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A prevalent musculoskeletal condition that has a substantial socioeconomic impact and causes considerable morbidity is chronic shoulder pain (CSP). CSP may result from a dysfunction of the upper quarter region's (UQR) myofascial continuum (MC), which is connected by deep fascia. Fascial Manipulation® (FM), proposed by Luigi Stecco, involves deep kneading performed at specific points on the deep fascia. FM is considered to reinstate the gliding of the fascial layers, thus may aid in the reduction of pain and improvement of shoulder function. This study aims to determine the influence of FM on shoulder pain, passive range of motion (PROM), and function in participants with CSP. Single group, pretest-posttest design. Eighteen individuals with CSP aged 18–45 years were recruited. FM was applied to the painful and densified centre of coordination (CC) points on the MC of the UQR based on Stecco's FM method. The therapist performed the baseline, post-treatment, and numerical pain rating scale (NPRS) at rest and during activity, PROM, and pressure pain threshold (PPT). The follow-up measurements were done after seven days following the FM intervention. Also, the baseline and follow-up measurements of disability of arm, shoulder, and hand (DASH) score were performed. A considerable improvement in all shoulder PROM (p < 0.01), DASH score (p = 0.01), and pain reduction (p = 0.01) following FM were observed. However, the PPT showed no differences following FM (p > 0.05). FM may be an effective treatment strategy in reducing pain and improving shoulder range of motion and function in patients with CSP. [ABSTRACT FROM AUTHOR]

This prospective study aimed to determine the impact of Fascial Manipulation® by Stecco (FM) on the range of motion (ROM) of internal rotation (IR) and horizontal adduction (HADD) in asymptomatic handball players, representing significant risk factors for shoulder injuries. A randomized controlled trial was conducted, with participants randomly assigned to either the investigated group (N = 29) receiving a single session of FM or the control group (N = 27) receiving no treatment. The ROM for IR and HADD were measured before, immediately after, and one month after the FM session. The investigated group experienced a statistically significant acute increase in glenohumeral IR (14 degrees, p < 0.001) and HADD (14 degrees, p < 0.001) compared to the control group (p < 0.001). The positive effects of FM persisted one month post-treatment, with increased IR ROM by 12 degrees (p < 0.001) and HADD ROM by 11 degrees (p < 0.001). Participants in the investigated group reported lower subjective tightness/stiffness immediately after (p < 0.001) and one month after treatment (p = 0.002) compared to the control group. This study demonstrates that a single application of FM effectively improves glenohumeral ROM in the dominant throwing shoulder of asymptomatic handball players. It highlights the immediate and sustained positive effects of FM on IR and HADD. These findings support the use of FM as an effective method for enhancing shoulder ROM and reducing subjective tightness/stiffness. The study was registered at ClinicalTrials.gov (NCT06009367). [ABSTRACT FROM AUTHOR]

One of the objectives of this study is to determine the effect of the eight-week fascial therapy program on flexibility, vertical jump, standing long jump, speed and anaerobic strength parameters in taekwondo athletes. Another aim of the research is to create a therapy protocol that can be used in athletes related to performance development through the relaxation of the fascial system, which is considered an indicator of physical fitness and has numerous functions in the body. This study included 32 taekwondo players who were licensed, actively attending taekwondo training. In the study, two groups were formed as fascial therapy group (FTG) (n ​= ​16) and control group (CG) (n ​= ​16). After the groups were randomized, fascial relaxation techniques were applied to the fascial therapy group for eight weeks, up to twice a week, and for 30 ​min. According to the findings obtained as a result of the research, FTG ([−0.36 ​± ​0.17] seconds [s]) for the 20 ​m (m) Sprint (T2–T1) had a lower mean time than CG (0.00 ​± ​0.07) s, FTG (0.06 ​± ​1.95) for the Flamingo Balance Test (T2–T1) had a lower mean fall than CG (1.25 ​± ​1.13), FTG ([3.56 ​± ​2.37] centimeters [cm]) for the Sit & Reach Test (T2–T1) had a lower mean fall than CG ([−0.19 ​± ​1.28] cm), FTG ([5.75 ​± ​2.54] cm) had a higher jump distance than CG ([1.88 ​± ​8.11] cm) according to the results of Vertical Jump Test (T2–T1) and finally FTG ([9.13 ​± ​5.56] cm) had a longer distance than CG ([−0.31 ​± ​1.85] cm) according to the results of Standing Long Jump Test (T2-T1). The result of our study has shown that fascial techniques can be used safely by experienced physiotherapists and can be included in the training program. It is recommended that coaches of sports disciplines work with experienced physiotherapists on this subject and include fascial methods in their training programs.

Abstract Background Neck pain is among the common musculoskeletal problem that hinders a person’s daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion. Objective The purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain. Methods A randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18–40 years with chronic neck pain of at least 3–6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied. Results The mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p

It is a common experience, reported by patients who have undergone manual therapy that uses deep friction, to perceive soreness in treatment areas; however, it is still not clear what causes it and if it is therapeutically useful or a simple side effect. The purpose of this narrative review is to determine whether manual and physical therapies can catalyze an inflammatory process driven by HA fragments. The literature supports the hypothesis that mechanical stress can depolymerize into small pieces at low molecular weight and have a high inflammatory capacity. Many of these pieces are then further degraded into small oligosaccharides. Recently, it has been demonstrated that oligosaccharides are able to stop this inflammatory process. These data support the hypothesis that manual therapy that uses deep friction could metabolize self-aggregated HA chains responsible for increasing loose connective tissue viscosity, catalyzing a local HA fragment cascade that will generate soreness but, at the same time, facilitate the reconstitution of the physiological loose connective tissue properties. This information can help to explain the meaning of the inflammatory process as well as the requirement for it for the long-lasting resolution of these alterations. [ABSTRACT FROM AUTHOR]

One of the objectives of this study is to determine the effect of the eight-week fascial therapy program on flexibility, vertical jump, standing long jump, speed and anaerobic strength parameters in taekwondo athletes. Another aim of the research is to create a therapy protocol that can be used in athletes related to performance development through the relaxation of the fascial system, which is considered an indicator of physical fitness and has numerous functions in the body. This study included 32 taekwondo players who were licensed, actively attending taekwondo training. In the study, two groups were formed as fascial therapy group (FTG) (n = 16) and control group (CG) (n = 16). After the groups were randomized, fascial relaxation techniques were applied to the fascial therapy group for eight weeks, up to twice a week, and for 30 min. According to the findings obtained as a result of the research, FTG ([-0.36 = 0.17] seconds [s]) for the 20 m (m) Sprint (T2-T1) had a lower mean time than CG (0.00 - 0.07) s, FTG (0.06 - 1.95) for the Flamingo Balance Test (T2-T1) had a lower mean fall than CG (1.25 - 1.13), FTG ([3.56 - 2.37] centimeters [cm]) for the Sit & Reach Test (T2-T1) had a lower mean fall than CG ([-0.19 - 1.28] cm), FTG ([5.75 - 2.54] cm) had a higher jump distance than CG ([1.88 - 8.11] cm) according to the results of Vertical Jump Test (T2-T1) and finally FTG ([9.13 - 5.56] cm) had a longer distance than CG ([-0.31 - 1.85] cm) according to the results of Standing Long Jump Test (T2-T1). The result of our study has shown that fascial techniques can be used safely by experienced physiotherapists and can be included in the training program. It is recommended that coaches of sports disciplines work with experienced physiotherapists on this subject and include fascial methods in their training programs. [ABSTRACT FROM AUTHOR]

Background: Neck pain is among the common musculoskeletal problem that hinders a person's daily activities. Fascial tightness is a familiar cause of chronic neck pain that is often neglected and can further cause neck disability and a limited range of motion. Objective: The purpose was to compare the effects of fascia therapy and fascial manipulation on pain, range of motion and function in patients with chronic neck pain. Methods: A randomized clinical trial was conducted from February to August 2022 in the Riphah Rehabilitation Centre, Lahore, Pakistan. Fifty-two participants of both genders, aged 18–40 years with chronic neck pain of at least 3–6 months were included. Group A (n = 26) received fascia therapy along with a conventional physical therapy protocol of hot pack, strengthening and stretching, while group B (n = 26) received the fascial manipulation treatment with conventional physical therapy. All the participants were assessed at baseline and after 3 weeks (3 sessions per week). Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometer (range of motions) were the outcome measures. SPSS 25 was used for the data analysis and normality of the data through the Shaphiro-Wilk test (p > 0.05), and parametric tests were applied. Results: The mean age of group A was 24.82 ± 2.64 years, and group B was 24.17 ± 2.20 years. The independent t-test result showed no significant difference (p ≥ 0.05) in all parameters except in cervical extension and right-side bending (p < 0.05). At the same time, the pair-wise comparison showed significant results (p < 0.05) for all outcome measures in both groups. Conclusion: DBM fascia therapy improved cervical extension and side bending (right) more than the fascial manipulation group.It is concluded that DBM fascia therapy shows more improvement as compared to other group. Trial registration number: This study was registered at ClinicalTrials.gov ID: NCT05272111 on 09/03/2022. [ABSTRACT FROM AUTHOR]

Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results. [ABSTRACT FROM AUTHOR]

Naprapathy is an integrative medicine therapy that can aide in decreasing medical costs by assisting in pain management and improving overall function in individuals experiencing musculoskeletal pain and dysfunction. Naprapathy was developed in 1907 by Oakley Smith. Naprapathy treats musculoskeletal pathologies by using connective tissue tension found within the vertebral column and peripheral joints with an emphasis on ligamentous tension. Current scientific studies have emphasized the role of fascia and its importance to manual medicine. Fascia has many properties including assisting in venous return, dissipation of tensional stress, pain, proprioception, and coordination of movement. Fascial restrictions occur when there is lack of glide between the fascial layers. These restrictions can be released with the utilization of different methods of fascial manipulation. Compared to other manual therapies, naprapathy has its own set of diagnostic tools and protocols emphasizing the treatment of fascial restrictions, stretching of buckled ligaments and tracing tension to the musculoskeletal system It includes within its scope of practice dietary counseling in conjunction with vitamin and mineral supplementation for assistance in decreasing pain and inflammation. Several organizations and schools throughout the U.S. and internationally promote the discipline of naprapathy with the goal of advancing the profession by preparing practitioners at the doctorate level, treating patients, and using evidence-based medicine providing support for the efficacy of naprapathy and its interventions.

Chronic pain is one of the biggest health problems concerning public healthcare at present. It is often associated with other complaints like fatigue, anxiety and depression and one of the major causes for inability to work and loss of productivity in general. Conventional therapy of chronic pain consists of elaborated treatment approaches that are often costly and limited in their generalizability as they come with severe risks and side-effects when employed long-term. Concerns about feasibility, sustainability and effectiveness raise the need for better understanding the processes involved with long-term pain and developing innovative treatment concepts. This narrative review aims at giving an overview of emerging fields of research like psycho-neuro-immunology, stress economy and fascial tension that are relevant to modern pain therapy, thus stressing the importance of including stress response, increased inflammatory activity, adverse childhood events, lack of personal resources and proprioceptive identity into a sustainable treatment approach. It further explores those clinical strategies and practices like manual therapy, acupuncture, body awareness techniques and psychotherapy which have already been well-researched and found effective, but are not part of regular treatment yet. Especially the intersection of trauma, ongoing psychological stress and pain can be understood by the idea of crystallization of inner tension into fascial adhesions and the modulation of the proprioceptive self. These avenues of experimental and clinical research are then discussed within the framework of integrative therapy that allows to include aspects of psychosomatics, salutogenesis, spirituality and traditional medical knowledge in an inclusive and approachable way. [ABSTRACT FROM AUTHOR]

Low back pain is one of the most common musculosceletal disorder and it has multifactorial etiology. It is considered to be the leading cause of global disability. It is the most frequent cause of activity limitation that can, eventually, result in disability, decreased quality of life, and work absenteeism. Low back pain manifests in different forms - acute, subacute and chronic. Within clinical examination it is a collected anamnesis, a general examination and functional testing from each patient. The importance of physical activity in the treatment of low back pain is generally accepted. However, an increase in physical activity has been suggested to be both a preventive factor and a possible risk factor for low back pain. There is an evidence for an association between high physical workloads and back injury. Treatment of low back pain includes many different types of exercises and physical therapy. Fascial manipulations has showed a great effectiveness in the treatment of low back pain in the general population, but also among the athletes. DOI: https://doi.org/10.24040/sjss.2022.8.2.2-11

Background: There are many therapeutic methods targeting fascia. However, the only method whose basic assumption is to eliminate the densification of fascia is Fascial Manipulation. Objective: To evaluate the effectiveness of various Fascial Manipulation (FM) protocols in reducing myofascial pain. Design: Randomized control trial. Subjects: A total of 54 individuals, aged 18–29 years, with musculoskeletal pain for at least 1 week. Methods: The patients were divided into four groups subjected to different treatment protocols: group 1—underwent the standard FM treatment protocol (STP), group 2—modified protocol (MTP), group 3—modified protocol 2 (MTP2), and the control group (CG)—did not undergo any therapy. Each protocol involved three treatments at intervals of 7–10 days and a follow-up examination after 30 days. The outcome was pain level measured using the VAS. Results: In the STP, all the measurements showed a significant decrease in pain level—the mean difference was 2.077 after the first treatment, 3.462 after the third treatment and 3.385 in the follow-up. In the MTP, a significant mean difference was noted after the third treatment, 3, and in the follow up, 2.4. In the MTP2, it was noted after the third session, 2, and in the follow up, 2.25. Only the CG group did not display significant changes. Conclusions: FM-based therapy results in pain relief. However, there are differences in the dynamics and durability of the results depending on the chosen protocol. [ABSTRACT FROM AUTHOR]

Shoulder pain is a serious clinical disease frequently related to absence from work. It is characterized by pain and stiffness, probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physiotherapy program has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could obtain better improvement regarding pain, strength, mobility, and function. A total of 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a five-session physiotherapy program; the study group (SG) underwent three sessions of physiotherapy and two sessions of fascial manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow-up visit, a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to obtain better results.

The integrity of connective tissue sheaths surrounding the nerves influences both the severity and the potential for recovery of brachial plexus lesions. This study presents an innovative, early onset, multidisciplinary approach to obstetric brachial plexus palsy. This approach is aimed at functional recovery of the nerve lesion and includes mobilization of the fascia using the Fascial Manipulation® method. This case study discusses how, in addition to conventional treatment, interventions aimed at the fascial system can potentially affect tension around the neural sheaths, enhance proprioceptive input and facilitate movement to influence obstetric brachial plexus palsy outcomes. [ABSTRACT FROM AUTHOR]

Low back pain is one of the most common musculosceletal disorder and it has multifactorial etiology. It is considered to be the leading cause of global disability. It is the most frequent cause of activity limitation that can, eventually, result in disability, decreased quality of life, and work absenteeism. Low back pain manifests in different forms - acute, subacute and chronic. Within clinical examination it is a collected anamnesis, a general examination and functional testing from each patient. The importance of physical activity in the treatment of low back pain is generally accepted. However, an increase in physical activity has been suggested to be both a preventive factor and a possible risk factor for low back pain. There is an evidence for an association between high physical workloads and back injury. Treatment of low back pain includes many different types of exercises and physical therapy. Fascial manipulations has showed a great effectiveness in the treatment of low back pain in the general population, but also among the athletes. [ABSTRACT FROM AUTHOR]

BackgroundFascial Manipulation® (FM®) is a manual method of treatment created by Luigi Stecco that centres on the muscular fascia. Fascia is a fibrous collagenous tissue which, with its wide strands, connects all the connective tissues in the body into a whole. Fascia can also cause restriction of motion of the organs as a result of an injury, inflammation or infection. FM® technique bases on identification and therapy of specific points, which are located at the point of convergence of the vectorial forces of the muscles involved in every movement. The aim of this literature review was to analyze publications on the use of FM® in treatment of pain and functional dysfunctions.Materials and methodsMaterial for this literature review was found by two independent authors using PubMed, Cochrane library, ScienceDirect and PEDro databases. In order to identify appropriate studies, a combination of keywords ,,fascial manipulation”, „pain”, „dysfunction” was used. Finally, 10 publications were qualified for a literature review.ResultsIn the analyzed ten publications, improvement after treatment, reduction of pain and better functional outcome in patients conditions were figured. Six authors had some similar conclusions which state that the positive results of treatment last over time. One study presented opposite findings and state that the treatment has not brought long-lasting effects. ConclusionsConsidering all the reports on this subject, it is suggested that FM® therapy is worth considering in treatment of pain disorders, orthopaedic dysfunctions and postural disabilities. Further research of the subject on whether the treatment results are sustainable is necessary.

We assessed effectiveness of Fascial Manipulation (FM) in reducing densification thickness and associated acute pain in normal humans. Fascial densifications were identified using palpation and measured with diagnostic ultrasound within self-reported painful somatic regions. Pain intensity ratings were obtained in response to deep palpation of the self-reported painful somatic region before and after a brief FM intervention. Brief FM resulted in reduced densification thickness as well pain intensity. Sex differences were found neither in densification thickness nor pain intensity at any time point. However, a statistically significant positive correlation between densification thickness and pain intensity was observed in females but not males at both pre-FM and post-FM time points. As such, FM may be an effective therapeutic approach for acute pain associated with fascial densifications. While males and females exhibited comparable densification thickness and pain intensity levels at both pre-FM and post-FM time points, only females showed a statistically significant relationship between pain and densification, suggesting that females may be better able to perceive subtle differences in the magnitude of noxious sensory input.

We assessed effectiveness of Fascial Manipulation (FM) in reducing densification thickness and associated acute pain in normal humans. Fascial densifications were identified using palpation and measured with diagnostic ultrasound within self-reported painful somatic regions. Pain intensity ratings were obtained in response to deep palpation of the self-reported painful somatic region before and after a brief FM intervention. Brief FM resulted in reduced densification thickness as well pain intensity. Sex differences were found neither in densification thickness nor pain intensity at any time point. However, a statistically significant positive correlation between densification thickness and pain intensity was observed in females but not males at both pre-FM and post-FM time points. As such, FM may be an effective therapeutic approach for acute pain associated with fascial densifications. While males and females exhibited comparable densification thickness and pain intensity levels at both pre-FM and post-FM time points, only females showed a statistically significant relationship between pain and densification, suggesting that females may be better able to perceive subtle differences in the magnitude of noxious sensory input. [ABSTRACT FROM AUTHOR]

Introduction and objective Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points – coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. Material and methods For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body’s temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. Results The average surface temperature of the treated area before mobilization was 33.4°C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p

Background and Objectives: Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases. In literature, it emerges that the “fascia”, by its anatomical continuity, if altered or densified in different regions of the body with respect to the sacroiliac joint and its surroundings, may have a fundamental role in the genesis of SIJD and low back pain. The purpose of the present study is to evaluate the effectiveness of incorporating a single session of Fascial Manipulation®-Stecco method®, treating the muscular fasciae at distance from the painful region. Materials and Methods: Twenty patients with acute and chronic sacroiliac joint dysfunction (SIJD) were recruited (16 males and 4 females, mean age of 46.6 ± 12.98 years). Patients underwent a predefined assessment protocol, followed by an evaluation of myofascial pain and subsequent manipulation of the fascia at points at least 20 cm away from the posterior inferior iliac spines (PIIS). Each patient underwent three pain evaluations: pre-treatment (t0), post-treatment (t1), and at a 1-month follow-up (t2). For the evaluation in t0, t1 the numerical rating scale (NRS) for the intensity of pain and the algometer for the pain threshold at the PIIS were used; in t2 only the NRS scale. Results: The results obtained by comparing the algometer measurements with the NRS values between t0 and t1 were in both cases statistically significant (p < 0.0001), whereas the comparison between the NRS values at t1 and at t2 was not statistically significant (p > 0.05). Conclusions: A single Fascial Manipulation treatment, even when applied at least 20 cm from the PIIS, can potentially decrease pain around the SIJ. The inclusion of this type of approach in SIJD can allow for improved patient management, better tolerance for other treatments and a more rapid application of pain-free exercise programs. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders, affecting up to 90% of people at some point in their lifetime. Up to 50% will have more than one episode of back pain. Previous studies have highlighted the benefits of fascial manipulation for chronic low back pain over manual therapy alone. But early detection of densification of specific points in the lateral thigh region in low back pain subjects in an acute phase itself will be of benefit in resolving the back pain as the deep friction on these points aims at restoring the physiological gliding properties of the fascia and lead to immediate pain relief in the low back, increased range of motion and improved functions. Methods: Sixty individuals were enrolled for the study and were randomly allotted to two groups using a simple random method, were samples were randomly allocated by the primary investigator before baseline assessment. Control group subjects in Group A received conventional exercises, including core stability exercises. Experimental group subjects in Group B received Fascial manipulation to the lateral aspect of the thigh region in the lower limb. Both the groups received interferential therapy for 20 minutes as a part of conventional treatment for low back pain for 15 days. The subjects were assessed for their pain level, using NPRS score, and range of motion (ROM) was assessed to find any restriction in the lumbar region due to fascial densification. The functional activities of daily life were assessed using the ODI scale. The above scores were recorded before and after the interventions for both the groups. Results: The pre-test and post-test results were analyzed using a Paired and Unpaired t-test. The outcome measures of the Numeric Pain Rating Scale, Modified Schober's test, the Oswestry Disability Index were used for the study. A comparison of post-test values between Group A and Group B using unpaired t-test revealed a significant difference of p

An inter and intra rater reliability (INTERR and INTRAR) study was designed. 71 subjects, with primary hip coxarthrosis, were included and randomly divided in a study group (SG= 36) and a control group (CG= 35) to assess the efficacy of the Fascial Manipulation® (FM®) method. The primary objective was the assessment of INTERR and INTRAR about movement verification (MV) and palpation verification (PV) of FM® performed by two physiotherapists (PtA and PtB). The secondary objective was evaluate the efficacy of FM® through MV, PV and pain score. Pain was assessed using the Numeric Rating Scale (NRS). SG received three weekly sessions of FM® byPtA. PtB re-evaluated all the subjects at the end of the study. Results of the INTERR analysis showed for SG: MV (ICC= 0.92, k= 72.7%); PV (ICC= 0.91, k= 75.7%). For CG : MV (ICC= 0.95, k= 84.2%); PV (ICC= 0.90, k= 75%). Results of the INTRAR analysis for SG reported: MV (ICC= 0.82, k= 74,8%); PV (ICC= 0.60, k= 46.8%); for CG: MV (ICC= 0.93, k= 78.7%); PV (ICC= 0.84, k= 53.3%). Statistical significance were reported in NRS (p = 0.001), MV (p = 0.0003) and PV (p < 0.0001) with better results for SG using "Intention To Treat" method. This study demonstrates that FM® assessment procedures have a high reliability even if applied by practitioners with basic experience. Furthermore FM® treatment can improve pain and ROM in individuals with primary coxarthrosis [ABSTRACT FROM AUTHOR]

Background and Objectives: Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases. In literature, it emerges that the “fascia”, by its anatomical continuity, if altered or densified in different regions of the body with respect to the sacroiliac joint and its surroundings, may have a fundamental role in the genesis of SIJD and low back pain. The purpose of the present study is to evaluate the effectiveness of incorporating a single session of Fascial Manipulation®-Stecco method®, treating the muscular fasciae at distance from the painful region. Materials and Methods: Twenty patients with acute and chronic sacroiliac joint dysfunction (SIJD) were recruited (16 males and 4 females, mean age of 46.6 ± 12.98 years). Patients underwent a predefined assessment protocol, followed by an evaluation of myofascial pain and subsequent manipulation of the fascia at points at least 20 cm away from the posterior inferior iliac spines (PIIS). Each patient underwent three pain evaluations: pre-treatment (t0), post-treatment (t1), and at a 1-month follow-up (t2). For the evaluation in t0, t1 the numerical rating scale (NRS) for the intensity of pain and the algometer for the pain threshold at the PIIS were used; in t2 only the NRS scale. Results: The results obtained by comparing the algometer measurements with the NRS values between t0 and t1 were in both cases statistically significant (p < 0.0001), whereas the comparison between the NRS values at t1 and at t2 was not statistically significant (p > 0.05). Conclusions: A single Fascial Manipulation treatment, even when applied at least 20 cm from the PIIS, can potentially decrease pain around the SIJ. The inclusion of this type of approach in SIJD can allow for improved patient management, better tolerance for other treatments and a more rapid application of pain-free exercise programs.

Introduction and objective. Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points – coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. Materials and method. For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body’s temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. Results. The average surface temperature of the treated area before mobilization was 33.4 °C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p<0.001). However, the highest temperature was observed 24 hours after mobilization (increase of 2.4 °C). The difference between the first and 7 other measurements was statistically relevant (p<0.001). Conclusion. The statistically relevant increase in temperature under the influence of fascial manipulation® in the treatment area can confirm the occurrence of inflammatory reaction. [ABSTRACT FROM AUTHOR]

Introduction. Fascial manipulations have received attention in the treatment of chronic low back pain (CLBP). The purpose of this study is to investigate the effectiveness of fascial manipulation on pain, flexibility, functional level, and kinesiophobia in patients with CLBP. Methods. Overall, 55 individuals with a history of CLBP, without neurological deficits, lumbar disc herniation, lumbarization, spondylosis, or lumbar surgical history were included in the study. The participants were randomly divided into 2 groups depending on the patient protocol numbers. Subjects with odd protocol numbers were assigned to the study group (fascial manipulation) and those with even numbers to the control group (conventional physiotherapy). Both groups were assessed before and after the treatment in terms of pain, flexibility, functional level, and kinesiophobia. Results. There were significant differences after both treatment methods in terms of pain, functional level, and flexibility (p < 0.05). However, pain levels decreased more statistically significantly in the fascial manipulation group than in the control group (p < 0.05). No significant difference was observed between the groups in terms of functional level, flexibility, or kinesiophobia after the treatment (p > 0.05). Conclusions. We stated that fascial manipulation was more effective on pain than conventional physiotherapy methods (hot pack, microwave diathermy, interferential flow-vacuum applications, posterior pelvic tilt and abdominal exercises, stretching hip flexors and lumbar extensors) in patients with CLBP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Spasticity, a common complication of cerebral palsy (CP), significantly impacts patients' functionality and quality of life. We present the case of a 46-year-old man diagnosed with CP. Despite childhood outpatient rehabilitation, his condition remained unchanged. In 2024, he relies on a wheelchair and third-party assistance due to spastic quadriplegic palsy. This study aimed to assess the effectiveness of Fascial Manipulation (FM) on joints range of motion (ROM). Before therapy, ROM was evaluated using a goniometer. The six-week FM therapy, combined with resistance exercises, improved ROM in all joints except the left hip. FM shows promise in enhancing limbs joints ROM for CP patients. Aim: Improve ROM in humeral, cubital, radiocarpal, hip, genu and ankle joints in a person suffering from CP by applying FM. Material and methods: Male, born on April 18, 1978, experienced hormonally induced labor. Intrauterine infection detected at birth led to juvenile CP diagnosis at 3 months. Currently, patient suffers from spastic quadriplegia, hypertonia, myoclonia. Therapy consisted of six sessions of FM weekly, along with resistance exercises. ROM in joints was assessed using a goniometer in the supine position before therapy, evaluated by the SFTR method. Therapies followed FM principles, employing centers of coordination and fusion. Results: After FM treatment, patient showed increased ROM in all joints and planes, except for abduction and external rotation in the left hip. Additionally, the patient reported improved motor functions, being able to transition autonomously from supine position to either side. Conclusions: This case report underscores the potential of fascial therapy in relieving motor dysfunction in CP patients by addressing ROM in peripheral joints. FM shows promise in enhancing the lives of those with central nervous system disorders by harmonizing body tensions and enhancing proprioception. nonetheless, more research with longer sessions and follow-up is needed for validation. [ABSTRACT FROM AUTHOR]

Abstract 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. [ABSTRACT FROM AUTHOR]

Background: Recent reports show that changes in fascia may be a source of many disturbances in human functioning. The concept of fascial manipulation (FM) postulates that removing the changes in ground substance of fascia reestablishes a proper tensional balance, reducing pain. Assessment of reactivity of soft tissues acts as an objective indicator, allowing for the confirmation of changes to pain levels. Aim of the study: The purpose of this study was to evaluate the influence of therapy using the FM method on pain sensations and change in reactivity of soft tissues. Material and methods: The research was carried out on 15 people (12 women and 3 men; aged between 18-30 years) who were randomly divided into three equal groups. Patients from the first group were treated using the standard protocol of Stecco's method, while in the second group the modified protocol was used. The last group was the control group. All patients undergo the diagnostic process specific for FM method and had their pain level (using the visual analog scale [VAS]) and reactivity of soft tissues (with the MyotonPro device) measured. Measurements of reactivity of soft tissues were taken from 10 points in pelvis (specific for Stecco's method). All measurements were taken three times; before and after the first treatment and after the third treatment. Outcomes were gathered and inputted to the STATI STICA 12 database and analyzed using ANOVA with repeated measures and Post-Hoc Tukey's test. Results: Statistical analysis showed statistically significant change in some parameters related to the reactivity of soft tissues in the first group. Statistically significant changes (p < 0.05) of VAS were observed in every group but the first group had the biggest and the most dynamic decrease in pain levels. Conclusions: Therapy using FM method causes significant changes in some reactivity of soft tissue parameters and in pain sensations. The biggest changes were observed in the first group, who were treated with Stecco's method. [ABSTRACT FROM AUTHOR]

Summary Pelvic floor muscle assessment in situations of hip/groin pain in both male and female patients can be a key element in treatment success. We present herein, a 32 year old male professional cyclist, exhibiting right hip and groin pain during cycling and prolonged sitting. The pain commenced after the patient suffered a right hip severe contusion in 2013 causing a tear in the tensor fascia lata and gluteus medius muscle. The patient did not complain of pelvic floor dysfunctions. After receiving several series of conventional physical therapy for the hip/groin pain, the patient experienced partial pain relief and slight improvement of hip range of motion. His pelvic floor muscles and fascial involvement were subsequently assessed. Two sessions of Pelvic Floor Fascial Mobilization (PFFM) were performed and the patient fully recovered. The authors suggest that PFFM , a novel fascial-oriented manual therapy of the pelvic floor approach, can be used for both hip/groin and pelvic floor pain or dysfunction. [ABSTRACT FROM AUTHOR]

Summary The etiopathogenesis of Carpal Tunnel Syndrome (CTS) is multifactorial and most cases are classified as idiopathic ( Thurston 2013 ). A randomized controlled trial was performed to compare the effectiveness of Fascial Manipulation ® (FM) and Low-Level Laser Therapy (LLLT) for CTS. This prospective trial included 42 patients (70 hands with symptoms) with clinical and electroneuromyographic diagnosis of CTS. The patients were randomly assigned to receive multiple sessions of FM or multiple session of LLLT. The Visual Analogic Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were performed at baseline, end of treatment and after three months. The group that received FM showed a significant reduction in subjective pain perception and an increased function assessed by BCTQ at the end of the treatment and follow-up. The group that received LLLT showed an improvement in the BCTQ at the end of the treatment but the improvement level was not sustained at the three month follow-up. FM is a valid alternative treatment for CTS. [ABSTRACT FROM AUTHOR]

Summary Many manual techniques describe palpable changes in the subcutaneous tissue. Many manual therapists have perceived palpable tissue stiffness and how it changes after treatment. No clear demonstration exists of the presence of specific alterations in the subcutaneous tissue and even less a visualization of their changes following manual therapy. This case study visualizes by ultrasound and elastography an alteration of the deep fascia in a 40-year-old male with subacute pain in the calf area. Ultrasound and elastography permits visualization of gliding, echogenicity and elasticity of deep fascia and their changes, after manual therapy (Fascial Manipulation © ). This study suggests the possible use of the ultrasound and elastography to furnish a more objective picture of the “sensations” that are commonly reported by manual therapists, and which supports clinicians in the diagnosis of the myofascial pain. [ABSTRACT FROM AUTHOR]

Recent studies reveal the role of the ankle retinacula in proprioception and functional stability of the ankle, but there is no clear evidence of their role in the outcomes of ankle sprain. 25 patients with outcomes of ankle sprain were evaluated by MRI to analyze possible damage to the ankle retinacula. Patients with damage were subdivided into two groups: group A comprised cases with ankle retinacula damage only, and group B those also with anterior talofibular ligament rupture or bone marrow edema. Both groups were examined by VAS, CRTA and static posturography and underwent three treatments of deep connective tissue massage (Fascial Manipulation technique). All evaluations were repeated after the end of treatment and at 1, 3 and 6 months. At MRI, alteration of at least one of the ankle retinacula was evident in 21 subjects, and a further lesion was also identified in 7 subjects. After treatment, VAS and CRTA evaluations showed a statistically significant decrease in values with respect to those before treatment ( p < 0.0001). There were also significant improvements ( p < 0.05) in stabilometric platform results. No significant difference was found between groups A and B. The initial benefit was generally maintained at follow-up. The alteration of retinacula at MRI clearly corresponds to the proprioceptive damage revealed by static posturography and clinical examination. Treatment focused on the retinacula may improve clinical outcomes and stabilometric data. [ABSTRACT FROM AUTHOR]

Summary: Classical anatomy still relegates muscular fascia to a role of contention. Nonetheless, different hypotheses concerning the function of this resilient tissue have led to the formulation of numerous soft tissue techniques for the treatment of musculoskeletal pain. This paper presents a pilot study concerning the application of one such manual technique, Fascial Manipulation©, in 28 subjects suffering from chronic posterior brachial pain. This method involves a deep kneading of muscular fascia at specific points, termed centres of coordination (cc) and centres of fusion (cf), along myofascial sequences, diagonals, and spirals. Visual Analogue Scale (VAS) measurement of pain administered prior to the first session, and after the third session was compared with a follow-up evaluation at 3 months. Results suggest that the application of Fascial Manipulation© technique may be effective in reducing pain in chronic shoulder dysfunctions. The anatomical substratum of the myofascial continuity has been documented by dissections and the biomechanical model is discussed. [Copyright &y& Elsevier]

Summary: According to Fascial Manipulation theory, patellar tendon pain is often due to uncoordinated quadriceps contraction caused by anomalous fascial tension in the thigh. Therefore, the focus of treatment is not the patellar tendon itself, but involves localizing the cause of this incoordination, considered to be within the muscular fascia of the thigh region. Eighteen patients suffering from patellar tendon pain were treated with the Fascial Manipulation technique. Pain was assessed (in VAS) before (VAS 67.8/100) and after (VAS 26.5/100) treatment, plus a follow-up evaluation at 1 month (VAS 17.2/100). Results showed a substantial decrease in pain immediately after treatment (p<0.0001) and remained unchanged or improved in the short term. The results show that the patellar tendon may be only the zone of perceived pain and that interesting results can be obtained by treating the muscular fascia of the quadriceps muscle, whose alteration may cause motor incoordination and subsequent pathology. [Copyright &y& Elsevier]