Cellular response to simulated myofascial release

One article on PainSci cites Meltzer 2010: Does Fascia Matter?

PainSci commentary on Meltzer 2010: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

I would never normally be interested in this paper. In fact, I would never have chosen to read it myself, because I don’t think it’s good enough science. I am spending some time on it only as a gesture of good faith to a critic, who supplied the paper as an example of basic fascia science that matters. It may not have been a good choice for that purpose.

This is a test tube study showing that naked cells handled stress better (fewer signs of harm) if they were treated with, believe it or not, “simulated” myofascial release (MFR). A meaningful, accurate simulation of manual therapy on naked cells is an amusing notion, and it’s clear that what happened to those cells differs dramatically from what would happen in a real living body.

Even if true and reproducible, this data would mainly support the rationale for MFR specifically for post-exercise soreness — something of a dead end for the clinical relevance of MFR, because exercise-induced soreness has little to do with the main claims of MFR, which primarily concern correcting postural asymmetries, eliminating alleged restrictions, and treating chronic pain.

Post-exercise soreness is comparatively trivial, and patients don’t seek therapy for it (it’s usually over before they can get to an appointment). There’s a lot of research showing that exercise-induced soreness is basically invincible anyway. For this property of fascia to be clinically relevant, it would have to imply that MFR might be able to treat chronic pain from other causes … not the transient annoyance of soreness after a game of soccer.

This isn’t a rejection of all possible clinical relevance of the data. My point is that there are so many problems that its relevance is watered down to quite a thin sauce — way too thin.

I do concede that the paper shows some evidence that fibroblasts have interesting and perhaps positive responses to mechanical forces. That is inherently interesting, and probably worth investigating further, but it’s a mighty reach to postulate any clinical relevance to what most therapists do, most of the time, with patient’s fascia.

“Reach” is what the authors do, in spades. They claim to have no conflicts of interest, and they probably don’t, technically. Nevertheless, I suspect their egos are deeply invested in the notion that “fascia is important,” because they seem to be seeking evidence to support their pre-conceptions — typical of research funded by The National Center for Complementary and Alternative Medicine, and a hallmark of junk science.

It’s quite likely that if less biased researchers did this experiment, they would not be able to reproduce these results.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:

• Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
• Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
• No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
• The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
• Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.