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Figure 3 Factors influencing the mechanical stiffness of fascial tissues and their hypothesised impact. Injury of fascial tissues: cellular and mechanical responses to damage Excessive or prolonged loading or direct trauma to fascial tissues initiates micro and macro changes necessary for tissue repair.

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Figure 4 Proposed timeline and mechanisms for fascial, adipose and muscle changes in the multifidus muscle after intervertebral disc lesion. Imaging and non-imaging tools for diagnosis and assessment Pathological changes in the mechanical properties of fascial tissues have been hypothesised to play an essential role in musculoskeletal disorders such as chronic pain conditions and overuse injuries. Table 1 Currently used diagnostic methods to examine fascial tissue structure and function. Figure 5 Tendon displacement measured by B-mode ultrasound. Mechanobiology of fascial tissues: effects of exercise and disuse The main principles of the above ultrasound-based methodology have been implemented in numerous studies over the last 20 years to study the adaptability of human tendons to exercise and disuse.

Interventions for fascial tissue pathologies in sports medicine Fascial tissue dysfunction in the field of sports medicine is rarely treated surgically. Defining the fascial system. J Bodyw Mov Ther ; 21 : — 7.

International Olympic committee consensus statement: molecular basis of connective tissue and muscle injuries in sport. Clin Sports Med ; 27 : — 9. The lumbodorsal fascia as a potential source of low back pain: a narrative review. Biomed Res Int ; : 1 — 6.

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Modeling active mechanosensing in cell-matrix interactions. Annu Rev Biophys ; 44 : 1 — OpenUrl CrossRef.

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Angiogenic and vascular modulation by extracellular matrix cleavage products. Curr Pharm Des ; 15 : — Endostatin: an endogenous inhibitor of angiogenesis and tumor growth. Cell ; 88 : — The angiogenesis inhibitor endostatin impairs blood vessel maturation during wound healing. Faseb J ; 14 : — 6. Circ Res ; 98 : — The role of sex, adiposity, and gonadectomy in the regulation of irisin secretion.

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Endocrine ; 54 : — From mechanical loading to collagen synthesis, structural changes and function in human tendon. Scand J Med Sci Sports ; 19 : — Tendon collagen synthesis at rest and after exercise in women. J Appl Physiol ; : — 6. The adaptability of tendon to loading differs in men and women. Int J Exp Pathol ; 88 : — Hormone receptor expression in human fascial tissue. Eur J Histochem ; 60 : Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women.

J Appl Physiol ; : — Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep ; 18 : Zhang C , Gao Y. Effects of aging on the lateral transmission of force in rat skeletal muscle. J Biomech ; 47 : — 8. Structural, biochemical, cellular, and functional changes in skeletal muscle extracellular matrix with aging.

Scand J Med Sci Sports ; 21 : — Franceschi C , Campisi J. Chronic inflammation inflammaging and its potential contribution to age-associated diseases. Calve S , Simon HG. Biochemical and mechanical environment cooperatively regulate skeletal muscle regeneration. Faseb J ; 26 : — OpenUrl PubMed. Osteopontin, inflammation and myogenesis: influencing regeneration, fibrosis and size of skeletal muscle.


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J Cell Commun Signal ; 8 : 95 — MCP-1 deficiency causes altered inflammation with impaired skeletal muscle regeneration. J Leukoc Biol ; 81 : — Altered macrophage phenotype transition impairs skeletal muscle regeneration. Am J Pathol ; : — The influence of anti-inflammatory medication on exercise-induced myogenic precursor cell responses in humans. Effect of anti-inflammatory medication on the running-induced rise in patella tendon collagen synthesis in humans.

Activation of satellite cells and the regeneration of human skeletal muscle are expedited by ingestion of nonsteroidal anti-inflammatory medication. Faseb J ; 30 : — Influence of acetaminophen and ibuprofen on skeletal muscle adaptations to resistance exercise in older adults. Tidball JG. Force transmission across muscle cell membranes.

Intra-, extra- and intermuscular myofascial force transmision of synergists and antagonists: effects of muscle length as well as relative position. J Mech Med Biol ; 02 : — Intermuscular force transmission between human plantarflexor muscles in vivo. Effects of knee joint angle on global and local strains within human triceps surae muscle: MRI analysis indicating in vivo myofascial force transmission between synergistic muscles.

Surg Radiol Anat ; 33 : — Myofascial force transmission between the human soleus and gastrocnemius muscles during passive knee motion. Magnetic resonance imaging assessment of mechanical interactions between human lower leg muscles in vivo. J Biomech Eng ; : Are muscles mechanically independent? Maas H , Sandercock T. Force transmission between synergistic skeletal muscles through connective tissue linkages. J Biomed Biotechnol Altered mechanical interaction between rat plantar flexors due to changes in intermuscular connectivity.

Scand J Med Sci Sports ; 27 : — Smeulders MJ , Kreulen M. Myofascial force transmission and tendon transfer for patients suffering from spastic paresis: a review and some new observations. J Electromyogr Kinesiol ; 17 : — Substantial effects of epimuscular myofascial force transmission on muscular mechanics have major implications on spastic muscle and remedial surgery. Muscle characteristics and altered myofascial force transmission in tenascin-X-deficient mice, a mouse model of Ehlers-Danlos syndrome. Recent developments in myofibroblast biology: paradigms for connective tissue remodeling.

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Strain hardening of fascia: static stretching of dense fibrous connective tissues can induce a temporary stiffness increase accompanied by enhanced matrix hydration. J Bodyw Mov Ther ; 16 : 94 — Relation between myofibers and connective tissue during muscle injury repair. Scand J Med Sci Sports ; 10 : — 7. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. J Physiol ; : — Lateral transmission of force is impaired in skeletal muscles of dystrophic mice and very old rats.

What is evidence-based about myofascial chains: a systematic review. Arch Phys Med Rehabil ; 97 : — The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine ; 20 : — 8. Pre-strained epimuscular connections cause muscular myofascial force transmission to affect properties of synergistic EHL and EDL muscles of the rat.

J Biomech Eng ; : — The anatomical and functional relation between gluteus maximus and fascia lata. J Bodyw Mov Ther ; 17 : — 7. Remote effects of lower limb stretching: preliminary evidence for myofascial connectivity? J Sports Sci ; 34 : — 8. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci ; Exercise treatment for sacroiliac pain.

Orthopedics ; 24 : 29 — Exposure-dependent increases in IL-1beta, substance P, CTGF, and tendinosis in flexor digitorum tendons with upper extremity repetitive strain injury. J Orthop Res ; 28 : — Inflammation reduces physiological tissue tolerance in the development of work-related musculoskeletal disorders.

J Electromyogr Kinesiol ; 14 : 77 — Increased serum and musculotendinous fibrogenic proteins following persistent low-grade inflammation in a rat model of long-term upper extremity overuse. PLoS One ; 8 : e Serum biomarkers as predictors of stage of work-related musculoskeletal disorders.

J Am Acad Orthop Surg ; 21 : — 6. Connective tissue research Driscoll M , Blyum L. The presence of physiological stress shielding in the degenerative cycle of musculoskeletal disorders. J Bodyw Mov Ther ; 15 : — Increased CCN2, substance P and tissue fibrosis are associated with sensorimotor declines in a rat model of repetitive overuse injury.

J Cell Commun Signal ; 9 : 37 — Effectiveness of conservative interventions for sickness and pain behaviors induced by a high repetition high force upper extremity task. BMC Neurosci ; 18 : The role of TNF-alpha in patients with chronic low back pain-a prospective comparative longitudinal study. Clin J Pain ; 24 : — 8. Eur Spine J ; 27 : — Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep.