Fascia Mobility, Proprioception and Myofascial Pain
Transcript of Fascia Mobility, Proprioception and Myofascial Pain
Fascia Mobility, Proprioception and Myofascial Pain
Helene Langevin, M.D., Director, NCCIHApril 24, 2021
Eyes
Skin
Musculoskeletal
Cardiovascular
Gastrointestinal
Impact of Ehlers Danlos Syndrome/Hypermobility Spectrum Disorders
Eyes
Skin
Musculoskeletal
Cardiovascular
Gastrointestinal
Joints—ligaments, joint capsules
Other connective tissues? Fasciae?
Impact of Ehlers Danlos Syndrome/Hypermobility Spectrum Disorders
Potential consequences of fascia hypomobility
▪ Increased mechanical coupling across muscle groups and adhesions
between layers due to lack of movement may further reduce mobility
▪ Reduced responsiveness of strain-sensitive mechanoreceptors?
Potential consequences of fascia hypermobility
▪ Reduced mechanical coupling—increased muscle work
▪ Increased risk of macro- or micro-trauma at high strains
▪ Increased responsiveness of strain-sensitive mechanoreceptors?
Myofascial pain and Ehlers Danlos
Syndrome/Hypermobility Spectrum Disorders
▪ Musculoskeletal pain very common in patients with EDS/HSD
▪ Prevalence of myofascial pain unknown due to lack of objective
methods to evaluate myofascial tissues
▪ Lack of objective measurements also impairs research to test
the efficacy of treatments
What proprioceptive signals
are generated by fasciae?
Blueprint Initiative
Functional Neural Circuits of
Interoception
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Hypermobility and proprioception
Hypothesized mechanisms of reduced proprioception
in EDS/HSD
▪ Joint receptor damage from excessive joint mobility
▪ Deterioration of proprioception with age
▪ General enhancement of number of activated mechanoreceptions in
the joint may occur from excessive motion
▪ Pain may reduce proprioceptive acuity
▪ Increased laxity may affect the feedback mechanisms with alterations
in sensitivity of reception organs, altering afferent input
▪ Reduction in proprioception may therefore be attributed to impaired
feedback mechanisms, pain or a combination of both
Research Results
Physical Therapy management of EDS/HSD
▪ Hypermobile ED and hypermobility spectrum disorders
▪ Small clinical trials (20-50 participants) and observational studies
▪ Interventions: PT, stabilization and proprioception exercises, CBT
▪ Outcomes included joint position sense, endurance, pain, physical
function and postural stability
▪ All studies observed improvements from pre- to post-treatment in
adults and children
▪ Need for larger randomized trials comparing different treatments
Knowledge gaps in understanding role of fascia
mobility and proprioception in myofascial pain
▪ Do myofascial tissues play a role in musculoskeletal pain in EDS/HSD?
▪ If so, does increased or decreased fascia mobility predispose to --or protect against—myofascial pain?
– Decreased fascia mobility may predispose to fibrosis and adhesions from poor posture
– Increased fascia mobility may lead to microinjuries from repetitive excessive strain
– Both may result in myofascial unit dysfunction, but mechanisms may be different
▪ How is responsiveness of mechanosensitive channels influenced by fascia stiffness and shear plane mobility?
– Strain-responsive channels may respond to lower levels of force in loose/hypermobile fascia than in stiff/hypomobile fascia
– Both hyper and hypo-mobility can influence interoceptive “sense of self”
▪ Need for in vivo non-invasive objective measures of fascia mobility to explore: – Basic sensory mechanisms—proprioception and nociception
– Pathophysiology of myofascial pain in relation to fascia mobility
– Biomarkers to use in clinical studies and test the efficacy of treatments