One article on PainSci cites Langevin 2017: Does Fascia Matter?
PainSci commentary on Langevin 2017: ?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.
Langevin et al. have reported increased thoracolumbar fascial thickness (Langevin 2009) and stiffness (Langevin 2011) in patients with chronic low back pain; and reported greater fascial stiffness in injured and hobbled pigs (Bishop 2016). This experiment injured pigs as in the 2016 experiment, but then attempted to reverse the fascial stiffness they’d induced by restoring normal movement and/or stretching the pigs for a few minutes a day.
In a nutshell, they failed.
Thirty pigs which were divided into three groups: ten that were unolested, ten that were injured, and ten that were injured and hobbled for eight weeks. After that, a few of the hobbled pigs remained hobbled, while the rest were either set free and stretched for 10 minutes per day, or just set free. Removing the hobble improved the pigs’ gait speed — imagine that — but adding stretching was no better. The fascial stiffness induced by the torture did not change. Their conclusion:
Reduced fascia mobility in response to injury and movement restriction worsens over time and persists even when movement is restored. Reversing fascia abnormalities may require either longer than 1 mo or a different treatment “dose” or modality.
These experiments are macabre to a degree that we have rarely seen in musculoskeletal medicine. I question whether the 2011 experiment by the same researchers established a clear enough need for more research, or high enough medical stakes, to justify torturing a lot of pigs.
~ 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.
OBJECTIVE: Stretching of fascia is an important component of manual and movement therapies. We previously showed that in pigs, a unilateral thoracolumbar fascia injury combined with movement restriction (hobble) produced contralateral loss of fascia mobility (shear strain during passive trunk flexion measured with ultrasound) similar to findings in human subjects with chronic low back pain. We now tested whether such abnormalities could be reversed by removing the hobble with or without daily stretching for 1 mo.
DESIGN: Thirty pigs were randomized to control, injury, or injury + hobble for 8 wks. The hobble restricted hip extension ipsilateral to the injury. At week 8, the injury + hobble group was subdivided into continued hobble, removed hobble, and removed hobble + stretching (passively extending the hip for 10 min daily).
RESULTS: Removing hobbles restored normal gait speed but did not restore fascia mobility. Daily passive stretching was not superior to removing hobbles, as there was no significant improvement in fascia mobility with either treatment group (removed hobble or stretching).
CONCLUSIONS: Reduced fascia mobility in response to injury and movement restriction worsens over time and persists even when movement is restored. Reversing fascia abnormalities may require either longer than 1 mo or a different treatment "dose" or modality.
- “Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain,” Helene M Langevin, Debbie Stevens-Tuttle, James R Fox, Gary J Badger, Nicole A Bouffard, Martin H Krag, Junru Wu, and Sharon M Henry, BMC Musculoskeletal Disorders, 2009.
- “Reduced thoracolumbar fascia shear strain in human chronic low back pain,” Helene M Langevin, James R Fox, Cathryn Koptiuch, Gary J Badger, Ann C Greenan-Naumann, Nicole A Bouffard, Elisa E Konofagou, Wei-Ning Lee, John J Triano, and Sharon M Henry, BMC Musculoskeletal Disorders, 2011.
- “Ultrasound evaluation of the combined effects of thoracolumbar fascia injury and movement restriction in a porcine model,” James H Bishop, James R Fox, Rhonda Maple, Caitlin Loretan, Gary J Badger, Sharon M Henry, Margaret A Vizzard, and Helene M Langevin, PLoS ONE, 2016.
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:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.