Painful Connections: Densification Versus Fibrosis of Fascia

Pavan, Piero G.; Stecco, Antonio; Stern, Robert; Stecco, Carla

doi:10.1007/s11916-014-0441-4

Cited by 139 publications

(120 citation statements)

References 47 publications

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“…It has been clearly demonstrated that damage to fasciae always causes inflammatory reactions which promote the healing process of collagen fibers, that may be remodeled and realigned: the fascia is affected by muscle traction because, during contraction, part of the force generated is transmitted to the surrounding fascia along clearcut lines of force 37 . If the fascia is damaged, the collagen fibers may not be remodeled along the correct lines, leading to fibrosis 38 …”

Section: Discussionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti‐S100 antibody for myelin‐forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto‐lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2, and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post‐operative pain.

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Section: Discussionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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“…Nonsteroidal anti‐inflammatory drugs (NSAIDS) are also commonly used treatments for acute and chronic musculoskeletal pain, yet are also not completely effective and may reduce tissue healing . NSAIDs may fail because they treat algesic symptoms but not the key underlying cause, which we and others believe are fibrotic adhesions tethering tissues and compressing nerves . The FG‐3019 antibody used here targets domain II of CCN2, the vWC domain, located within the amino‐terminal half of the full‐length protein .…”

Section: Discussionmentioning

confidence: 99%

Blocking CCN2 Reduces Progression of Sensorimotor Declines and Fibrosis in a Rat Model of Chronic Repetitive Overuse

Barbe

Hilliard

Delany

et al. 2019

Journal Orthopaedic Research

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Fibrosis may be a key factor in sensorimotor dysfunction in patients with chronic overuse‐induced musculoskeletal disorders. Using a clinically relevant rodent model, in which performance of a high demand handle‐pulling task induces tissue fibrosis and sensorimotor declines, we pharmacologically blocked cellular communication network factor 2 (CCN2; connective tissue growth factor) with the goal of reducing the progression of these changes. Young adult, female Sprague–Dawley rats were shaped to learn to pull at high force levels (10 min/day, 5 weeks), before performing a high repetition high force (HRHF) task for 3 weeks (2 h/day, 3 days/week). HRHF rats were untreated, or treated in task weeks 2 and 3 with a monoclonal antibody that blocks CCN2 (FG‐3019), or a control immunoglobulin G (IgG). Control rats were untreated or received FG‐3019, IgG, or vehicle (saline) injections. Mean task reach rate and grasp force were higher in 3‐week HRHF + FG‐3019 rats, compared with untreated HRHF rats. Grip strength declined while forepaw mechanical sensitivity increased in untreated HRHF rats, compared with controls; changes improved by FG‐3019 treatment. The HRHF task increased collagen in multiple tissues (flexor digitorum muscles, nerves, and forepaw dermis), which was reduced with FG‐3019 treatment. FG‐3019 treatment also reduced HRHF‐induced increases in CCN2 and transforming growth factor β in muscles. In tendons, FG‐3019 reduced HRHF‐induced increases in CCN2, epitendon thickening, and cell proliferation. Our findings indicate that CCN2 is critical to the progression of chronic overuse‐induced multi‐tissue fibrosis and functional declines. FG‐3019 treatment may be a novel therapeutic strategy for overuse‐induced musculoskeletal disorders. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2004–2018, 2019

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“…This is out of a more topographical view which reinforces the likely repercussions caused osteomioarticular after episiotomy. The pain levels present in the group I may be occurring because according to a study, the deep fascia was considered one of the origins of pain (Pavan, 2014). Therefore, this painful condition experienced pathological changes in the fascia as densification and fibrosis.…”

Section: Discussionmentioning

confidence: 98%

Relation Between Episiotomy and Osteomioarticular Symptoms

Rodrigues

Filho

Silva³

et al. 2016

ESJ

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Childbirth is a social and cultural phenomenon which has faced drastic changes from twentieth century as a shift to a gynecological position and an episiotomy routine. Fascia represents "the philosophy of the body" and any pathologic alteration in that tissue will affect the whole body. This study aims to verify the relation between episiotomy and osteomioarticular symptoms. 60 women who participated in this study were divided equally into two groups: group I (vaginal delivery with episiotomy) and group II (vaginal delivery without episiotomy). To assess them, we used an Initial assessment form and a Nordic Musculoskeletal Questionnaire. The data were analyzed with the Spearman Correlation Test and t Student Test for independent samples with a statistical significance of p≤0,05. Based on the results of the study, 60% women from group I related low back repercussions during the last year, while 53% women from group I related hip/lower limbs repercussions during the last week. Level of pain and musculoskeletal complaints prevailed in group I, as well. We concluded that there is a high prevalence of osteomioarticular symptoms in women who had episiotomy in her deliveries.

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Painful Connections: Densification Versus Fibrosis of Fascia

Cited by 139 publications

References 47 publications

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Blocking CCN2 Reduces Progression of Sensorimotor Declines and Fibrosis in a Rat Model of Chronic Repetitive Overuse

Relation Between Episiotomy and Osteomioarticular Symptoms

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