Effects of myofascial release or self-myofascial release and control position exercises on lower back pain in idiopathic scoliosis

Methods

• Articles analyzed: 17
• Search string: ((“idiopathic scoliosis” MeSH) OR “scoliosis” (MeSH term) OR “spine” (all fields) OR “back pain” (MeSH term) AND (“myofascial release” (all fields) OR “foam roller” (all fields) OR “fascia” (all fields)
• Criteria of inclusion:studies concerning the effects of myofascial massage or myofascial self-massage on the posterior chain of the human body or on scoliosis; randomized controlled trials on a sample of at least 15 people; observational studies; studies that have empirically evaluated the effect of myofascial massage; studies in English and Spanish; studies whose full-text resulted available
• Criteria of exclusion: systematic reviews and meta-analysis, studies on animals, studies on body parts different from the posterior chain of the human body

Characteristics of the studies

• 2 studies on scoliosis
  • 1 experimental study
  • 1 study to evaluate the connection between scoliosis and pain mediated by the myofascial system
• 6 studies on the effects of myofascial self-massage on low back pain and mobility
• 9 studies on the effects of myofascial release
• Evaluation of the quality of the studies through the Cochrane Collaboration Risk of Bias Tool scale
  • 16 studies with low risk of bias and 1 study with a moderate risk
  • 10 studies did not have a control group

Participants

• number in the smaller study (with exception of the studies on single cases): 10 people
• Number in the biggest study: 75 women
• total: 533 people (396 female and 137 male)
• mean age: from 18 to 63 years

Interventions and evaluations

• There was a great variety in the evaluation instruments used: from pain evaluation scales like Visual Analog Scale (VAS) to a quality of life evaluation scale
• Interventions ranging from 1 session to 6-month programs, with variable duration of the treatment session itself
  • in some cases it was defined by the treated areas: from 30 seconds to 4 minutes of massage for each body area
  • in other cases was defined by session: from 15 to 60 minutes
• In the treatment groups: myofascial release techniques applied by practitioners (10 studies), from the patients themselves as self-massage using specific instruments (6 studies) or both (1 study)
  • 1 study evaluating the myofascial release and 1 study evaluating self-myofascial release, they both also evaluated a program of exercises aimed at postural control
  • the instruments used in case of self-massage were massage balls and sticks, foam roller
• In the control group: none, sham treatment

Results

Primary outcomes: All 11 studies evaluating low back pain reported a statistically significant improvement due to both myofascial release (7 studies) and self-myofascial release (4 studies).
With regard to flexibility and ROM, all 5 studies that evaluated the effect of self-myofascial release showed statistically significant improvements in flexibility of thigh flexor muscles and in the back and pelvis flexion. The 7 studies that evaluated myofascial release (4 of them in people with back pain or pathologies) showed a statistically significant improvement in trunk rotation and mobility. One of these studies reported a similar effect through myofascial release applied to the diaphragm.With regard to postural control, the 2 studies evaluating myofascial release together with exercises for postural control observed an improved mobility (ROM of the trunk) and a decrease of low back pain, in a statistically significant manner.

The same effects were also reported in the study specifically evaluating the effect of myofascial release on people with scoliosis. in this respect, the study evaluating the link between scoliosis and pain reported that fascial alterations and trigger points can mediate this link and, therefore, myofascial release can reduce the negative impact of scoliosis on quality of life.

Discussion

Myofascial release, both when applied by professional practitioners and when self-applied by patients, showed to improve both the functionality of the myofascial system, intended as ROM and mobility, and to reduce low back pain. These results have also emerged in the case of idiopathic scoliosis.
A possible explanation of the myofascial release effect, especially applied to the posterior chain of the human body could be found in the organization of the nervous system, as tendons, muscles and fascial tissues are densely innervated with receptors which, when stimulated, send multiple signals to the central nervous system, reprocess them to redefine a new balance.
At a complementary level, another possible explanation may lie in the organization of the myofascial system as tensegritive structure, for which each body area tends to be connected with the others in order to distribute the mechanical tension throughout the whole body, favoring a global readjustment in the face of mechanical stimuli.

These mechanisms could also underlie improvement in postural control. In addition, the myofascial release may have activated the parasympathetic system, thus favoring a decrease in pain and a better awareness of one’s posture.

Although more in-depth studies are needed, particularly on scoliosis, the positive evidence from the myofascial release makes this intervention particularly useful. In addition, the fact that this massage can be performed by patients autonomously increases its clinical usefulness.