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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
9
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