Effect of Myofascial Release Technique on Lumbar Fascia Thickness and Low Back Pain: A Clinical Trial
,
Abstract
Introduction: This study aims to evaluate the effect of lumbar myofascial release (MFR) technique on pain and thickness of the lumbar fascia tissue in patients with non-specific low back pain.
Materials and Methods: In this clinical trial, 20 subjects with non-specific low back pain were treated by MFR on the lumbar region at 4 sessions. Low back pain severity and thickness of the lumbar fascia tissue were assessed by ultrasonographic imaging before and after the intervention.
Results: Subjects showed significant reduction in lumbar fascia thickness (P=0.000) and low back pain severity (P=0.000).
Conclusion: The lumbar MFR technique is effective in patients with non-specific low back pain due to reducing the lumbar fascia thickness and low back pain.
1. Williams DA, Feuerstein M, Durbin D, Pezzullo J. Health care and indemnity costs across the natural history of disability in occupational low back pain. Spine. 1998;23(21):2329-36.
2. van den Hoogen HJ, Koes BW, van Eijk JTM, Bouter LM, Devillé W. On the course of low back pain in general practice: a one year follow up study. Annals of the rheumatic diseases. 1998;57(1):13-9.
3. De Luca CJ. Low back pain: a major problem with low priority. Journal of rehabilitation research and development. 1997;34(4):VII.
4. Van Nieuwenhuyse A, Fatkhutdinova L, Verbeke G, Pirenne D, Johannik K, Somville P-R, et al. Risk factors for first-ever low back pain among workers in their first employment. Occupational Medicine. 2004;54(8):513-9.
5. Olyaei G, Arslan SA, Hadian MR, Bagheri H, Yekaninejad MS, Talebian S. Associated Risk Factors Causing Low Back Pain Among Office Workers in Iran. Journal of Modern Rehabilitation. 2017:181-8.
6. El-Sayed AM, Hadley C, Tessema F, Tegegn A, Cowan Jr JA, Galea S. Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia. Spine. 2010;35(6):684.
7. Deyo R, Weinstein J. Low Back Pain. New England Journal of Medicine. 2001;344(5):363-70.
8. Hurwitz EL, Morgenstern H, Yu F. Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Journal of clinical epidemiology. 2003;56(5):463-71.
9. Dionne CE. Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. Journal of clinical epidemiology. 2005;58(7):714-8.
10. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27(5):E109-E20.
11. Swinkels-Meewisse IE, Roelofs J, Oostendorp RA, Verbeek AL, Vlaeyen JW. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain. 2006;120(1-2):36-43.
12. Grotle M, Vøllestad NK, Veierød MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain. 2004;112(3):343-52.
13. van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. Journal of electromyography and kinesiology. 2003;13(4):333-51.
14. Moseley GL, Nicholas MK, Hodges PW. Does anticipation of back pain predispose to back trouble? Brain. 2004;127(10):2339-47.
15. Grimstone SK, Hodges PW. Impaired postural compensation for respiration in people with recurrent low back pain. Experimental brain research. 2003;151(2):218-24.
16. Mok NW, Brauer SG, Hodges PW. Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine. 2004;29(6):E107-E12.
17. Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2004;50(2):613-23.
18. Stokes IA, Fox JR, Henry SM. Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. European Spine Journal. 2006;15(5):658-67.
19. Dittrich R. Soft tissue lesions as cause of low back pain: Anatomic study. The American Journal of Surgery. 1956;91(1):80-5.
20. Bonner CD, Kasdon SC. Herniation of fat through lumbodorsal fascia as a cause of low-back pain. New England Journal of Medicine. 1954;251(27):1102-4.
21. Herz R. Herniation of fascial fat as a cause of low back pain: With relief by surgery in six cases. Journal of the American Medical Association. 1945;128(13):921-5.
22. Dittrich R. Lumbodorsal fascia and related structures as factors in disability. The Journal-lancet. 1963;83:393-8.
23. Faille RJ. Low back pain and lumbar fat herniation. American Surgeon. 1978 ;44(6):359-61.
24. Bednar DA, Orr FW, Simon G. Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain. A microscopic study. Spine. 1995;20(10):1161-4.
25. Gatton M, Pearcy M, Pettet G, Evans J. A three-dimensional mathematical model of the thoracolumbar fascia and an estimate of its biomechanical effect. Journal of biomechanics. 2010;43(14):2792-7.
26. Wilke J, Krause F, Vogt L, Banzer W. What is evidence-based about myofascial chains: a systematic review. Archives of physical medicine and rehabilitation. 2016;97(3):454-61.
27. Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH, Wu J, Henry SM. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC musculoskeletal disorders. 2009;10(1):1-9.
28. Myers T, Earls J. Fascial release for structural balance: North Atlantic Books; 2017, 200-210.
29. Barker PJ GK, Grkovic I , Briggs CA , Jones DC , Thomas CD. Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: Young Investigator Award winner. Spine. 2006;31:397-405.
30. Barker PJ, Briggs CA. Attachments of the posterior layer of lumbar fascia. Spine. 1999;24(17):1757.
31. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640-50.
32. Chen Y CH, Shau Y, Wang C, Wang S,. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Manual Therapy. 2016;23:69-75.
33. Davis CM. Complementary therapies in rehabilitation: evidence for efficacy in therapy, prevention, and wellness. 3rd ed. united states of america: Slack Incorporated; 2009, 94-100.
34. Fourie W. Considering wider myofascial involvement as a possible contributor to upper extremity dysfunction following treatment for primary breast cancer. Journal of bodywork and movement therapies. 2008;12(4):349-55.
35. Cantu R, Grodin A. Histology and biomechanics of myofascia. Myofascial Manipulation: Theory and Clinical Application. 3rd ed. Aspen Publicashions, Gaithersburg. 2011, 25-46.
36. Langevin HM KE, Badger GJ , Churchill DL , Fox JR , Ophir J , Garra BS. Tissue displacements during acupuncture using ultrasound elastography techniques. Ultrasound in Medicine & Biology. 2004;30(9):1173-83.
37. Thomas K, Shankar H. Targeting myofascial taut bands by ultrasound. Current pain and headache reports. 2013;17(7):349.
38. Drakonaki E, Allen G, Wilson D. Ultrasound elastography for musculoskeletal applications. The British journal of radiology. 2012;85(1019):1435-45.
39. Brandsma R, Verbeek RJ, Maurits NM, Hamminga JT, Brouwer OF, van der Hoeven JH, et al. Visual assessment of segmental muscle ultrasound images in spina bifida aperta. Ultrasound in medicine & biology. 2012;38(8):1339-44.
40. Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC musculoskeletal disorders. 2011;12(1):1-11.
41. Abràmoff MD, Magalhães PJ, Ram SJ. Image processing with ImageJ. Biophotonics international Journal. 2004;11(7):36-42.
42. Freyd M. The graphic rating scale. Journal of educational psychology. 1923;14(2):83-102.
43. Arguisuelas MD, Lisón JF, Sánchez-Zuriaga D, Martínez-Hurtado I, Doménech-Fernández J. Effects of myofascial release in nonspecific chronic low back pain: a randomized clinical trial. Spine. 2017;42(9):627-34.
44. Myers TW. Anatomy Trains E-Book: Myofascial Meridians for Manual Therapists and Movement Professionals: Elsevier Health Sciences; 2020, 200-220.
45. Kane D, Greaney T, Shanahan M, Duffy G, Bresnihan B, Gibney R, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology. 2001;40(9):1002-8.
46. Vohra PK, Kincaid BR, Japour CJ, Sobel E. Ultrasonographic evaluation of plantar fascia bands: a retrospective study of 211 symptomatic feet. Journal of the American Podiatric Medical Association. 2002;92(8):444-9.
47. Akfirat M, Sen C, Günes T. Ultrasonographic appearance of the plantar fasciitis. Clinical imaging. 2003;27(5):353-7.
48. Ozdemir H, Yilmaz E, Murat A, Karakurt L, Poyraz AK, Ogur E. Sonographic evaluation of plantar fasciitis and relation to body mass index. European journal of radiology. 2005;54(3):443-7.
49. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. Journal of ultrasound in medicine. 2005;24(8):1041-8.
50. Draghi F, Gitto S, Bortolotto C, Draghi AG, Belometti GO. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights into imaging. 2017;8(1):69-78.
51. Fede C, Gaudreault N, Fan C, Macchi V, De Caro R, Stecco C. Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature. Surgical and Radiologic Anatomy. 2018;40(12):1329-41.
52. Wong K CH, Chen Y, Wang C, Shau Y, Wang S,. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound imaging. Musculoskeletal Science and Practice. 2017;27:124-30.
53. Ajimsha M, Chithra S, Thulasyammal RP. Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Archives of physical medicine and rehabilitation. 2012;93(4):604-9.
54. Kain J, Martorello L, Swanson E, Sego S. Comparison of an indirect tri-planar myofascial release (MFR) technique and a hot pack for increasing range of motion. Journal of bodywork and movement therapies. 2011;15(1):63-7.
55. Albert HB, Kjær P, Jensen TS, Sorensen JS, Bendix T, Manniche C. Modic changes, possible causes and relation to low back pain. Medical hypotheses. 2008;70(2):361-8.
56. Longworth JC. Psychophysiological effects of slow stroke back massage in normotensive females. Advances in Nursing Science. 1982;4(4):44-61.
57. Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. Journal of bodywork and movement therapies. 2014;18(2):273-81.
58. Földi E, Földi M, Clodius L. The lymphedema chaos: a lancet. Annals of plastic surgery. 1989;22(6):505-15.
59. Földi E, Földi M, Weissleder H. Conservative treatment of lymphoedema of the limbs. Angiology. 1985;36(3):171-80.
2. van den Hoogen HJ, Koes BW, van Eijk JTM, Bouter LM, Devillé W. On the course of low back pain in general practice: a one year follow up study. Annals of the rheumatic diseases. 1998;57(1):13-9.
3. De Luca CJ. Low back pain: a major problem with low priority. Journal of rehabilitation research and development. 1997;34(4):VII.
4. Van Nieuwenhuyse A, Fatkhutdinova L, Verbeke G, Pirenne D, Johannik K, Somville P-R, et al. Risk factors for first-ever low back pain among workers in their first employment. Occupational Medicine. 2004;54(8):513-9.
5. Olyaei G, Arslan SA, Hadian MR, Bagheri H, Yekaninejad MS, Talebian S. Associated Risk Factors Causing Low Back Pain Among Office Workers in Iran. Journal of Modern Rehabilitation. 2017:181-8.
6. El-Sayed AM, Hadley C, Tessema F, Tegegn A, Cowan Jr JA, Galea S. Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia. Spine. 2010;35(6):684.
7. Deyo R, Weinstein J. Low Back Pain. New England Journal of Medicine. 2001;344(5):363-70.
8. Hurwitz EL, Morgenstern H, Yu F. Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Journal of clinical epidemiology. 2003;56(5):463-71.
9. Dionne CE. Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings. Journal of clinical epidemiology. 2005;58(7):714-8.
10. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27(5):E109-E20.
11. Swinkels-Meewisse IE, Roelofs J, Oostendorp RA, Verbeek AL, Vlaeyen JW. Acute low back pain: pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain. 2006;120(1-2):36-43.
12. Grotle M, Vøllestad NK, Veierød MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain. 2004;112(3):343-52.
13. van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. Journal of electromyography and kinesiology. 2003;13(4):333-51.
14. Moseley GL, Nicholas MK, Hodges PW. Does anticipation of back pain predispose to back trouble? Brain. 2004;127(10):2339-47.
15. Grimstone SK, Hodges PW. Impaired postural compensation for respiration in people with recurrent low back pain. Experimental brain research. 2003;151(2):218-24.
16. Mok NW, Brauer SG, Hodges PW. Hip strategy for balance control in quiet standing is reduced in people with low back pain. Spine. 2004;29(6):E107-E12.
17. Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2004;50(2):613-23.
18. Stokes IA, Fox JR, Henry SM. Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. European Spine Journal. 2006;15(5):658-67.
19. Dittrich R. Soft tissue lesions as cause of low back pain: Anatomic study. The American Journal of Surgery. 1956;91(1):80-5.
20. Bonner CD, Kasdon SC. Herniation of fat through lumbodorsal fascia as a cause of low-back pain. New England Journal of Medicine. 1954;251(27):1102-4.
21. Herz R. Herniation of fascial fat as a cause of low back pain: With relief by surgery in six cases. Journal of the American Medical Association. 1945;128(13):921-5.
22. Dittrich R. Lumbodorsal fascia and related structures as factors in disability. The Journal-lancet. 1963;83:393-8.
23. Faille RJ. Low back pain and lumbar fat herniation. American Surgeon. 1978 ;44(6):359-61.
24. Bednar DA, Orr FW, Simon G. Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain. A microscopic study. Spine. 1995;20(10):1161-4.
25. Gatton M, Pearcy M, Pettet G, Evans J. A three-dimensional mathematical model of the thoracolumbar fascia and an estimate of its biomechanical effect. Journal of biomechanics. 2010;43(14):2792-7.
26. Wilke J, Krause F, Vogt L, Banzer W. What is evidence-based about myofascial chains: a systematic review. Archives of physical medicine and rehabilitation. 2016;97(3):454-61.
27. Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH, Wu J, Henry SM. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC musculoskeletal disorders. 2009;10(1):1-9.
28. Myers T, Earls J. Fascial release for structural balance: North Atlantic Books; 2017, 200-210.
29. Barker PJ GK, Grkovic I , Briggs CA , Jones DC , Thomas CD. Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: Young Investigator Award winner. Spine. 2006;31:397-405.
30. Barker PJ, Briggs CA. Attachments of the posterior layer of lumbar fascia. Spine. 1999;24(17):1757.
31. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21(22):2640-50.
32. Chen Y CH, Shau Y, Wang C, Wang S,. Increased sliding of transverse abdominis during contraction after myofascial release in patients with chronic low back pain. Manual Therapy. 2016;23:69-75.
33. Davis CM. Complementary therapies in rehabilitation: evidence for efficacy in therapy, prevention, and wellness. 3rd ed. united states of america: Slack Incorporated; 2009, 94-100.
34. Fourie W. Considering wider myofascial involvement as a possible contributor to upper extremity dysfunction following treatment for primary breast cancer. Journal of bodywork and movement therapies. 2008;12(4):349-55.
35. Cantu R, Grodin A. Histology and biomechanics of myofascia. Myofascial Manipulation: Theory and Clinical Application. 3rd ed. Aspen Publicashions, Gaithersburg. 2011, 25-46.
36. Langevin HM KE, Badger GJ , Churchill DL , Fox JR , Ophir J , Garra BS. Tissue displacements during acupuncture using ultrasound elastography techniques. Ultrasound in Medicine & Biology. 2004;30(9):1173-83.
37. Thomas K, Shankar H. Targeting myofascial taut bands by ultrasound. Current pain and headache reports. 2013;17(7):349.
38. Drakonaki E, Allen G, Wilson D. Ultrasound elastography for musculoskeletal applications. The British journal of radiology. 2012;85(1019):1435-45.
39. Brandsma R, Verbeek RJ, Maurits NM, Hamminga JT, Brouwer OF, van der Hoeven JH, et al. Visual assessment of segmental muscle ultrasound images in spina bifida aperta. Ultrasound in medicine & biology. 2012;38(8):1339-44.
40. Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan-Naumann AC, Bouffard NA, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC musculoskeletal disorders. 2011;12(1):1-11.
41. Abràmoff MD, Magalhães PJ, Ram SJ. Image processing with ImageJ. Biophotonics international Journal. 2004;11(7):36-42.
42. Freyd M. The graphic rating scale. Journal of educational psychology. 1923;14(2):83-102.
43. Arguisuelas MD, Lisón JF, Sánchez-Zuriaga D, Martínez-Hurtado I, Doménech-Fernández J. Effects of myofascial release in nonspecific chronic low back pain: a randomized clinical trial. Spine. 2017;42(9):627-34.
44. Myers TW. Anatomy Trains E-Book: Myofascial Meridians for Manual Therapists and Movement Professionals: Elsevier Health Sciences; 2020, 200-220.
45. Kane D, Greaney T, Shanahan M, Duffy G, Bresnihan B, Gibney R, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology. 2001;40(9):1002-8.
46. Vohra PK, Kincaid BR, Japour CJ, Sobel E. Ultrasonographic evaluation of plantar fascia bands: a retrospective study of 211 symptomatic feet. Journal of the American Podiatric Medical Association. 2002;92(8):444-9.
47. Akfirat M, Sen C, Günes T. Ultrasonographic appearance of the plantar fasciitis. Clinical imaging. 2003;27(5):353-7.
48. Ozdemir H, Yilmaz E, Murat A, Karakurt L, Poyraz AK, Ogur E. Sonographic evaluation of plantar fasciitis and relation to body mass index. European journal of radiology. 2005;54(3):443-7.
49. Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. Journal of ultrasound in medicine. 2005;24(8):1041-8.
50. Draghi F, Gitto S, Bortolotto C, Draghi AG, Belometti GO. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights into imaging. 2017;8(1):69-78.
51. Fede C, Gaudreault N, Fan C, Macchi V, De Caro R, Stecco C. Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature. Surgical and Radiologic Anatomy. 2018;40(12):1329-41.
52. Wong K CH, Chen Y, Wang C, Shau Y, Wang S,. Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound imaging. Musculoskeletal Science and Practice. 2017;27:124-30.
53. Ajimsha M, Chithra S, Thulasyammal RP. Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Archives of physical medicine and rehabilitation. 2012;93(4):604-9.
54. Kain J, Martorello L, Swanson E, Sego S. Comparison of an indirect tri-planar myofascial release (MFR) technique and a hot pack for increasing range of motion. Journal of bodywork and movement therapies. 2011;15(1):63-7.
55. Albert HB, Kjær P, Jensen TS, Sorensen JS, Bendix T, Manniche C. Modic changes, possible causes and relation to low back pain. Medical hypotheses. 2008;70(2):361-8.
56. Longworth JC. Psychophysiological effects of slow stroke back massage in normotensive females. Advances in Nursing Science. 1982;4(4):44-61.
57. Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. Journal of bodywork and movement therapies. 2014;18(2):273-81.
58. Földi E, Földi M, Clodius L. The lymphedema chaos: a lancet. Annals of plastic surgery. 1989;22(6):505-15.
59. Földi E, Földi M, Weissleder H. Conservative treatment of lymphoedema of the limbs. Angiology. 1985;36(3):171-80.
| Files | ||
| Issue | Vol 16 No 3 (2022) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v16i3.10148 | |
| Keywords | ||
| Low back pain Fascia Myofascial pain syndromes Manual therapy Ultrasonography | ||
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How to Cite
1.
Tamartash H, Bahrpeyma F, Mokhtari Dizaji M. Effect of Myofascial Release Technique on Lumbar Fascia Thickness and Low Back Pain: A Clinical Trial. jmr. 2022;16(3):244-251.
