Can Myofascial Interventions Have a Remote Effect on ROM? A Systematic Review and Meta-Analysis

in Journal of Sport Rehabilitation
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Context: Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM). Objective: To determine if remote myofascial techniques can effectively increase the range of motion at a distant body segment. Evidence Acquisition: In November 2018, the authors searched 3 electronic databases (CENTRAL, MEDLINE, and PEDro) and hand-searched journals and conference proceedings. Inclusion criteria were randomized controlled trials comparing remote myofascial techniques with passive intervention (rest/sham) or local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model. Evidence Synthesis: Eight randomized controlled trials, comprising N = 354 participants were included (mean age range 22–36 y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just 2 used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (standard mean difference 0.23; 95% confidence intervals; −0.09 to 0.55; 4 studies) at immediate follow-ups. Effects sizes were small, corresponding to mean differences of 9% or 5° in cervical spine ROM, and 1 to 3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups. Conclusions: Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.

Burk, Perry, and Lis are with the Doctor of Physical Therapy, High Point University, High Point, NC, USA. Dischiavi and Bleakley are with the Department of Physical Therapy, High Point University, High Point, NC, USA.

Bleakley (chrisbleakley77@gmail.com) is corresponding author.
Journal of Sport Rehabilitation
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References
  • 1.

    Tidball JG. Force transmission across muscle cell membranes. J Biomech. 1991;24(suppl 1):4352. doi:

  • 2.

    Wilke JKrause FVogt LBanzer W. What is evidence-based about myofascial chains: a systematic review. Arch Phys Med Rehabil. 2016;97(3):454461. PubMed ID: 26281953 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Myers T. Anatomy trains and force transmission. In: Schleip RFindley TWChaitow LHujing P eds. Fascia: The Tensional Network of the Human Body. London, UK: Churchill Livingstone; 2012:131135.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Krause FWilke JVogt LBanzer W. Intermuscular force transmission along myofascial chains: a systematic review. J Anat. 2016;228(6):910918. PubMed ID: 27001027 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Vleeming APool-Goudzwaard ALStoeckart Rvan Wingerden JPSnijders CJ. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine. 1995;20(7):753758. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Carvalhais VOOcarino Jde MAraujo VLet al. Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: an in vivo experiment. J Biomech. 2013;46(5):10031007. PubMed ID: 23394717 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Mooney VPozos RVleeming AGulick JSwenski D. Exercise treatment for sacroiliac pain. Orthopedics. 2001;24(1):2932. PubMed ID: 11199347 doi:

  • 8.

    Tak IJLanghout RFGroters SWeir AStubbe JHKerkhoffs GM. A new clinical test for measurement of lower limb specific range of motion in football players: design, reliability and reference findings in non-injured players and those with long-standing adductor-related groin pain. Phys Ther Sport. 2017;23:6774. PubMed ID: 27646678 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    McMullen JUhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329337. PubMed ID: 16558646

  • 10.

    Myers T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 3rd ed. United States of America: Churchill Livingstone Elsevier; 2014.

    • Search Google Scholar
    • Export Citation
  • 11.

    Zugel MMaganaris CNWilke Jet al. Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement. Br J Sports Med. 2018;52(23):1497. PubMed ID: 30072398 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Kamper SJMoseley AMHerbert RDMaher CGElkins MRSherrington C. 15 years of tracking physiotherapy evidence on PEDro, where are we now? Br J Sports Med. 2015;49(14):907909. PubMed ID: 25833902 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Aparicio EQQuirante LBBlanco CRSendín FA. Immediate effects of the suboccipital muscle inhibition technique in subjects with short hamstring syndrome. J Manipulative Physiol Ther. 2009;32(4):262269. PubMed ID: 19447262 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wilke JNiederer DVogt LBanzer W. Remote effects of lower limb stretching: preliminary evidence for myofascial connectivity? J Sports Sci. 2016;34(22):21452148. PubMed ID: 27124264 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Wilke JVogt LNiederer DBanzer W. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci. 2017;35(20):20212027. PubMed ID: 27819537 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Jung JChoi WLee Yet al. Immediate effect of self-myofascial release on hamstring flexibility. Kor Academy of Phys Ther Rehab Sci. 2017;6:4551.

    • Search Google Scholar
    • Export Citation
  • 17.

    Hyong HKang JH. The immediate effects of passive hamstring stretching exercises on the cervical spine range of motion and balance. J Phys Ther Sci. 2013;25(1):113116. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Do KKim JYim J. Acute effect of self-myofascial release using a foam roller on the plantar fascia on hamstring and lumbar spine superficial back line flexibility. Phys Ther Rehabil Sci. 2018;7(1):3540. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Grieve RGoodwin FAlfaki MBourton AJJeffries CScott H. The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: a pilot randomised controlled trial. J Bodyw Mov Ther. 2015;19(3):544552. PubMed ID: 26118527 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Joshi DGBalthillaya GPrabhu A. Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals – A randomized clinical trial. J Bodyw Mov Ther. 2018;22(3):832837. PubMed ID: 30100320 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Oschman JL. Charge transfer in the living matrix. J Bodyw Mov Ther. 2009;13(3):215228. PubMed ID: 19524846 doi:

  • 22.

    Simmonds NMiller PGemmell H. A theoretical framework for the role of fascia in manual therapy. J Bodyw Mov Ther. 2012;16(1):8393. PubMed ID: 22196432 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Stecco AStern RFantoni IDe Caro RStecco C. Fascial disorders: implications for treatment. PM R. 2016;8(2):161168. PubMed ID: 26079868 doi:

  • 24.

    Kelly SBeardsley C. Specific and cross-over effects of foam rolling on ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2016;11(4):544551. PubMed ID: 27525179

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Chaouachi APadulo JKasmi SOthmen ABChatra MBehm DG. Unilateral static and dynamic hamstrings stretching increases contralateral hip flexion range of motion. Clin Physiol Funct Imaging. 2017;37(1):2329. PubMed ID: 26017182 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Langevin HMFox JRKoptiuch Cet al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord. 2011;12:203. PubMed ID: 21929806 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Epro GMierau ADoerner Jet al. The Achilles tendon is mechanosensitive in older adults: adaptations following 14 weeks versus 1.5 years of cyclic strain exercise. J Exp Biol. 2017;220(Pt 6):10081018. PubMed ID: 28298464 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Kelly GReilly AMoloney HMoran JCunningham CBroderick J. 50 years of randomised controlled trials published in the journal Physiotherapy: a review 1967 to 2017. Physiotherapy. 2018;104(4):359366. PubMed ID: 30318126 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Fu RHolmer HK. Change score or follow-up score? Choice of mean difference estimates could impact meta-analysis conclusions. J Clin Epidemiol. 2016;76:108117. PubMed ID: 26931293 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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