To date, the TVI has been attributed to the VL. Indeed, the affiliation of the TVI to the VL is confirmed by the close relationship of the two muscle heads in the proximal aspect. However, the course and function of the TVI and its neurovascular supply suggest that it is aligned more with the VI than the VL. Yet, when the nerves supplying the quadriceps femoris are viewed as a whole, the TVI should be considered together with the VL and the lateral portion of the VI as a func- tional unit. All three lamellar muscles are closely related and are supplied by the same deep lateral divi- sion of the femoral nerve.
Purpose: Recent evidence suggested the signiﬁcance of integrity of the tension balance of the muscle-
fascia corset system in spinal stability, particularly the posterior musculofascial junction which is adja-
cent to dorsal located paraspinal muscles joining each other at lateral raphe (LR). The purpose of this
study was to compare the contraction of the transversus abdominis (TrA) at both anterior and posterior
musculofascial muscle-fascia junctions in patients with low back pain (LBP) and asymptomatic partici-
pants before and immediately after a sustained manual pressure to LR.
Methods: The present observational cohort study used a single-instance, test-retest design. The outcome
variables included the resting thickness (Tr), the thickness during contraction (Tc), change in thickness
(DT), sliding of musculofascial junction (DX), muscle length at rest (L) and displacement pattern (DD) of
the TrA using ultrasonography. Vertical tolerable pressure at the LR was applied manual for 1 min. Tr, Tc,
DT, and DX were analyzed by three-way ANOVA (musculofascial junction sites*group* pre-post manual
release). DL and DD were analyzed by two-way ANOVA (group* pre-post manual release).
Results: Participants with LBP revealed less Tc, DT and DX at both sites (p < 0.005). After myofascial
release, LBP group demonstrated a positive DD of the musculofascial junctions at both end (p < 0.001).
Nevertheless, both groups increased the DT and DX at both sites (p < 0.001 and 0.001, respectively).
Conclusion: The result indicated immediately effect of sustained manual pressure on musculofascial
junction of TrA and supported the concept that the possible imbalanced tension of the myofascia corset
of TrA in patients with LBP.
In spite of all the research and additional under- standing of hamstring muscle injures over the past 20–30 years, we have not reduced the incidence of first-time injuries and the recurrence rate is still extremely high. While research published over the past couple of years has led to an increased under- standing of these challenging injuries, we still have a long way to go in the management of hamstring muscle injuries.
Purpose: The sacroiliac joint (SIJ) may be a cause of sciatica. The aim of this study was to assess which treatment is successful for SIJ-related back and leg pain.
Methods: Using a single-blinded randomized trial, we assessed the short-term therapeutic efficacy of physiotherapy, manual therapy, and intra-articular injection with local corticosteroids in the SIJ in 51 patients with SIJ-related leg pain. The effect of the treatment was evaluated after 6 and 12 weeks.
Results: Of the 51 patients, 25 (56 %) were successfully treated. Physiotherapy was successful in 3 out of 15 patients (20 %), manual therapy in 13 of the 18 (72 %), and intra-articular injection in 9 of 18 (50 %) patients (p = 0.01). Manual therapy had a significantly better success rate than physiotherapy (p = 0.003).
Conclusion: In this small single-blinded prospective study, manual therapy appeared to be the choice of treatment for patients with SIJ-related leg pain. A second choice of treatment to be considered is an intra-articular injection.
Implications profound for neurological diseases from autism to Alzheimer’s to multiple sclerosis.
In a stunning discovery that overturns decades of textbook teaching, researchers at the University of Virginia School of Medicine have determined that the brain is directly connected to the immune system by vessels previously thought not to exist. That such vessels could have escaped detection when the lymphatic system has been so thoroughly mapped throughout the body is surprising on its own, but the true significance of the discovery lies in the effects it could have on the study and treatment of neurological diseases ranging from autism to Alzheimer’s disease to multiple sclerosis.
“Instead of asking, ‘How do we study the immune response of the brain?’ ‘Why do multiple sclerosis patients have the immune attacks?’ now we can approach this mechanistically. Because the brain is like every other tissue connected to the peripheral immune system through meningeal lymphatic vessels,” said Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA’s Center for Brain Immunology and Glia (BIG). “It changes entirely the way we perceive the neuro-immune interaction. We always perceived it before as something esoteric that can’t be studied. But now we can ask mechanistic questions.”
“We believe that for every neurological disease that has an immune component to it, these vessels may play a major role,” Kipnis said. “Hard to imagine that these vessels would not be involved in a [neurological] disease with an immune component.”
Discussion: Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population.
Summary: Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.
Analysis of cellular mechanotransduction, the mechanism by which cells convert mechanical signals into biochemical responses, has focused on identification of critical mechanosensitive molecules and cellular components. Stretch-activated ion channels, caveolae, integrins, cadherins, growth factor receptors, myosin motors, cytoskeletal filaments, nuclei, extracellular matrix, and numerous other structures and signaling molecules have all been shown to contribute to the mechanotransduction response. However, little is known about how these different molecules function within the structural context of living cells, tissues, and organs to produce the orchestrated cellular behaviors required for mechanosensation, embryogenesis, and physiological control. Recent work from a wide range of fields reveals that organ, tissue, and cell anatomy are as important for mechanotransduction as individual mechanosensitive proteins and that our bodies use structural hierarchies (systems within systems) composed of interconnected networks that span from the macroscale to the nanoscale in order to focus stresses on specific mechanotransducer molecules. The presence of isometric tension (prestress) at all levels of these multiscale networks ensures that various molecular scale mechanochemical transduction mechanisms proceed simultaneously and produce a concerted response. Future research in this area will therefore require analysis, understanding, and modeling of tensionally integrated (tensegrity) systems of mechanochemical control
Excessive cervical facet capsular ligament stretch has been implicated as a cause of whiplashassociated disorders following rear-end impacts, but the pathophysiological mechanisms that produce chronic pain in these cases remain unclear. Using a rat model of C6/C7 cervical facet joint capsule stretch that produces sustained mechanical hyperalgesia, the presence of neuronal hyperexcitability was characterized 7 days after joint loading.
The repair process of damaged tissue involves the coordinated activities of several cell types in response to local and systemic signals. Following acute tissue injury, infiltrating inflammatory cells and resident stem cells orchestrate their activities to restore tissue homeostasis. However, during chronic tissue damage, such as in muscular dystrophies, the inflammatory-cell infiltration and fibroblast activation persists, while the reparative capacity of stem cells (satellite cells) is attenuated. Abnormal dystrophic muscle repair and its end stage, fibrosis, represent the final common pathway of virtually all chronic neurodegenerative muscular diseases. As our understanding of the pathogenesis of muscle fibrosis has progressed, it has become evident that the muscle provides a useful model for the regulation of tissue repair by the local microenvironment, showing interplay among muscle-specific stem cells, inflammatory cells, fibroblasts and extracellular matrix components of the mammalian wound-healing response. This article reviews the emerging findings of the mechanisms that underlie normal versus aberrant muscle-tissue repair.
Another great article we will be discussing at tomorrow at the Logan Symposium. Offers a wonderful insight of the skin as the largest sensory organ and its influence of the autonomic nervous system. Since all fascial techniques are delivered through or pass through the skin interface this is important information on how what we do effects our patients on a sensory level.