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Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men: A study of dynamic ultrasound imaging

PainSci » bibliography » Wong et al 2017
Tags: treatment, fascia, controversy, debunkery, etiology, pro, massage, manual therapy

PainSci commentary on Wong 2017: ?This page is one of thousands in the 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.

This trial measures nice hard-edged primary outcome — the stiffness of the thoracolumbar fascia before and after “myofascial release” — but it’s got big problems.

There’s weirdly no attempt to define the intervention in the abstract (ridiculous given the huge range of possible meanings of “myofascial release”), and this experiment did not, could not possibly isolate “fascial” manipulation: it’s not a test of “fascial” therapy, but of “laying on of hands,” which definitely has all kinds of short term effects. This isn’t remotely the first time minor short term effects of manipulation have been demonstrated — it’s just a slightly novel and fascia-specific way of measuring it, which doesn’t remotely show clinical significance. The effect, even if real and reproducible, might be gone in 30 seconds, or could have been produced by a radically different technique that ignored fascia entirely.

~ 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.

BACKGROUND: Myofascial release (MR) on the posterior thoracolumbar fascia (PLF) is one of the manual techniques aim to restore the normal length and tension of restricted fasciae and muscles.

OBJECTIVES: The present study aimed to quantify the immediate effects of MR on fascial properties of the PLF in healthy men.

DESIGN: Cross-sectional study.

METHOD: Participants (N = 10, aged 22.8 ± 2.0 years) performed a press-down to maximal voluntary contraction (MVC) in the prone position. Deformation of the PLF was measured using an ultrasonographic apparatus. Force output was simultaneously measured. The stiffness index and hysteresis index were then represented by the slope of the loading curve, and the percentage of the area within the loading-unloading curve. One-way ANCOVA was used to compare differences in the stiffness index or hysteresis index of the PLF before and after MR. Two-way repeated ANOVA was used to compare deformation of the PLF or force output after MR.

RESULTS: The primary findings included a decrease (before: 24.1 ± 8.3 vs. after: 18.9 ± 5.3 N/mm; mean difference, -5.2 ± 4.9 N/mm, p = 0.002 < 0.05) in the stiffness index of the PLF and a greater difference in deformation of the PLF between 50% and 100% MVC (before: Def50% = 6.5 ± 1.8 mm and Def100% = 9.8 ± 1.9 mm vs. after: Def50% = 6.4 ± 2.5 mm and Def100% = 10.2 ± 2.4 mm; p = 0.037 < 0.05, power = 58.5%).

CONCLUSION: After MR, stiffness of the PLF decreased in healthy men.

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