Myofascial release: an evidence-based treatment approach?
Lars Remvig,Richard M. Ellis &Jacob Patijn
International Musculoskeletal Medicine Pages 29-35
Published online: 18 Jul 2013
Download citation https://doi.org/10.1179/175361408X293272
https://www.tandfonline.com/doi/abs/10.1179/175361408X293272?src=recsys
昨今、メディアで、ファスチアに関して見聞きする事が多くなった
なんらかのエビデンスでも確立したのか？
NHKがあいかわらずアホ？
https://www.nhk.or.jp/beautyscience-blog/2019/154/371174.html
ちょっと調べてみた
最近のシステマティック・レビューの質は向上しているとのこと
Improving the quality of myofascial release research - A critical appraisal of systematic reviews.
J Bodyw Mov Ther. 2019 Jul;23(3):561-567. doi: 10.1016/j.jbmt.2019.03.011. Epub 2019 Mar 29.
https://www.ncbi.nlm.nih.gov/pubmed/31563370
その中でもっとも信頼性が高いとされている文献の結論
CONCLUSION:
Current evidence on myofascial release therapy is not sufficient to warrant this treatment in chronic musculoskeletal pain.あ
.Laimi, K., M€akil€a, A., B€arlund, E., Katajapuu, N., Oksanen, A., Seikkula, V.,Karppinen, J., Saltychev, M., 2018. Effectiveness of myofascial release in treat-ment of chronic musculoskeletal pain: a systematic review. Clin. Rehabil. 32 (4),440e450.
https://www.ncbi.nlm.nih.gov/pubmed/28956477
まだまだ・・・
Fascia Research Congresses (FRC) のfascia定義
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3091474/
Recommended use of terms regarding fascial structures
Int J Ther Massage Bodywork. 2009; 2(4): 3–8.
| Dense connective tissue | Connective tissue containing closely packed, irregularly arranged (that is, aligned in many directions) collagen fibers. |
| Non-dense (areolar) connective tissue | Connective tissue containing sparse, irregularly arranged collagen fibers. |
| Superficial fascia | Enveloping layer directly beneath the skin containing dense and areolar connective tissue and fat. |
| Deep fascia | Continuous sheet of mostly dense, irregularly arranged connective tissue that limits the changes in shape of underlying tissues. Deep fasciae may be continuous with epimysium and intermuscular septa and may also contain layers of areolar connective tissue. |
| Intermuscular septa | A thin layer of closely packed bundles of collagen fibers, possibly with several preferential directions predominating, arranged in various layers. The septa separate different, usually antagonistic, muscle groups (for example, flexors and extensors), but may not limit force transmission. |
| Interosseal (interosseous?) membrane | Two bones in a limb segment can be connected by a thin collagen membrane with a structure similar to the intermuscular septa. |
| Periost | Surrounding each bone and attached to it is a bi-layered collagen membrane similar in structure to the epimysium. |
| Neurovascular tract | The extramuscular collagen fiber reinforcement of blood and lymph vessels and nerves. This complex structure can be quite stiff. The diameter and, presumably, the stiffness of neurovascular tracts decrease along limbs from proximal to distal parts. Their stiffness is related to the angle or angles of the joints that they cross. |
| Epimysium | A multi-layered, irregularly arranged collagen fiber sheet that envelopes muscles and that may contain layers of both dense and areolar connective tissue. |
| Intra- and extramuscular aponeurosis | A multilayered structure with densely laid down bundles of collagen with major preferential directions. The epimysium also covers the aponeuroses, but is not attached to them. Muscle fibers are attached to intramuscular aponeuroses by their myotendinous junctions. |
| Perimysium | A dense, multi-layered, irregularly arranged collagen fiber sheet that envelopes muscle fascicles. Adjacent fascicles share a wall of the tube (like the cells of a honeycomb). |
| Endomysium | Fine network of irregularly arranged collagen fibers that form a tube enveloping and connecting each muscle fiber. Adjacent muscle fibers share a wall of the tube (like the cells of a honeycomb). |
この報告の結論としては「"fascia"(筋膜)を広義意味合いとして腱や靱帯まで含めることを推奨しない」ということで、腱や靱帯との接合部分での混同につながり、結合組織一般化となり"muddy"な状況を生む可能性がある
Why myofascial release will never be evidence-based.
International Musculoskeletal Medicine, 31(2), 55-56.
Kidd, R. F., 2009.
Effectiveness of myofascial release: systematic review of randomized controlled trials.
Ajimsha et al.
J Bodyw Mov Ther. 2015 Jan;19(1):102-12.
doi: 10.1016/j.jbmt.2014.06.001.
Epub 2014 Jun 13.
https://www.ncbi.nlm.nih.gov/pubmed/25603749
＜序文＞
Myofascial release (MFR) is a widely employed manual therapy treatment that involves specifically guided low load, long duration mechanical forces to manipulate the myofascial complex, intended to restore optimal length, decrease pain, and improve function (Barnes., 1990) .
https://www.amazon.com/Myofascial-Release-Excellence-Comprehensive-Evaluatory/dp/1929894007
MFR when used in conjunction with conventional treatment is said to be effective to provide immediate relief of pain and tissue tenderness (Hou et al., 2002, McKenney et al., 2013) .
It has been hypothesized that fascial restrictions in one region of the body cause undue stress in other regions of the body due to fascial continuity .
This may result in stress on any structures that are enveloped, divided, or supported by fascia (Schleip., 2003) .
Myofascial practitioners claim that by restoring the length and health of restricted connective tissue, pressure can be relieved on pain sensitive structures such as nerves and blood vessels .
MFR generally involves slow, sustained pressure (120-300 s) applied to restricted fascial layers either directly (direct MFR technique) or indirectly (indirect MFR technique) .
- Direct MFR technique is thought to work directly over the restricted fascia: practitioners use knuckles or elbow or other tools to slowly sink into the fascia, and the pressure applied is a few kilograms of force to contact the restricted fascia, apply tension, or stretch the fascia .
- Indirect MFR involves a gentle stretch guided along the path of least resistance until free movement is achieved (GOT, 2009) . The pressure applied is a few grams of force, and the hands tend to follow the direction of fascial restrictions, hold the stretch, and allow the fascia to loosen itself (Ajimsha et al., 2013)
The rationale for these techniques can be traced to various studies that investigated plastic, viscoelastic, and piezoelectric properties (圧伝導特性)of connective tissue (Schleip., 2003,2012; Pischinger., 1991; Greenman., 2003) .
＜Fascia定義について＞
Recent Fascia Research Congresses (FRC) define fascia as a ‘soft tissue component of the connective tissue system that permeates the human body’ (Huijing and Langevin, 2009) .；最上部分文献
＜Fascia定義が曖昧になってきている＞
One could also describe them as fibrous collagenous tissues that are part of a body-wide tensional force transmission system (Schleip R et al., 2012) .
The complete fascial net includes dense planar tissue sheets, ligaments, tendons, superficial fascia and even the innermost intramuscular layer of the endomysium .
The term fascia now includes the dura mater, the periosteum, perineurium, the fibrous capsular layer of vertebral discs, organ capsules as well as bronchial connective tissue and the mesentery of the abdomen (Schleip R et al., 2012) .
Fascial tissues are seen as one interconnected tensional network that adapts its fiber arrangement and density, according to local tensional demands (Schleip R et al., 2012) .
＜広範囲定義の元...＞
Authors such as Day (2009), Stecco (2013) and Langevin (2011) and colleagues, have suggested that connective tissue could become tighter/denser in overuse syndromes, or after traumatic injuries, but it is unclear if this is due to an alteration of collagen fiber composition, of fibroblasts, or of ground substance .
The same authors suggest that the alteration of fascial pliability could be a source of body misalignment, potentially leading to poor muscular biomechanics, altered structural alignment, and decreased strength and motor coordination .
MFR practitioners claim to be clinically efficacious in providing immediate pain relief and to improve physiologic functions that have been altered by somatic dysfunctions (Hou et al., 2002, McKenney et al., 2013) .
MFR directs force to fascial fibroblasts, as well as indirect strains applied to nerves, blood vessels, the lymphatic system, and muscles .
Laboratory experiments suggest that fibroblasts, the primary cell type of the fascia, adapt specifically to mechanical loading in manners dependent upon the strain magnitude, duration and frequency .
Meltzer et al (2010), in their in-vitro modeling study demonstrated that treatment with MFR, after repetitive strain injury, resulted in normalization of apoptotic rate, and reduction in production of inflammatory cytokines .
MFR is being used to treat patients with a wide variety of conditions, but there is little research to support its efficacy .
According to Kidd (2009) the application of MFR is inherently not evidence- based medicine since it relies on clinician-patient interaction, it cannot be a neutral treatment; therefore, the subjectivity of the interaction cannot be removed when we try to determine its outcome .
Kidd indicated that much of the effect of MFR relies on the skill of the clinician and his or her ability to sense the changes in the tissue .
In addition, biological effects of touch can change the effectiveness of the treatment, depending on the state of either the clinician or the patient .
This variability means that interrater reliability is low, and therefore, according to Kidd, prevents MFR from being considered evidence-based .
Yet the same arguments have been applied to other manual therapies in the past that now are considered part of evidence-based practice .
Although MFR is a popular therapy and anecdotal reports describe positive outcomes from MFR treatments, research is necessary to demonstrate its effectiveness to refute Kidd’s argument .
Therefore, the purpose of this systematic review was to critically analyze previously published literatures of RCTs to gather the documented effectiveness of MFR .
myofacial pain syndromeとして“トリガーポイント”治療の病態生理を解説している患者向け解説報告があるが、
JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY
PATIENT EDUCATION AND SELF-ADVOCACY: QUESTIONS AND RESPONSES ON PAIN MANAGEMENT
Edited by Yvette ColónPathophysiology of Trigger Points in Myofascial Pain Syndrome
Trigger points are specific tender areas in a muscle.They are part of a condition called myofascial painsyndrome, which involves muscle stiffness, tenderness,and pain that radiates to other areas, also known asreferred pain.
完全に筋肉が主役の話である。故に、myofascialと命名する理由がわからない
流行にのってるだけのような・・・
でないという証拠を誰か見せてくれ
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