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The Somatic Connection  |   July 2018
Remote MFR Increases Hamstring Flexibility: Support for the Fascial Train Theory
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon 
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2018
Remote MFR Increases Hamstring Flexibility: Support for the Fascial Train Theory
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 490-491. doi:https://doi.org/10.7556/jaoa.2018.111
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 490-491. doi:https://doi.org/10.7556/jaoa.2018.111
Joshi DG, Balthillaya G, Prabhu A. Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals - a randomized clinical trial [published online February 17, 2018]. J Bodyw Mov Ther. doi:10.1016/j.jbmt.2018.01.008 
The principle that all body structures are interconnected stands as a central concept in osteopathic medicine and is often used as a rationale when applying manual treatments. Recently, fascia and the anatomic trains created by its continuity have been of particular interest. As such, seemingly unrelated structures are theorized to have significant interplay with each other, affecting and influencing the health of individual organs and the body as a whole. Researchers from India evaluated the effect of remote myofascial release (MFR) on hamstring flexibility to demonstrate this phenomenon. 
The researchers compared the effect of static stretching, remote MFR, or a combination of the 2 on hamstring flexibility. Static stretching involved directly stretching the hamstrings using hip flexion and knee extension. Distant MFR included direct, firm pressure suboccipital release and deep knuckle kneading on the plantar fascia. Fifty-eight randomly assigned participants received pre-intervention measurements of hamstring flexibility using the criterion standard Knee Extension Angle (KEA) and the Sit-and-Reach Test (SRT). A physical therapist applied the intervention(s) at 7 sessions over 10 days; hamstring flexibility was subsequently remeasured. Participants were then instructed to perform their particular intervention(s) as a home-exercise program for 2 weeks, after which final measurements were taken. Analyses were conducted for both the therapist and the self-administered treatment periods. 
The results showed that therapist-administered interventions in all 3 groups led to statistically significant increases in both KEA and SRT measures of hamstring flexibility, with no statistically significant differences between groups. During the self-treatment period, SRT results revealed significant increases in the SS and combination groups, but KEA results were not significant in any groups. 
These findings support the fascial train theory and validate its clinical application. Therapist-administered MFR at the plantar and suboccipital fascia yielded statistically significant improvements in hamstring flexibility in lieu of, and in combination with, SS. The limitations of this study include a small sample size, lack of home program standardization, and lack of a sham or control group. Nonetheless, it offers encouraging findings regarding the whole-body approach of osteopathic physicians and supports the concept of treating fascial trains.