Fascial release effects on patients with non-specific cervical or lumbar pain.

BACKGROUND: Myofascial Release (MFR) and Fascial Unwinding (FU) are widely used manual fascial techniques (MFTs), generally incorporated in treatment protocols to release fascial restrictions and restore tissue mobility. However, the effects of MFT on pain perception, and the mobility of fascial layers, have not previously been investigated using dynamic ultrasound (US) in patients with neck pain (NP) and low back pain (LBP).
OBJECTIVES: a) To show that US screening can be a useful tool to assess dysfunctional alteration of organ mobility in relation to their fascial layers, in people with non-specific NP or LBP, in the absence of any organ disease; b) To assess, by dynamic US screening, the change of sliding movements between superficial and deep fascia layers in the neck, in people with non-specific NP, before and after application of MFTs c) To assess, by dynamic US screening, the variation of right reno-diaphragmatic (RD) distance and of neck bladder (NB) mobility, in patients with non-specific LBP, before and after application of MFTs d) To evaluate 'if' and 'at what degree' pain perception may vary in patients with NP or LBP, after MFTs are applied, over the short term.
METHODS: An Experimental group of 60 subjects, 30 with non-specific NP and 30 with non-specific LBP, were assessed in the area of complaint, by Dynamic Ultrasound Topographic Anatomy Evaluation (D.US.T.A.-E.), before and after MFTs were applied in situ, in the corresponding painful region, for not more than 12 min. The results were compared with those from the respective Sham-Control group of 30 subjects. For the NP sub-groups, the pre- to post- US recorded videos of each subject were compared and assessed randomly and independently by two blinded experts in echographic screening. They were asked to rate the change observed in the cervical fascia sliding motions as 'none', 'discrete' or 'radical'. For the LBP sub-groups, a pre- to post- variation of the right RD distances and NB mobility were calculated on US imaging and compared. For all four sub-groups, a Short-Form McGill Pain Assessment Questionnaire (SF-MPQ) was administered on the day of recruitment as well as on the third day following treatment.
RESULTS: The Chi square test has shown a significant correlation (0.915) with a p-Value < 0.0001 between the two examiners' results on US videos in NP sub-groups. The ANOVA test at repeated measures has shown a significant difference (p-Value < 0.0001) within Experimental and Control groups for the a) pre- to post- RD distances in LBP sub-groups, b) pre- to post- NB distances in LBP sub-groups; as well as between groups as for c) pre- to post- SF-MPQ results in NP and LBP sub-groups.
CONCLUSIONS: Dynamic US evaluation can be a valid and non-invasive instrument to assess and monitor effective sliding motion of fascial layers in vivo. MFTs are effective manual techniques to release area of impaired sliding fascial mobility, and to improve pain perception over a short term duration in people with non-specific NP or LBP.