Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over the past few decades; however, these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting lower back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane, and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies satisfied the following: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, after which data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met the inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in lower back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Additional knowledge of fascial neurological components could impact LBP treatment.
Background: Myofascial Reorganization (MFR) is a physiotherapy technique that mixes myofascial pressures and slips and has been used as a simple and non-invasive method that readjusts soft tissues, as well as myofascial adhesions and contractures that may cause decreased blood supply and consequently of physical activity. Objective: To verify if the MFR alters the tissue oxygenation of the trapezius muscle (TM) in subjects without the pain symptom in the evaluation day. Methods: The sample consisted of eight subjects with a mean age of 23 (± 6) years and a body mass index of 23.2 (±15.0) kg.m-2. Changes in muscle oxygenation were measured by near infrared spectroscopy (NIRS) (Portamon, Artinis, the Netherlands) in TM before and after 15 minutes of intervention. The proposed MFR protocol lasted approximately 10 minutes and consisted of pressures, stretching and myofascial slippage of the upper, middle and lower TM fibers. Data normality was performed using the Shapiro Wilk test and due to the parametric nature of the data, the paired t-test was used for pre and post intervention comparison. Results: There was a significant increase in the tissue saturation index (TSI) in the trapezius muscle (80.7±2.7% vs. 89.4±4.6%; p= 0.002) in the pre and post intervention comparison. The pre-post variation delta of oxyhemoglobin - O2 Hb (8.1±11.2 g/dL), deoxyhemoglobin - HHb (-0.72±1.6 g/dL) and total hemoglobin - tHB (7.4±12.3 g/dL) showed no significant difference. However, there was an increase in O2 Hb, tHB levels and a decrease in HHb. Conclusion: The findings showed that the MFR applied on trapezius muscle increased the TSI, which reflects on peripheral muscle oxygenation in subjects without pain in the day of evaluation.
Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over decades, however these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting low back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies were: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in low back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Greater knowledge of fascial neurological components could impact LBP treatment.
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