., Methodology: SRs on MFR published until 2018 were selected for this analysis. The methodological qualities of the SRs were assessed by AMSTAR II tool., Results: The SRs demonstrated moderate methodological quality. The overall confidence rating of the results of the review by AMSTAR II was low to moderate, mainly due to the omission of a risk of bias analysis in two of the reviews., Conclusion: This review concludes that the SRs analysed were completed with moderate methodological quality, but with procedural weaknesses and interpretation biases. The most recent review was qualitatively superior due to the inclusion of risk of bias analysis and effect size calculation. This critical appraisal and the derived recommendations can act as 'stepping stones' on which high quality future MFR trials and evidence can be built., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Richman, ED, Tyo, BM, and Nicks, CR. Combined effects of self-myofascial release and dynamic stretching on range of motion, jump, sprint, and agility performance. J Strength Cond Res 33(7): 1795-1803, 2019-Massage has been used as both a pre- and post-exercise modality with purported benefits to flexibility and athletic performance. This study was designed to determine the effect of a 6-minute protocol of self massage known as self-myofascial release (SMR) using a foam rolling device in conjunction with a general warm-up and sport-specific dynamic stretching (DS) session on flexibility and explosive athletic performance in a sample of 14 female collegiate athletes. After familiarization, participants completed 2 testing sessions that began with 5 minutes of jogging at a self-selected pace, followed by either a 6-minute foam rolling session (SMR) or 6 minutes of light walking (LW) and a subsequent 6-minute period of sport-specific DS. Sit-and-reach (SR) was measured after a general warm-up, the SMR, or LW session, and following DS, after which participants performed 3 trials each of squat jump (SJ), countermovement jump (CMJ), and drop jump (DJ). Two additional tests, the agility T-Test (TT) and a 10-yd short sprint (SP), were then performed. The change in SR after SMR was significantly greater than the change seen in SR after LW, although the total changes seen in each condition were not statistically different after the addition of DS. Squat jump and CMJ improved by 1.72 ± 2.47 cm and 2.63 ± 3.74 cm (p = 0.070, p = 0.070), with no significant change to DJ, SP, and TT. Self-myofascial release in the form of foam rolling after a general warm-up and preceding a DS session seems to improve SJ and CMJ with no detriment to flexibility, DJ, sprint, and agility performance in comparison with LW and DS.

Objective: To systematically review the effects of soft tissue mobilization (STM) on both surgical and non-surgical abdominal adhesion-related symptoms., Study Design: Systematic Review., Background: It is known that abdominal adhesions can cause a variety of symptoms with one of the most common being abdominal pain. To date, there is no known systematic review that documents the effects of STM on adhesion-related abdominal symptoms., Methods and Measures: A systematic review of literature was indexed in the following databases: PubMed, Cochrane, Google Scholar, OVID, and EBSCO. The quality of the studies was assessed using the MINORS scale., Results: Nine studies satisfied the eligibility criteria for this systematic review. The studies' population age ranged from 10.7 to 89.4 years. Four articles were nonrandomized and had scores ranging from 3 to 14 out of 16 total on the MINORS scale. Five articles were randomized controlled trials or comparative studies and scores ranged from 16 to 23 out of 24 total on the MINORS scale. There were five articles that used pain as an objective measure and all of them reported a decrease in pain after treatment. Two studies looked at quality of life and function and both saw objective improvements following abdominal adhesion treatment. Collectively, there were also improvements seen in scar mobility, infertility, posture, a reduction in medication, increased pressure tolerance and decreased postoperative ileus., Conclusion: The results of this review indicate preliminary strong evidence for the benefits of STM on symptoms relating to acute post-surgical adhesions, preliminary moderate evidence for the benefits of STM on symptoms relating to chronic non-surgical related adhesions (fertility and SBO) and moderate evidence for the benefits of STM on symptoms relating to chronic post-surgical adhesions., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Chronic ankle instability (CAI) is one of the most common syndromes that occurs following an initial ankle sprain. Sprains are often correlated with recurrent sprains, loss of range of motion (ROM) and deficits in proprioception and postural control. The objectives were to evaluate the effectiveness of Fascial Manipulation ® (FM) as a preventative measure in semi-professional athletes with CAI, and to monitor the symptomatology, equilibrium and ROM of the injured ankle. A single-blinded randomized controlled trial was conducted in the rehabilitation department of a medical centre. Twenty-nine semi-professional male footballers were recruited. Nine subjects with no previous symptomatology, were assigned to a baseline group, twenty symptomatic subjects were randomized into either the study or the control group. All three groups followed a specific training program. The control group followed normal training protocols and received standard medical care. The study group received an additional three FM treatment sessions. Symptomatology and ROM outcomes were recorded for all players at baseline, before each treatment for the treatment group, and at 1-, 3-, and 6-month follow-ups. At one year, an additional follow-up on was performed via phone. Four severe ankle traumas and one mild ankle trauma were reported in the control group during the trial period. The 6-month outcomes in the study group showed statistically significant improvements. The 1-year follow-up reported the absence of any reported trauma in the study group. FM was effective in improving ROM and symptomatology in footballers with CAI. FM intervention was effective in preventing injury in the study sample., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: To determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM., Methods: Sixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups., Results: The MANOVA found significant ROM differences between the three intervention groups (F 6,110  = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods., Conclusion: A single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Pain is a common complaint of cancer patients, experienced by 38%-85% of patients. Some studies have shown a high incidence of myofascial pain syndrome (MPS) in cancer patients., Aims: 1) To estimate the prevalence of MPS in cancer patients; 2) to examine the efficacy of current treatment options for MPS in cancer patients., Methods: Narrative review. PubMed, CINAHL, PEDro, and Google Scholar databases were searched from inception until November 2017, for the keywords: cancer; cancer pain; breast cancer; mastectomy; lumpectomy; myofascial pain; trigger points. Trials of any methodological quality were included. All published material with an emphasis on randomized control trials was analyzed., Results: MPS is prevalent in cancer patients who suffer from pain, with a prevalence of between 11.9% and 44.8% in those diagnosed either with neck or head or breast cancer. Clinical studies showed conflicting results. Four interventional studies found that specific treatment for MPS may reduce the prevalence of active myofascial trigger points and therefore decrease pain level, sensitivity, and improve range of motion (in shoulder) in cancer patients. Two recent randomized control trials showed that pressure release of trigger points provides no additional beneficial effects to a standard physical therapy program for upper limb pain and function after breast cancer surgery., Conclusions: We recommend including the evaluation of myofascial pain in routine clinical examination of cancer patients suffering from pain. Future studies are needed to investigate the long- and short-term effect of MPS treatments in cancer patients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Manipulative therapies include osteopathic manipulative treatment and many other forms of manual therapies used to manage a variety of conditions in adults and children. Spinal manipulative therapy may provide short-term improvement in patients with acute or chronic low back pain, comparable with other standard treatments. When compared with oral analgesics, cervical manipulation and/or mobilization appears to provide better short-term pain relief and improved function in patients with neck pain. Manipulative therapies may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intensity of pain. Although manipulative therapy is sometimes recommended to treat conditions in children (e.g., musculoskeletal problems, otitis media, respiratory conditions, infantile colic, allergies), there is supporting evidence only for reducing the length of hospital stay for preterm infants. Mild adverse events, such as muscle stiffness and soreness, occur in up to 50% of adults who undergo manipulative therapy. Although serious adverse events such as lumbar disk herniation, cauda equina syndrome, and vertebrobasilar injury are rare, they can cause significant disability or death. Given the limited proven benefits of manipulative therapies and small risk of serious adverse events, additional high-quality, adequately powered studies are needed before definitive recommendations can be made for treating many conditions.

Objectives: The goal of this study was to analyze skeletal, dental, and soft tissue changes of patients treated with customized lingual systems and to evaluate the clinical effectiveness of miniscrew anchorage., Methods: Nine upper first premolar extraction patients who were treated with customized lingual appliances were included in this study. Miniscrews were used for reinforcement of molar anchorage. Cephalometric films and study models were obtained before treatment (T1), after alignment (T2), and after treatment (T3). Treatment effects were analyzed by cephalometric radiographs and study models., Results: The upper anterior teeth were retracted significantly at T2 and T3 (4.41 ± 4.14 mm and 5.51 ± 2.48 mm, respectively). During space closure, the upper first molars showed slight mesial movement (1.50 ± 1.97 mm). The intercanine width of the upper arch increased at T2 (1.59 ± 1.81 mm), but decreased at T3 (0.11 ± 1.00 mm). The sella-nasion-A, A-nasion-B, and mandibular plane angles were not significantly changed at T3. The upper lip showed continuous retraction at both T2 and T3 (1.40 ± 1.46 mm and 2.32 ± 2.48 mm, respectively)., Conclusions: By using miniscrew anchorage for lingual orthodontics, patients' dental and soft tissue changes considerably improved and molar anchorage was reinforced.

Objective: Introduction: Today, chronic pain remains a pressing medical and socio-economic problem, despite the rapid development of medical technologies, the presence of a vast arsenal of drug and non-drug treatments. Estimates for chronic pain prevalence ranged from 8% to 60%. At the same time, about 40% of patients report insufficient effectiveness in the treatment of chronic pain syndrome. The aim of the study was to compare the effectiveness of MTrPS management by biomechanical correction of the musculoskeletal system combined with therapeutic exercises, DN and TrPs-pressure release with the effectiveness of MTrPS management by therapeutic exercises combined with DN and TrPs-pressure release in patients with chronic neck-shoulder myofascial pain and FHP., Patients and Methods: Materials and methods: 87 patients (mean age - 39±4,9 years) with chronic neck-shoulder myofascial pain and FHP were randomly assigned to 2 treatment groups. Group 1 received a biomechanical correction, DN, TrPs-pressure release. Group 2 - therapeutic exercises, DN, TrPs-pressure release. Study protocol included CVA-measurement, assessment of pain intensity with VAS, assessment of QoL using MOS SF-36., Results: Results: increase of CVA (59,07°±1,41 in the 1st group, and 51,2°±2,01 in the 2nd group (p=0,036)), decrease of pain and decrease of influence of neck pain in performance of everyday activities, the improvement of QoL immediately after treatment occurred in both groups. However, after 3 months of therapy, 1-st group revealed more improvement than the 2-nd., Conclusion: Conclusion: Comparison of the effectiveness of MTrPS management by biomechanical correction of the musculoskeletal system combined with therapeutic exercises, DN and TrPs-pressure release with the effectiveness of MTrPS management by therapeutic exercises combined with DN and TrPs-pressure release in patients with chronic neck-shoulder myofascial pain and FHP demonstrated no significant differences between the therapeutic approaches in the short term. In the medium term, the inclusion of biomechanical correction in the treatment protocol demonstrated higher efficiency compared with the combination of therapeutic exercises, DN and TrPs-pressure release.

Tension type headache (TTH), the most common type of headache, is known to be associated with myofascial pain syndrome and the existence of myofascial trigger points. There are several treatment options for myofascial trigger points. In this study we compared the effectiveness of dry needling and friction massage to treat patients with TTH. A convenience sample of 44 patients with TTH participated in this randomized clinical trial. The frequency and intensity of headache, pressure pain threshold at the trigger point site, and cervical range of motion were recorded. Then the participants were randomly assigned to one of two treatment groups for dry needling or friction massage, delivered in 3 sessions during 1 week. The participants were evaluated 48 h after the last treatment session. Analysis of covariance, paired t-test and Wilcoxon's test were used for statistical analysis. The results showed that both treatment methods significantly reduced headache frequency and intensity, and increased pain threshold at the trigger points. However, neither treatment had any effect on cervical range of motion except for extension, which increased in the dry needling group. Between-group comparisons showed that dry needling increased pain threshold significantly more than friction massage. There were no significant differences between groups in any other outcome variables. Dry needling and friction massage were equally effective in improving symptoms in patients with TTH. The decreases in frequency and intensity of headache were similar after both dry needing and friction massage., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Minimally invasive non-surgical techniques have been widely used worldwide to treat musculoskeletal injuries. Of these techniques, injectable pharmaceutical agents are the most commonly employed treatments, with corticosteroids being the most widely used drugs. The aim of this article is to review current scientific evidence as well as the effectiveness of minimally invasive non-surgical techniques, either alone or combined, for the treatment of plantar fasciitis., Methods: This systematic review was conducted from April 2016 until March 2017, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and was registered with PROSPERO. Randomized controlled trials (RCTs) of adult patients diagnosed with plantar fasciitis were included as well as intervention studies, with a minimal sample size of 20 subjects per study (10 per group). Assessment of study eligibility was developed by three reviewers independently in an unblinded standardized manner. The physiotherapy evidence database (PEDro) scale was used to analyse the methodological quality of studies., Results: Twenty-nine full-text articles on minimally invasive techniques were reviewed. These articles focused on corticosteroid injections, platelet-rich plasma, Botox, dextrose injections, as well as comparative studies with dry needling vs sham needling., Conclusion: The treatment of plantar fasciitis has dramatically improved in the past decade with minimally invasive techniques becoming increasingly available. Research findings have shown that the long term effects of minimally invasive (non-surgical) treatments such as shock wave therapy, botulinum toxin type-A injections, platelet-rich plasma injections and intratissue percutaneous electrolysis dry needling show similar and sometimes better results when compared to only corticosteroid injections. The latter have been the mainstay of treatment for many years despite their associated side effects both locally and systemically. To date, there is no definitive treatment guideline for plantar fasciitis, however the findings of this literature review may help inform practitioners and clinicians who use invasive methods for the treatment of plantar fasciitis regarding the levels of evidence for the different treatment modalities available., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Myofascial release (MFR) is used to restore tissue extensibility of the fascia tissue and is considered to be useful in a number of clinical settings such as low back pain, ankle injuries, fibromyalgia, and headaches. There is, however, despite the popularity of MFR in manual therapy, little consensus on whether it leads to biomechanical, systemic or interoceptive outcomes., Aims: This study aimed to explore the immediate biomechanical (increased elasticity for increased range of motion), systemic (local vs. distal areas of pain threshold) and bodily awareness effects (interoception) of a myofascial release technique on the thoracic spine., Method: Twelve healthy participants took part in this triple-bind, repeated measures, cross-over design study, and were randomised into counterbalanced sequences of three conditions; a control, a sham, and the MFR condition. The outcome measures used were; range of motion (ROM), pain pressure thresholds (PPT), and interoceptive sensitivity (IS) to assess biomechanical, systemic, and interoceptive effects of MFR., Results: There were significant increases in ROM and PPT (both local and distal) post MFR intervention. There was also a positive correlation between baseline interoceptive sensitivity and post-MFR ROM and a negative correlation for baseline interoceptive sensitivity and post-MRF PPT. Interoceptive sensitivity did increase post-MFR but this was non-significant., Conclusions: The increase in ROM suggests that the MFR may have caused a biomechanical change in tissue elasticity creating an increase in tissue flexibility. The increase in both local and distal sites of the PPT suggest an overall systemic response to the therapy. The correlation between baseline IS and post-MFR ROM and PPT suggest that IS may be usefully applied as a predictor for ROM and PPT post-MFR., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: Latent myofascial trigger points (TrP) can alter joint kinematics, reduce strength and alter activation patterns, affecting athletic performance. TrP sensitivity can be measured with the pressure pain threshold (PPT). Dry needling (DN) has been used to treat latent TrPs, but may cause post-needling soreness. Radial extracorporeal shockwave therapy (rESWT) could be used as an alternative to DN during heavy training or competition., Methods: After baseline measures, 21 recreational athletes were split into three groups: DN, rESWT or control group, and were treated for three sessions in one week. Follow-up outcome sessions were conducted two to four and seven days after the last treatment. TrP sensitivity was measured using the PPT., Results: There was a groupXtime interaction for the PPT (p < 0.05). After a decrease in PPT during treating, there was a significant increase (p < 0.05) in PPT for the DN group (12.92%). The rESWT group also significantly (p < 0.05) increased (13.26%), but did not show any post-treatment soreness during the treatment phase. There was no difference in the PPT in the control group during any session., Conclusion: DN is effective for increasing PPT of latent TrPs, but can be associated with post-treatment soreness. rESWT is as effective, but without the post-treatment soreness. Future studies should include treating multiple TrPs in the lower kinetic chain as well as measuring muscle activation and joint function. Furthermore, consideration for the current training load and up-coming competition is needed. Optimum timing and longer follow-up periods of such interventions should be explored., Level of Evidence: 2b., Summary: Treating latent TrPs in the lower kinetic chain may improve muscle activation. Unlike DN, rESWT does not cause post- treatment soreness. Consideration of training load and up-coming competition is needed to deliver the optimum treatment strategy for athletes with latent TrPs., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives and background: Tissue stabilized-guided subcision (TS-GS) treatment has emerged as a single session treatment for cellulite dimples. To date, studies on a few patients were reported. We present data concerning efficacy and safety of TS-GS for cellulite in a cohort of Italian patients. Patients and Methods: This is a retrospective study involving 122 patients requiring cellulite treatment, classified according to validate cellulite dimples scale at rest, at T0. TS-GS technique is assessed in terms of efficacy (masked evaluations of pre- and post-treatment pictures, satisfaction of patients and variations in cellulite dimples scale at rest), safety of results at 12 months follow-up (T1). U nivariate and multivariate analyses were carried out to evaluate variables associated with the size effect. Results: Masked evaluations of 112 patients completing the study resulted in the correct selection of pre- and post-treatment images in all cases and all patients were satisfied. The mean cellulite dimples scale at rest score improved ≥1 point at T1. We found a significant association between size effect, higher satisfaction ( p < .01), cellulite grading at T0 ( p < .01), higher BMI ( p = .037); a higher BMI was correlated to an increased cellulite grading at T0 ( p = .02). Only minor and temporary adverse events were reported. Conclusions: We confirm herein the clinical efficacy and safety of TS-GS for cellulite dimples treatment in a cohort of Italian patients assessed with the validated cellulite dimples scale at rest.

Background: Adolescent idiopathic scoliosis (AIS) is a common orthopedic condition with a prevalence of 2%-3% in children aged 10-16 years. Conservative interventions remain controversial and are usually based on physical therapy exercises and treatments. Manual therapy techniques may also serve as adequate treatments for AIS due to their ability to improve range of motion and decrease muscle tone and pain., Objective: To critically assess the current literature on the effectiveness of manual therapy methods used to treat AIS., Methods: PubMed, PEDro, BioMed Central, and Google Scholar databases were searched from inception until December 2016 using keywords associated with scoliosis and manual therapy. Criteria for inclusion were studies investigating the effect of manual therapy methods on AIS treatment. We analyzed all published material with an emphasis on randomized controlled trials (RCT). Trials of any methodological quality written in English were included in the review., Major Findings: Fourteen papers were reviewed, all presenting manual therapy treatments such as manipulation, mobilization, and soft tissue techniques used to treat AIS. All case studies showed a significant improvement, post-treatment, in most measured parameters. Observational studies showed mixed results. Only one RCT concluded manual therapy techniques were ineffective in improving trunk morphology and spine flexibility in AIS patients., Conclusion: Case reports and small-scale clinical trials of poor methodological quality presented in this review did not allow us to draw a clear conclusion about the effectiveness of manual therapy in the treatment of AIS. On the other hand, they provide us a basis to assume that manual therapy techniques such as myofascial release and spinal manipulative techniques may potentially be effective in treating AIS in conjunction with other conservative treatments. Further high-quality studies are essential to determine the effectiveness of the different manual therapy techniques., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Abdominal wall pain is considered as pain that arises from the abdominal muscles rather than the underlying viscera or the spine. It is frequently overlooked and is often misdiagnosed, as these patients continue to suffer with pain. Many such patients would have even been subjected to a psychiatric evaluation in view of the absence of any ostensible clinical cause for the pain. In this study, we describe the role of myofascial trigger points in the abdominal wall pain that could be a cause of chronic pain and present our findings of pain relief by dry needling technique., Objectives: To report the effect of dry needling treatment for patients who suffer from chronic abdominal wall pain of uncertain etiology and in whom specific myofascial trigger points were identified., Methods: Twelve patients diagnosed with chronic abdominal wall pain were included in the study. All patients were clinically evaluated and subjected to a combination of imaging techniques. Once categorized as patients suffering from chronic abdominal wall pain, they were subjected to a thorough palpation of the abdominal wall to identify the presence of myofascial trigger points (MTrPs) over the abdominal muscles. All had MTrPs over one or more abdominal muscles either unilaterally or bilaterally. Dry Needling using a standard technique was done based on the side and localization of the myofascial trigger points. Numerical pain rating scale (NPRS) was used to measure pain before and after treatment and at the end of four months. All patients were then seen by the primary clinician and re-evaluated., Results: Eleven out of twelve patients had significant reduction with a mean difference 5.95 in NPRS in their pain levels at four months follow up. Seven patients had complete resolution of the pain. Some patients had improvement in complaints such as Dysmenorrhea, Urinary Frequency and constipation., Conclusion: Dry Needling can be a useful adjunct in treating chronic abdominal wall pain especially in those patients in whom Myofascial Trigger Points in the muscles of abdomen are identified by palpation., Level of Evidence: Level 4., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Connective tissue mobility alters motor unit recruitment, but the restoration of fascial mobility allows for optimal motor function. The Fascial Manipulation ® (FM ® ) method is a multiplanar approach that assesses and treats the mobility of deep fascia in specific anatomical locations where motor units converge., Objectives: To assess the effects of FM ® vs. standard physical therapy treatment (SPT) in patients with low back pain (LBP)., Design: Six-months controlled clinical trial., Method: 102 participants with LBP received SPT or FM ® . Numeric Pain Rating Scale (NPRS), 15- point Global Rating of Change (GROC), and Oswestry Disability Index (ODI) were used to monitor progress., Results: The FM ® group had a significantly lower ODI (p < 0.009) and NPS scores (p < 0.0001) and significantly higher GROC scores (p < 0.003) once their means were adjusted for initial scores. When comparing the SPT to FM ® , the final ODI decreased by at least 1 category in 48.9% of the SPT cases, while in 36.2% of the cases was no change. ODI minimal clinical importance difference (MCID) change of 10% decrease in scores occurred in 70.2% of the SPT group compared to 96% of the FM ® group (p = 0.003). ODI MCID change of 50% decrease in scores occurred in 40% of the SPT group compared to 64.6% of the FM ® group (p = 0.02) 44.7% of the participants in the SPT group had final GROC values above +5 at discharge, compared to 92% of the participants from the FM ® group (p = 0.0001). The FM ® subjects had almost three times the change in NPRS compared to SPT counterparts (-4.3 ± 2.2 to -1.5  ± 2.4, p=0.0001)., Conclusions: FM ® appears to improve NPRS, GROC, and ODI more than SPT. FM ® may provide an effective treatment technique for LBP., (Copyright © 2018 Elsevier Ltd. All rights reserved.)