Search Results (42)

Background and Objectives: The thoracolumbar fascia (TLF) has been implicated in low back pain, but imaging-based characterization in degenerative lumbar disorders, particularly in surgical cohorts, remains limited. To describe MRI-derived and US-derived TLF thickness estimates in a heterogeneous degenerative lumbar surgical cohort and explore preliminary imaging patterns and associations with selected clinical variables. Materials and Methods: In this prospective single-center cohort, adults scheduled for elective lumbar surgery underwent preoperative US (short- and long-axis at L3) and review of routine lumbar MRI (axial and sagittal T1-weighted measurements at L3) using standardized protocols. Twenty-six patients were included (15 with lumbar spinal stenosis, five with lumbar disc herniation, four with spondylolisthesis, and two with scoliosis). Disability was assessed using the Oswestry Disability Index (ODI). Exploratory subgroup comparisons, correlation analyses, and Bland–Altman agreement analysis were used to examine subgroup patterns, patient–factor associations, and MRI–US agreement. Results: Interpretable data were available for 19 axial MRI, 18 sagittal MRI, 19 short-axis US, 15 long-axis US, and 19 ODI assessments; paired MRI–US measurements were available in 11 cases for sagittal/long-axis analysis and 12 for axial/short-axis analysis. Mean TLF thickness was 0.89 ± 0.33 mm on axial MRI, 1.16 ± 0.48 mm on sagittal MRI, 2.53 ± 1.44 mm on short-axis US, and 2.49 ± 1.14 mm on long-axis US. Exploratory subgroup analyses showed a between-diagnosis difference only for axial-MRI-derived TLF thickness (p = 0.007), with lower thickness in disc herniation than in stenosis (p = 0.008), while sagittal MRI and US thickness measures did not differ between groups (p ≥ 0.301). ODI was not consistently associated with TLF thickness on MRI or US. Conclusions: In this exploratory surgical cohort, US-derived TLF thickness values were higher than those previously reported in the literature, suggesting possible fascial alteration in degenerative lumbar disease. However, TLF thickness was not consistently associated with disability, and MRI- and US-derived measurements should be interpreted as modality-specific estimates rather than interchangeable values. Given the small heterogeneous cohort and measurement constraints, these findings are descriptive and preliminary, but they provide an imaging framework to guide future standardized studies. Full article

Background/Objectives: Superior cluneal nerve entrapment syndrome (SCNES) is an underrecognized cause of chronic low back pain, particularly in adolescents where published experience is limited. This article describes a reproducible open surgical technique for superior cluneal nerve (SCN) decompression. Methods: We outline indications and relative contraindications, required instrumentation, key surface landmarks, and a stepwise operative approach. The nerve is identified where SCN branches traverse the thoracolumbar fascia and fibro-osseous tunnel near the posterior iliac crest. Decompression is performed via limited fasciotomy and release of surrounding soft tissues, with attention given to identifying additional branches requiring release. Results: The technique provides consistent exposure and decompression of the SCN branches using an approximately 5 cm oblique incision centered over the expected crossing point (about 7 cm lateral to the midline and roughly 4 cm lateral to the PSIS). Pearls and pitfalls are provided to reduce peri-incisional numbness and avoid thermal injury to the nerve. Conclusions: Open SCN decompression is a focused procedure that can be considered after confirmation of SCNES by clinical criteria and response to diagnostic block. Standardizing technique and postoperative care may facilitate broader adoption and future outcome studies in pediatric populations. Full article

Biophysical, neurophysiological, psychological and social processes along with their interactions are complex, often non-linear and inherently time-dependent. However, time series analysis of such measurements usually requires extensive data processing and is therefore potentially associated with structural biases. This exploratory secondary analysis introduces cross-recurrence quantification analysis (CRQA), which is explicitly suited to time series with complicated non-stationary properties. We illustrate and validate CRQA using a previous study that investigated the dynamic relationship between thoracolumbar fascia deformation and back extensor muscle activity in patients with low back pain. CRQA revealed significant differences in the relationships between fascia and muscles in low back pain patients compared to healthy individuals. The analysis revealed more specific aspects of fascia-muscle coupling than traditional analytical approaches, suggesting that CRQA is a useful additional tool for investigating time-dependent interactions with dynamic complex nonlinear patterns. Full article

Background: Superior cluneal nerve (SCN) entrapment is frequently underrecognized as a contributor to chronic Low Back Pain (cLBP) and gluteal pain. Musculoskeletal ultrasound may reveal surrogate markers indicative of a biomechanical entrapment environment. The primary objective was the prevalence of the ultrasound marker triad (Copeman Nod-ules-CN, thoracolumbar fascia-TLF thickening > 3 mm, and iliac enthesophytes. Secondary objectives included mean TLF thickness and its correlation with numeric pain rating scale (NPRS) and Douleur Neuropathique en 4 questions scores (DN4). Methods: In this single-center, cross-sectional observational pilot study, we enrolled 12 patients with cLBP (>12 weeks) localized to the SCN distribution and a healthy control group (12). Ultrasound measurements included TLF thickness in longitudinal and transverse planes, TLF convexity loss, iliac crest enthesophytes, and CN. Statistical analyses comprised Mann-Whitney U test, Fisher exact test, Spearman rank correlation, and multivariate logistic regression. Significance was set at p < 0.05. Results: The ultrasound marker triad (CN, iliac enthesophytes, and TLF thickening > 3 mm) demonstrated high diagnostic specificity: individually, CN were present in 91.7% of patients vs. 8.3% of controls (p < 0.001), iliac enthesophytes in 58.3% vs. 0% (p = 0.005), TLF thickening > 3 mm in 41.7% of patients vs. 0% of controls (p < 0.001)and TLF convexity loss in 100% vs. 75% (p = 0.03). Mean TLF thickness was significantly greater in patients—3.53 ± 0.46 mm longitudinal and 3.42 ± 0.39 mm transverse—compared with controls (2.61 ± 0.28 mm and 2.50 ± 0.32 mm; both p < 0.001). TLF thickness correlated strongly with NPRS (Spearman rho = 0.825; p = 0.001) but not with DN4. Logistic regression demonstrated that the marker triad accounted for 67% of NPRS variance (R² = 0.67). Conclusions: Ultrasound-detected fascial alterations and enthesopathic changes act as reliable surrogate markers for SCN entrapment and correlate strongly with nociceptive pain severity. The absence of correlation with neuropathic pain scores suggests a predominant fascial-muscular biomechanical mechanism rather than direct nerve damage. Incorporating this non-invasive protocol into clinical practice may enhance diagnostic precision and inform targeted rehabilitative strategies. Future multicenter, prospective studies with larger cohorts are warranted to validate these findings and establish standardized ultrasound criteria. Full article

Aim: This study examined how load size and symmetry affect trunk muscle activation patterns, vertical ground reaction forces, and estimated lumbar spine compression during overground walking in individuals with chronic low back pain (CLBP) and those without symptoms. Methods: Thirty male participants (15 with CLBP, 15 controls; ages 23–28 years) performed walking tests under four load conditions: symmetric and asymmetric carriage at 10% and 20% of body weight. Bilateral surface electromyography measured activation from seven trunk muscles (rectus abdominis, external oblique, internal oblique, latissimus dorsi, lumbar erector spinae, multifidus) and the thoracolumbar fascia region, normalized to maximum voluntary isometric contractions (%MVIC). Force plates recorded vertical ground reaction forces synchronized with heel-strike events. A repeated-measures ANOVA with Bonferroni corrections was used to analyze the effects of load configuration and magnitude. Results: Asymmetric loading at 20% body weight caused significantly higher peak vertical ground reaction forces compared to symmetric loading (mean difference = 47.3 N, p < 0.001), with a significant interaction between load magnitude and configuration (p = 0.004, ηp² = 0.26). Participants with CLBP showed consistently higher trunk muscle activation throughout the gait cycle (peak: 37% MVIC vs. 30% MVIC in controls; p < 0.001, d = 1.68), with maximum recruitment at shorter muscle lengths and 24% less activation at optimal length (95% CI: 18.2–29.8%). The lumbar erector spinae and multifidus muscles exhibited the highest activation during asymmetric 20% loading in CLBP participants (0.282 and 0.263%MVIC, respectively), indicating compensatory neuromuscular strategies. Conclusion: Asymmetric load carriage creates disproportionately high mechanical and neuromuscular demands, effects that are greatly amplified in individuals with CLBP. These findings support rehabilitation strategies that improve load distribution and restore motor control, thereby reducing compensatory strain and enhancing trunk stability. Full article

Background: Foam rolling has become an increasingly popular self-myofascial release (SMR) technique among athletes to prevent injuries, improve recovery, and increase athletic performance. This study investigated how SMR improves mechanical and movement efficiency in recreational road cyclists. Methods: We conducted an exploratory randomized controlled trial (RCT) to investigate the effects of SMR using a foam roller on biomechanical and physiological performance parameters over a six-month period. A total of 32 male participants, aged 26–57 years, with a mean Body Mass Index (BMI) of 24.0 kg/m² (SD = 2.2), were randomly assigned to either an intervention group (n = 16), which incorporated a standardized SMR program into their post-exercise recovery, or a control group (n = 16), which followed the same cycling protocol without SMR. The training program included heart rate-controlled strength endurance intervals. As the primary target, the variables we investigated included torque effectiveness, leg force symmetry, and pedal smoothness. Secondary measurements included submaximal oxygen uptake (VO₂) as well as bioelectrical variables, which we analyzed using classic, repeated-measures ANOVA models and descriptive statistical methods. Results: The analysis revealed significant interaction effects in favor of the intervention group for torque effectiveness (η²_p = 0.434), leg strength symmetry (η²_p = 0.303), and pedal smoothness (η²_p = 0.993). No significant group × time interactions were found for submaximal VO₂ or bioelectrical parameters. Conclusions: Our findings indicate that foam rolling may serve as an effective adjunct to endurance training by enhancing functional neuromuscular performance in cyclists, particularly in torque control and pedal coordination. Its impact on aerobic efficiency and muscle composition appears to be minimal. The results support theoretical models that attribute SMR benefits to proprioceptive, circulatory, and neuromuscular mechanisms rather than structural tissue adaptations. Full article

The deep fascia, traditionally regarded as a passive structural tissue, is now recognized as a metabolically and biologically active structure where biochemical signals and biomechanical forces interact to influence proprioception, pain, force transmission, and adaptation to mechanical load. In this study, the convergence point between Angiotensin II (Ang II) signaling via its receptor, Angiotensin type 1 receptor (AT1R), and the mechanosensor Yes-associated protein (YAP) was investigated in human fascial fibroblasts. The presence of angiotensin II (Ang II) receptors was confirmed in fibroblasts from the deep fascia, with the AT1 receptor being the most prevalent subtype. Short-term exposure to Ang II (15–30 min) caused YAP dephosphorylation and its translocation to the nucleus, indicating YAP activation. Notably, prolonged Ang II treatment (7 days) significantly increased the expression of fibrosis-related genes, including collagen types I and III (COL1A1, COL3A1), and hyaluronan binding protein 2 (HABP2). This gene expression was decreased by pretreatment with the AT1R antagonist irbesartan or the YAP inhibitor verteporfin. Additionally, Ang II promoted fibroblast proliferation/migration, key features of fibrotic progression, through AT1R-dependent pathways. These findings show that Ang II acts as both a biochemical and biomechanical signal in the deep fascia, activating YAP signaling and promoting fibrotic remodeling. Our results uncover a new Ang II–YAP pathway in fascial fibroblasts, offering potential targets for therapy in fibrosis and related conditions involving the deep fascia. Full article

Despite growing evidence on the adaptive movement patterns that horses adopt during water treadmill (WT) exercise, underlying adaptations in muscle activity remain uninvestigated. This feasibility study aimed to develop a method for the synchronous measurement of muscle activity and movement of horses during WT exercise. Combined surface electromyography (sEMG) (2000 Hz) from selected hindlimb (biceps femoris, gluteus medius, tensor fasciae latae) and epaxial (longissimus dorsi) muscles, and three-dimensional kinematic (200 Hz) data from the back and pelvis of one (n = 1) horse were collected during overground (OG), dry treadmill (TM), and WT walking conditions. Statistical parametric mapping evaluated differences in time- and amplitude-normalised sEMG and thoracolumbar and pelvis kinematic waveforms between conditions. Distinct, significant (p < 0.05) adaptations in hindlimb and epaxial muscle activation patterns and axial and pelvic kinematics, were observed in this horse across exercise conditions. Adaptive muscle activity was most pronounced in this horse during WT, compared to OG walking. These findings demonstrate the feasibility of this method, which combines sEMG and motion capture technologies to synchronously quantify equine movement and muscle activation patterns during WT exercise. This justifies the replication of this work in a larger sample of horses to inform evidence-based training and rehabilitation programmes. Full article

Background and Objectives: The hypothesis that fascial thickness variability may serve as a biomarker for low back pain (LBP) requires a clear understanding of typical thickness values in both LBP and non-LBP populations—an area still lacking in the literature. This narrative review aims to define reference values and patterns of variability for the superficial fascia, deep fascia, and subcutaneous tissue in individuals with and without LBP. Methods: A literature search was conducted in PubMed and ScienceDirect using keywords such as superficial fascia, deep fascia, thoracolumbar, subcutaneous fat, back pain, lumbar, thorax, and thickness. Inclusion criteria focused on human studies with proper identification of the relevant soft tissue structures. A total of 21 studies, published up to February 2024, met the inclusion criteria and were analyzed. Results: The review revealed notable intra- and inter-study variability in the thickness of the investigated structures. In LBP populations, both deep fascia and subcutaneous tissues were generally equal to or thicker than in controls (non-LBP), whereas consistent data on superficial fascia thickness remain limited. Age, sex, and anatomical location were discussed as potential influencing factors. Conclusions: These findings support the establishment of reference thickness values for subcutaneous and fascial tissues and encourage further investigation into their structural and functional roles in LBP. The observed variability may offer a basis for patient- and site-specific assessment and intervention strategies. Full article

Objective: We aimed to quantify the mechanical pressure required to reach the deep cervical and thoracolumbar fasciae, to examine its association with pressure pain threshold (PPT) and adipose tissue thickness, and to determine whether PPT and adipose tissue thickness can predict the mechanical pressure needed to reach the fascia. Methods: Forty-three subjects’ PPT, mechanical pressure and skinfold in the trapezius and lumbar regions were evaluated using an algometer, an ultrasound scanner, and an adipometer. The Wilcoxon test, Student’s t-test, and Pearson and Spearman’s correlation tests were used (p < 0.05). Results: The values of mechanical pressure in the cervical and lumbar regions were 6.06 ± 0.186 N/cm² and 5.85 ± 5.280, 7.287 N/cm², respectively. PPT values were 18.88 ± 0.917 N/cm², and 46.46 ± 2.408 N/cm², respectively (p < 0.001), and the adipose tissue thickness values in the cervical and lumbar regions were 0.88 ± 0.675 cm, 1.08 and 1.48 ± 0.069 cm (p < 0.001). There was no correlation between the variables in either region under study. Conclusions: The mechanical pressure required to reach the deep cervical and thoracolumbar fasciae was similar with an average value of approximately 6 N/cm², suggesting a consistent mechanical response across these anatomical regions. Mechanosensitivity and subcutaneous adipose tissue thickness did not influence the mechanical pressure needed to access the deep fascial tissue. Full article

In recent years, the concept of the myofascial network has transformed biomechanical understanding by emphasizing the body as an integrated, multidirectional system. This study advances that paradigm by applying graph theory to model the osteo-myofascial system as an anatomical network, enabling the identification of topologically central nodes involved in force transmission, stability, and coordination. Using the aNETomy model and the BIOMECH 3.4 database, we constructed an undirected network of 2208 anatomical nodes and 7377 biomechanical relationships. Centrality analysis (degree, betweenness, and closeness) revealed that structures such as the sacrum and thoracolumbar fascia exhibit high connectivity and strategic importance within the network. These findings, while derived from a theoretical modeling approach, suggest that such key nodes may inform targeted treatment strategies, particularly in complex or compensatory musculoskeletal conditions. The proposed concept of a polyconnective skeleton (PCS) synthesizes the most influential anatomical hubs into a functional core of the system. This framework may support future clinical and technological applications, including integration with imaging modalities, real-time monitoring, and predictive modeling for personalized and preventive medicine. Full article

Androgens are emerging as important regulators of connective tissue remodeling, but current knowledge about their role in human fascia is still limited. This study examined the expression of the androgen receptor (AR) in human deep fascia and investigated the effects of dihydrotestosterone (DHT) on collagen production by fascial fibroblasts. Fascia lata and thoracolumbar fascia samples were collected from four adult donors (two male and two female). AR expression was assessed by immunohistochemistry and immunocytochemistry. Fascial fibroblasts were treated in vitro for 24 h with DHT at concentrations reflecting physiological levels: 0.4 ng/mL (female), 4 ng/mL (male average), and 10 ng/mL (high male dose). Collagen content was quantified using Picrosirius Red staining, and collagen I and III were evaluated using immunocytochemistry and image analysis, and were compared to an untreated control group. AR was detected in all samples. Low-dose DHT (0.4 ng/mL) significantly increased collagen I (4.80 ± 1.75%) and decreased collagen III (3.32 ± 0.46%) compared to controls (2.09 ± 0.91% and 10.46 ± 0.53%, respectively; p < 0.05). Higher DHT doses induced smaller or no significant changes in collagen subtype expression (e.g., 10 ng/mL: 2.03 ± 0.81% for collagen I, 8.49 ± 1.85% for collagen III). The results demonstrated that human fascia is hormonally responsive via AR, with DHT modulating matrix composition in a dose-dependent manner. The distinct effects at male and female levels may help explain gender differences in fascial stiffness and pain. Full article

Background/Objectives: Cycling has become a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanied myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. Methods: To achieve this goal, we conducted a randomized controlled trial (RCT) with 35 cyclists. A difference-in-differences (DiD) regression analysis was employed to analyze the effects of the intervention. Results: The DiD analysis revealed, on the one hand, no statistically significant effect of the intervention on the overall injury score. On the other hand, the intervention group showed a significantly smaller increase in perceived training intensity compared to the control group, supporting the hypothesis that myofascial self-massage decreases the perception of training intensity. In one of our strongest models, which estimated the impact of the intervention from baseline to the second post-test, we observed an adjusted R-squared value of 0.89 and an interaction term coefficient of 1.35 at a significance level of p < 0.01. This indicates that, on average, the increase in perceived training intensity was 1.35 points higher (on a scale of 0 to 10) in the control group than in the intervention group. Conclusions: This study found no evidence to support the effectiveness of a training-accompanied myofascial self-massage in reducing injury levels, but it demonstrated that the intervention may reduce perceived training intensity. Future studies with larger sample sizes and more objective injury tracking methods are needed to further explore these findings and their long-term implications for injury prevention in cycling. Full article

In a world where the incidence of non-specific lower back pain (LBP) is steadily increasing, researchers are still searching for effective solutions for patients. Hyaluronic acid (HA) viscosupplementation is commonly used to restore lubrication in osteoarthritis (OA) and other medical applications, but its rapid metabolism limits efficacy. This study evaluates whether an HA derivative can replace native HA for the treatment of non-specific LBP while maintaining or enhancing its frictional properties and improving in vivo stability. Six HA-based lubricants, both native and derivatized, were tested in a tribological rabbit fascia model and a new synthetic model. Reduced HA derivative showed better tribological properties and longer in vivo residence time compared to native HA, as demonstrated in pharmacokinetic studies in rabbits. The 316 kDa HA and reduced HA exhibited the most stable tribological properties, which were influenced by their molecular weight and concentration. These findings suggest that both native and reduced HA are promising viscosupplements for intrafascial injection in the treatment of LBP, with reduced HA potentially enhancing effectiveness through a prolonged effect. Full article

Background: Running, a fundamental motor skill, evolves with experience, significantly influencing coordination and thoracic mobility. Our study aims to investigate whether prolonged engagement in running could result in distinct variations in thoracolumbar mobility and kinematic efficiency among individuals with varying levels of running experience. Methods: This study examined thoracic mobility among sedentary individuals and runners who have been running for the last six months and the last two years. Measurements included latissimus dorsi (LD) muscle tone, elasticity, stiffness, trunk flexibility and range of motion (ROM), lumbar extensor shortness, thoracolumbar fascia (TLF) length, and the modified Schober test. Results: LD tone was lower in six-month runners, while sedentary individuals had the greatest LD elasticity and stiffness. The modified Schober test results indicated that the six-month runners scored the highest. Two-year runners had significantly greater dominant-side lateral flexion than sedentary individuals and six-month runners. TLF length was highest in running for two-year runners. Two-year runners exhibited the greatest dominant-side lateral flexion, while six-month runners showed more flexion and two-year runners more extension. Conclusions: Prolonged running experience may enhance thoracolumbar mobility and muscle tone. Furthermore, the observed stiffness and reduced elasticity in sedentary individuals highlight the detrimental effects of inactivity on spinal and muscular health. Full article