the role of connective tissue in the embryology of the musculoskeletal system towards a paradigm shift

This paper presents a review of literature regarding the role of embryological connective tissue in the formation of muscles and the organization of the musculoskeletal system. The intention is to introduce a potential paradigm shift with regards to understanding peripheral coordination of movement and movement patterns. This new perspective could improve comprehension of the normal physiological function of connective tissue and, whenever it is pathological, resultant symptoms. Furthermore, this paper briefly discusses some implications of this paradigm shift in the interpretation of movement patterns, posing further questions for future research

The Fascial Manipulation Technique and Its Biomechanical Model: A Guide to the Human Fascial System

This paper examines the principal characteristics of an innovative biomechanical model for interpreting the human fascial system and discusses the mechanisms that underlie the model in reference to some current trends in musculoskeletal research. The model, developed specifically for manual therapists working with movement dysfunction and pain, is the fruit of thirty-five years of study and physiotherapy clinical practice. It presents a functional interpretation of the relationship between muscles, deep fascia, and its derivatives (epimysium, perimysium, and endomysium). This model guides the clinical reasoning process employed in the manual therapy method known as Fascial Manipulation. Reference is made throughout to recent anatomical dissections designed specifically to examine the connections between deep fascia and muscles, the histological aspects of deep fascia, and its biomechanical characteristics. This knowledge could contribute to clinician\u2019s understanding of the myofascial system and the role that deep fascia may play in musculoskeletal dysfunctions

Humid Air Gas Turbine Cycle: a Possible Optimization

The humid air turbine (HAT), patented by FLuor Daniel, is an innovative cycle which allows to obtain an increase in efficiency and power production. The modification proposed by DEF allows to optimize the plant when natural gas is injected in the combustion chamber. Assuming a TIT (Temperature Inlet Turbine) at 1273°K and the cooling of recirculating water in the refrigerators, we studied the effects of the relative humidity and the compression ration on the cycle's performances. The aim of this paper is to suggest the parameters which allow to obtain high efficiency with high specific power, the possibility to modulate power production without a decrease in efficiency and low water consumption

Analysis of the presence of the hyaluronic acid inside the deep fasciae and in the muscles

Recent works have demonstrated that the deep fascia is a multilayer structure, formed by different layers of collagen fibers and loose connective tissue (LCT). The aim of this work was to study the layers of LCT inside the deep fasciae, and in particular to evaluate the presence of Hyaluronic acid (HA). Three fresh not embalmed cadavers were studied. Samples of the deep fascia together with the underlying muscles were taken from the neck over the SCOM, from the abdomen over the rectus muscle and from the thigh over the sartorius muscle. Samples were stained with hematoxylin-eosin, azan-Mallory, Alcian blue and a biotinylated HA-binding protein that has high specificity for HA. At the microscopic evaluation, the deep fascia was formed of two or three layers of parallel collagen fibre bundles, densely packaged. Each collagen layer presented a mean thickness (± SD) of 277.6 ± 86.1 µm. Between the different layers, a thin layer of loose connective tissue could be recognized, having mean thickness 43 ± 12 µm. Staining with the Alcian Blue and with the highly specific HA-binding peptide documented a layer of hyaluronan between fascia and muscle and inside deep fascia, in particular inside the loose connective tissue separating the fibrous sub-layer of the fascia. In some samples, some fibroblast-like cells that stained very well at the Alcian Blue stain were observed. It was postulated that these were specialized cells for the biosynthesis of the HA-rich matrix, that we’ll call “fasciacyte”. This means that the fascia thus provides an extracellular matrix that is a gliding lubricant over muscle, permitting the free contraction of muscles, but also a unique matrix for its repair and regeneration. Besides, the HA inside the deep fascia facilitates the free sliding of two adjacent fibrous fascial layers, guaranteed the normal functionality of the deep fascia. If the HA assumes a more packed conformation, or more generally if the loose connective tissue inside the fascia alters its density, the behavior of the whole deep fascia and of the underlying muscle could be compromised. This could be at the origin of many myofascial pains

The possible use of ultrasonography for the diagnosis of myofascial neck pain

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain. The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical Range Of Motion (ROM) was analysed and the Neck Pain Disability Questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analysed by ultrasonography. There were significant differences between healthy subjects in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia. Analysis of the thickness of the sub-layers showed a significant increase of the loose connective tissue inside the fascia, rather than of the fibrous sublayers. The data support the hypothesis that the loose connective tissue inside the fasciae plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue, and probably more specifically with hyaluronan

A global approach for plantar fasciitis with extracorporeal shockwaves treatment

Extracorporeal Shockwaves Treatment is considered an effective therapeutic option for plantar fasciitis, but the standard application in the medial insertion of the plantar fascia on the calcaneus has provided ambiguous evidences. In this case, a 63-year man with plantar fasciitis was treated in a 3-session program and Foot and Ankle Outcome Scale and Foot Functional Index questionnaires were chosen for the clinical outcome evaluation. The therapy was focused on the active trigger or myofascial points of the leg, thigh and pelvis in order to return the correct equilibrium of the myofascial system of the whole limb. The patient has already reported an improvement after the second session (FAOS: 76 vs 33, FFI: 85%) which was confirmed in the third one and in the 1-month follow up (FAOS: 79, FFI: 6%) Results suggest that plantar fasciitis may be due to proximal rigidity or tension of the fascia and a global approach using ESWT may have a similar or better outcome respect to the standard application

2019 Ejtm Special on Muscle Fascia

For many years the fasciae have been considered by the anatomists only as a “white envelope for the muscles”, that is generally removed in anatomical tables, to recognize muscle nerves and vessels. This is one of the reasons that different descriptions of the fasciae exist. On the other hand, in the last years the fasciae and their properties are becoming of central importance to clinicians practicing in various conventional and alternative therapies. The results from the worldwide research activities constitute a body of significant and important data, but this clinical interest is not supported by in-depth comprehension to how integrate the new knowledge about fasciae with the classical biomechanical models based on muscles, tendons and bones. To close this gap an Ejtm Special on “Muscle Fascia” will be published September 30, 2019, but the typescripts will be added to the Ejtm Early Release list as soon as all authors will approve their Epub papers. Deadline for original articles and reviews is June 1st, 2019, but the Editors hope that authors submit their typescripts much earlier

Peritoneal Hydatidosis

Secondary peritoneal hydatidosis is caused by spontaneous or iatrogenic rupture of hepatic echinococcal cysts. We describe the case of a 65-year-old Tunisian male patient with previous history of liver hydatidosis who presented to our attention with subocclusive status. Imaging revealed a retrovesical hydatid cyst, adherent to the sigmoid colon. The treatment of choice was surgical removal of the cyst and the sigmoid colon. The patient is now being closely followed up

Expression of the endocannabinoid receptors in human fascial tissue.

open7noCannabinoid receptors have been localized in the central and peripheral nervous system as well as on cells of the immune system, but recent studies on animal tissue gave evidence for the presence of cannabinoid receptors in different types of tissues. Their presence was supposed also in myofascial tissue, suggesting that the endocannabinoid system may help resolve myofascial trigger points and relieve symptoms of fibromyalgia. However, until now the expression of CBI (cannabinoid receptor I) and CB2 (cannabinoid receptor 2) in fasciae has not yet been established. Small samples of fascia were collected from volunteers patients during orthopedic surgery. For each sample were done a cell isolation, immunohistochemical investigation (CB1 and CB2 antibodies) and real time RT-PCR to detect the expression of CB1 and CB2. Both cannabinoid receptors are expressed in human fascia and in human fascial fibroblasts culture cells. although to a lesser extent than the control gene. We can assume that the expression of mRNA and protein of CBI and CB2 receptors in fascial tissue are concentrated into the fibroblasts This is the first demonstration that the fibroblasts of the muscular fasciae express CBI and CB2. The presence of these receptors could help to provide a description of cannabinoid receptors distribution and to better explain the role of fasciae as pain generator and the efficacy of some fascial treatments. Indeed the endocannabinoid receptors of fascial fibroblasts can contribute to modulate the fascial fibrosis and inflammation.noneopenFede, C; Albertin, G; Petrelli, L; Sfriso, Mm; Biz, C; De Caro, R; Stecco, CFede, C; Albertin, Giovanna; Petrelli, Lucia; Sfriso, MARIA MARTINA; Biz, Carlo; DE CARO, Raffaele; Stecco, Carl

The Fascial Manipulation Technique and Its Biomedical Model: A Guide to the Human Fascial System

This is the expanded abstract of a workshop presented at the Second International Fascia Research Congress; October 27 – 30, 2009; Amsterdam, Netherlands