MYOFASCIAL RELEASE: AN EVIDENCE-BASED TREATMENT APPROACH? Remvig L, Ellis RM, Patijn J. International Musculoskeletal Medicine,

2008;30(1):29-35

This assesses the current state of scientific knowledge about myofascial release (MFR), a non-invasive manual treatment technique, and to identify the reliability of diagnostic tests for myofascial dysfunction and efficacy of the treatment. A literature search was undertaken, as well as exploring more widely for information concerning the subject, allowing an assessment of the rationale for the treatment and of the studies carried out. Results: Twenty-three items were identified in the literature search. No studies were found with which to determine reliability of the diagnostic method, but four randomised controlled studies of the treatment were identified. Two of the efficacy studies comprised several different modalities of treatment, meaning no conclusions could be drawn. In one further study, the numbers were too small to allow safe conclusions; in the other, the myofascial release treatment was inferior to an isometric contract-relax technique. Therefore the authors felt unable

PREVENTION OF OVERUSE INJURIES BY A CONCURRENT EXERCISE PROGRAM IN SUBJECTS EXPOSED TO AN INCREASE IN TRAINING LOAD. Brushøj C, Larsen

C, Albrecht-Beste E, Nielsen B, Løye F, Hölmich P. The American Journal of Sports Medicine 2008;36:663-670

This randomised controlled trial set out to look at the possibility that an exercise programme could prevent overuse injuries in the lower extremity, specifically overuse knee injuries and medial tibial stress syndrome, given that an often encountered and important risk factor for the development of such injuries is an abrupt increase in activity level. The preventive training programme was based on a literature review of intrinsic risk factors and was performed concurrently with an increase in physical activity. A total of 1020 soldiers aged 20.9 years (range 19–26 years) undergoing 3 months of basic military training undertook either a prevention programme of 15 minutes exercise 3 times a week, including

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to reach any conclusion on the diagnostic criteria and methods or on any efficacy. However from the studies found they were able to state the following: n There is evidence that fascias are built by elements that can be stretched, and or, can be passively shrunk and that these processes have been seen in practice. n There is evidence that fascia contains contractile elements that can contract through pharmacological and mechanical stimulation but there is no evidence of relaxation due to reduction in inherent tone. n There is evidence that fascias contain nerve endings; nociceptors, mechanoreceptors, procrioceptors, and blood vessels.

Theoretically it is possible to stretch fascias through the skin but stretching probably takes place through a combination of a compression and stretching force applied directly to the fascia through the skin. There is no scientific evidence yet available to prove it actually happens during MFR.

Fascia can theoretically be exposed to

overload or overuse. There is a vascular and nerve supply so pain and inflammation can take place. Some studies note the presence of nociceptive (pain producing) substances subfascially.

five exercises for strength, flexibility, and coordination or a placebo programme of five exercises for the upper body. Results: During the observation period, 223 subjects sustained an injury, with 50 and 48 of these fulfilling the study criteria for overuse knee injuries or medial tibial stress syndrome respectively. There were no significant differences in incidence of injury between the prevention group and the placebo group. However, the soldiers in the prevention group had greater improvement in their times for a 12-minute run test.

sportEX comment You can equate basic recruit training to the pre-season phase of sport and anything that contributes to injury prevention should be welcomed. This programme was worth looking at but it hasn’t really given us an answer, probably because there would have been so much going on during the 3 months that isolating underlying injury causes is difficult. It is significant however that their run test score improved and should tell us something about what to include in a training programme.

There are no reliable (meaning reproducibility and validity) studies for fascial looseness/tightness tests.

Without reliable tests it isn’t possible

to make a reliable diagnosis and therefore judge the result of clinical trials. There is one low quality randomised control trial reporting positive effects of MFR treatment and two more which have MFR as an adjunct to other modalities.

sportEX comment This is an excellent paper and should be a recommended read for all soft tissue therapists. Although the authors feel that overall no good evidence of efficacy has been shown from the studies found in their search, they have gone a long way to providing evidence for the use MFR. On the points where the evidence isn’t conclusive they highlight the difficulties in finding good evidence. As the authors themselves say, “Lack of reliability does not necessarily mean that the reliability is poor”. Although the medical profession now prides itself on evidence based practice, the reliability of many diagnostic tests and treatments is yet not known. There is scope for much more research.

CHANGES IN SHOULDER AND ELBOW PASSIVE RANGE OF MOTION AFTER PITCHING IN PROFESSIONAL BASEBALL PLAYERS. Reinold MM Wilk KE et al. The American

Journal of Sports Medicine 2008;36:523-527

Although it is accepted that range of motion is altered, the acute effect of baseball pitching on shoulder and elbow range of motion has not been established. Sixty-seven asymptomatic male professional baseball pitchers participated in the study. Passive range of motion measurements were recorded for shoulder external rotation, shoulder internal rotation, total shoulder rotational motion, elbow flexion, and elbow extension on the dominant and nondominant arms. Testing was performed on the first day of spring training. Measurements were taken before, immediately after and 24 hours after pitching. Results: A significant decrease in shoulder internal rotation (-9.5°), total motion (-10.7°),

sportEX dynamics 2008;17(Jul):4-5