Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

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Abstract

The fascial system builds a three-dimensional continuum of soft, collagen-containing, loose and dense fibrous connective tissue that permeates the body and enables all body systems to operate in an integrated manner. Injuries to the fascial system cause a significant loss of performance in recreational exercise as well as high-performance sports, and could have a potential role in the development and perpetuation of musculoskeletal disorders, including lower back pain. Fascial tissues deserve more detailed attention in the field of sports medicine. A better understanding of their adaptation dynamics to mechanical loading as well as to biochemical conditions promises valuable improvements in terms of injury prevention, athletic performance and sports-related rehabilitation. This consensus statement reflects the state of knowledge regarding the role of fascial tissues in the discipline of sports medicine. It aims to (1) provide an overview of the contemporary state of knowledge regarding the fascial system from the microlevel (molecular and cellular responses) to the macrolevel (mechanical properties), (2) summarise the responses of the fascial system to altered loading (physical exercise), to injury and other physiological challenges including ageing, (3) outline the methods available to study the fascial system, and (4) highlight the contemporary view of interventions that target fascial tissue in sport and exercise medicine. Advancing this field will require a coordinated effort of researchers and clinicians combining mechanobiology, exercise physiology and improved assessment technologies.

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Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.

J A Hides, C A Richardson, G A Jull (1996)

A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group. To document the natural course of lumber multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery. Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms. Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination. Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination. Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.

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Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length.

Vivian Lee, S. Ward, Henry G. Chambers … (2011)

Cerebral palsy (CP) results from an upper motoneuron (UMN)lesion in the developing brain. Secondary to the UMNl esion,which causes spasticity, is a pathological response by muscle - namely, contracture. However, the elements within muscle that increase passive mechanical stiffness, and therefore result in contracture, are unknown. Using hamstring muscle biopsies from pediatric patients with CP (n =33) and control (n =19) patients we investigated passive mechanical properties at the protein, cellular, tissue and architectural levels to identify the elements responsible for contracture. Titin isoform, the major load-bearing protein within muscle cells, was unaltered in CP. Correspondingly, the passive mechanics of individual muscle fibres were not altered. However, CP muscle bundles, which include fibres in their constituent ECM, were stiffer than control bundles. This corresponded to an increase in collagen content of CP muscles measured by hydroxyproline assay and observed using immunohistochemistry. In vivo sarcomere length of CP muscle measured during surgery was significantly longer than that predicted for control muscle. The combination of increased tissue stiffness and increased sarcomere length interact to increase stiffness greatly of the contracture tissue in vivo. These findings provide evidence that contracture formation is not the result of stiffening at the cellular level, but stiffening of the ECM with increased collagen and an increase of in vivo sarcomere length leading to higher passive stresses.

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Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods.

Michel Jaffrin, Patrick Morel (2008)

This paper reviews various bioimpedance methods permitting to measure non-invasively, extracellular, intracellular and total body water (TBW) and compares BIA methods based on empirical equations of the wrist-ankle resistance or impedance at 50 kHz, height and weight with BIS methods which rely on an electrical model of tissues and resistances measured at zero and infinite frequencies. In order to compare these methods, impedance measurements were made with a multifrequency Xitron 4200 impedance meter on 57 healthy subjects which had undergone simultaneously a Dual X-ray absorptiometry examination (DXA), in order to estimate their TBW from their fat-free-mass. Extracellular (ECW) and TBW volumes were calculated for these subjects using the original BIS method and modifications of Matthie[Matthie JR. Second generation mixture theory equation for estimating intracellular water using bioimpedance spectroscopy. J Appl Physiol 2005;99:780-1], Jaffrin et al. [Jaffrin MY, Fenech M, Moreno MV, Kieffer R. Total body water measurement by a modification of the bioimpédance spectroscopy method. Med Bio Eng Comput 2006;44:873-82], Moissl et al. [Moissl UM, Wabel P, Chamney PW, Bosaeus I, Levin NW, et al. Body fluid volume determination via body composition spectroscopy in health and disease. Physiol Meas 2006;27:921-33] and their TBW resistivities were compared and discussed. ECW volumes were calculated by BIA methods of Sergi et al. [Sergi G, Bussolotto M, Perini P, Calliari I, et al. Accuracy of bioelectrical bioimpedance analysis for the assessment of extracellular space in healthy subjects and in fluid retention states. Ann Nutr Metab 1994;38(3):158-65] and Hannan et al. [Hannan WJ, Cowen SJ, Fearon KC, Plester CE, Falconer JS, Richardson RA. Evaluation of multi-frequency bio-impedance analysis for the assessment of extracellular and total body water in surgical patients. Clin Sci 1994;86:479-85] and TBW volumes by BIA methods of Kushner and Schoeller [Kushner RF, Schoeller DA. Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 1986;44(3):417-24], Lukaski et al. [Lukaski HC, Bolonchuk WW. Estimation of body fluid volumes using tetrapolar bioelectrical impedance measurements. Aviat Space Environ Med 1988;59:1163-9], Hannan et al. [Hannan WJ, Cowen SJ, Fearon KC, Plester CE, Falconer JS, Richardson RA. Evaluation of multi-frequency bio-impedance analysis for the assessment of extracellular and total body water in surgical patients. Clinical Science 1994;86:479-85], Deurenberg et al. [Deurenberg P, van der Koy K, Leenen R, Westrate JA, Seidell JC. Sex and age specific prediction formulas for estimating body composition from bioelectric impedance: a cross validation study. Int J Obesity 1991;15:17-25] These volumes were compared against those given by BIS method and, in the case of TBW, with those by DXA. For ECW, a good agreement was found between various BIS methods and that of Sergi while Hannan's values were higher. Both Matthie's and Moissl's methods gave mean TBW resistivities and volumes lower than those of Jaffrin's and DXA methods. Kushner et al. method gave values of TBW not significantly different from those of Jaffrin et al. and DXA, as Hannan's method in men, but Lukaski and Deurenberg methods led to an underestimation.

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Author and article information

Journal

Journal ID (nlm-ta): Br J Sports Med

Journal ID (iso-abbrev): Br J Sports Med

Journal ID (hwp): bjsports

Journal ID (publisher-id): bjsm

Title: British Journal of Sports Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0306-3674

ISSN (Electronic): 1473-0480

Publication date (Print): December 2018

Publication date (Electronic): 2 August 2018

Volume: 52

Issue: 23

Page: 1497

Affiliations

[1 ] departmentDivision of Sports Medicine , Ulm University , Ulm, Germany

[2 ] departmentResearch Institute for Sport and Exercise Sciences , Liverpool John Moores University , Liverpool, UK

[3 ] departmentDepartment of Sports Medicine , Goethe University , Frankfurt, Germany

[4 ] departmentDepartment of Neurosurgery , Ulm University , Ulm, Germany

[5 ] departmentDepartment of Anesthesiology , BKH Günzburg , Günzburg, Germany

[6 ] departmentInstitute of Health and Biomedical Innovation , Queensland University of Technology , Brisbane, Queensland, Australia

[7 ] departmentDepartment of Physical Medicine , New Jersey Medical School, Rutgers, The State University of New Jersey , New Brunswick, New Jersey, USA

[8 ] departmentDepartment of Anatomy and Cell Biology , Temple University School of Medicine , Philadelphia, Pennsylvania, USA

[9 ] departmentDepartment of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences , Medical University Ghent , Ghent, Belgium

[10 ] departmentDepartment of Molecular and Cellular Sport Medicine, Institute of Cardiovascular Research and Sport Medicine , German Sport University Cologne , Cologne, Germany

[11 ] departmentFascia Research Group , Experimental Anesthesiology, Ulm University , Ulm, Germany

[12 ] departmentCentre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane, Queensland, Australia

Author notes

[Correspondence to ] Professor Paul William Hodges, Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia; p.hodges@ 123456uq.edu.au

Author information

Paul William Hodges http://orcid.org/0000-0002-1206-9107

Article

Publisher ID: bjsports-2018-099308

DOI: 10.1136/bjsports-2018-099308

PMC ID: 6241620

PubMed ID: 30072398

SO-VID: 580738ac-5eb7-4eec-a127-2c5039fcb730

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 30 May 2018

Funding

Funded by: National Health and Medical Research Council of Australia;

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ScienceOpen disciplines: Sports medicine

Keywords: injury,consensus statement,tendon,soft tissue

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ScienceOpen disciplines: Sports medicine

Keywords: injury, consensus statement, tendon, soft tissue

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Fascial tissue research in sports medicine: from molecules to tissue adaptation, injury and diagnostics: consensus statement

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Most cited references 100

Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.

Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length.

Body fluid volumes measurements by impedance: A review of bioimpedance spectroscopy (BIS) and bioimpedance analysis (BIA) methods.

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