The Somatic Connection  |   October 2012
Empirical Measurement of the Effects of Myofascial Release in Cervical and Lumbar Regions
Article Information
The Somatic Connection   |   October 2012
Empirical Measurement of the Effects of Myofascial Release in Cervical and Lumbar Regions
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 655-656. doi:10.7556/jaoa.2012.112.10.655
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 655-656. doi:10.7556/jaoa.2012.112.10.655
Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with nonspecific cervical or lumbar pain. J Bodyw Mov Ther. 2011;15:405-416.  
In the world of manual medicine, the topic of fascia, including its anatomy, biomechanics, and treatment, seems to be growing by leaps and bounds; in the past 5 years, there have been 3 International Fascia Research Congresses, the successes of which have led to the formation of the Fascia Research Society. However, fascia has been a topic of concern in osteopathic medicine since the very formation of the profession. In Philosophy and Mechanical Principles of Osteopathy, Andrew Taylor Still, MD, DO, wrote, “I write at length of the universality of the fascia to impress the reader with the idea that this connecting substance must be free at all parts to receive and discharge all fluids, and eject all impurities. … A knowledge of the universal extent of the fascia is imperative, and is one of the greatest aids to the person who seeks the causes of disease.”1 
Research by Standley and colleagues2,3 has shown potentially beneficial effects on human bibroblast cells from use of manual fascial techniques. In addition, a summary of osteopathic manipulative treatment approaches to fascia was published recently.4 With this recent focus on fascia, osteopathic medical researchers and clinicians may be interested in the comprehensive review and focused research project on manual fascial techniques carried out by Italian researchers Tozzi and colleagues. Two of the researchers were Italian allopathic physicians who became osteopaths through additional education and practice similar to that delivered in US osteopathic medical training. An osteopath performed all assessments in the study. 
The research project took place at the Centro di Ricerche Olistiche per la Medicina Osteopatica e Naturale in Rome, Italy. During a 1-year period, 356 patients who presented to the clinic with nonspecific neck pain (NP) and nonspecific low back pain (LBP) were screened. Inclusion criteria were age 18 to 60 years; complaint of nonspecific pain in the cervical or lumbar region, with or without associated neurologic symptoms, lasting at least 3 weeks and not more than 6 months; and magnetic resonance imaging or ultrasonography findings indicative of absence of inherited or acquired pathologies of the neck, spine, kidneys, or bladder. Exclusion criteria were pregnancy, use of physical or manual therapy, or use of analgesic or anti-inflammatory medication in the previous 72 hours. One hundred twenty patients were selected for the study and were randomly assigned to the following groups: 30, NP experimental; 30, LBP experimental; 30, NP sham-control; and 30, LBP sham-control. 
A real-time ultrasonography video recording technology known as Dynamic Ultrasound Topographic Anatomy Evaluation (D.US.T.A.-E) was performed on each participant in the NP experimental and sham-control groups. Each participant lay in the supine position with his or her head in mild extension and right side-bending rotation. The participant's head rested on a comfortable table before and after the manual fascial techniques or sham treatments had been applied. 
For participants in the LBP experimental group, lumbar D.US.T.A.-E was performed with participants supine. The probe was positioned on the right lateral aspect to assess movement of the superior pole of the kidney and the respective diaphragmatic crura at maximal inspiration and maximal expiration. The researchers aimed to measure the range of the kidney's supero-inferior sliding motion before and after forced respiration. The pelvic probe was positioned above the pubic symphysis to measure the distance between the neck of the bladder and the anterior vesical wall. The Short-Form McGill Pain Questionnaire was used to assess pain. 
The NP experimental group received 6 minutes of intervention, including 2 minutes of myofascial release technique that consisted of low load, long duration stretching along the lines of fascial restriction, with one hand of the operator contacting the participant's sternum and the other hand on the participant's forehead for 2 minutes. Then, fascial unwinding was performed for 2 minutes according to the method presented by Robert C. Ward, DO.5 
The LBP experimental group received 12 minutes of intervention, including 6 minutes of myofascial release and 6 minutes of fascial unwinding. Myofascial release technique was applied in 2 stages, first to stretch and release the right and then left psoas major and the iliacus muscles and then to release the pelvic floor muscles with a global pelvic anterior/posterior contact. Fascial unwinding was applied to the area psoas muscle, kidney, and lumbar spine. 
The sham-control NP and sham-control LBP groups received hand contact by an individual who did not have any knowledge of anatomy or manual therapy whatsoever. In the sham-control NP group, the operator rested his hands on the participant's neck for 3 minutes in each of the hand placements used in the experimental NP group for a total of 6 minutes to match the duration of contact in the experimental NP group. For the sham-control LBP group, the operator rested his hands on the participant's lumbar and lumbopelvic regions for 12 minutes to match the duration of contact used in the experimental LBP group. 
All D.US.T.A.-E images were independently evaluated by medical doctors blinded to the groups with which the images corresponded. The evaluators were asked to rate changes in quality and quantity of fascial sliding motions as “none,” “discrete,” or “radical.” The interexaminer reliability showed a highly significant correlation (r=0.915, P<.001). The results showed significantly more mobility changes in neck, kidney, and bladder structures for the experimental group with virtually no changes for the sham-control groups. The Short-Form McGill Pain Questionnaire results showed statistically significant improvement with the experimental groups, while questionnaire results for the control group showed no change. 
These findings suggest that ultrasonography is a valid diagnostic tool for osteopathic manipulative treatment research and that myofascial procedures do appear to affect the position of internal organs affected by somatic structures to which they are attached. If the freer motion in the myofascial and visceral structures demonstrated in this study can ever be associated with the function of those structures, then A.T. Still's assertion regarding the freer motion “to receive and discharge all fluids, and eject all impurities”1 would have empirical validation. —H.H.K. 
Still AT. Philosophy and Mechanical Principles of Osteopathy. Kansas City, MO: Hudson-Kimberly Pub Co; 1902:61.
Meltzer KR, Standley PR. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. 2007;107(12):527-536. [PubMed]
Eagen TS, Meltzer KR, Standley PR. Importance of strain direction in regulating human fibroblast proliferation and cytokine secretion: a useful in vitro model for soft tissue injury and manual medicine treatments. J Manipulative Physiol Ther. 2007;30(8):584-592. [CrossRef] [PubMed]
King HH. Osteopathic manipulative therapies and fascia. In: Schleip R, Findley TW, Chaitow L, Huijing PA, eds. Fascia: The Tensional Network of the Human Body. Edinburgh, Scotland: Churchill Livingstone; 2012:319-326.
Ward RC. Integrated neuromusculoskeletal release and myofascial release. In: Ward RC, executive ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2003:931-968.