PainSci summary of 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 at the bottom of the page, as often as possible. ★★★☆☆3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
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.
One article on PainScience.com cites Langevin 2017 as a source:
- PS Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties
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:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.