Date Presented 04/04/19
This session will inform practitioners about recent evidence surrounding the efficacy of myofascial release in the treatment of adults with upper-extremity orthopedic or peripheral nerve conditions. Content will address implications and limitations.
Primary Author and Speaker: Sheryl Zylstra
Additional Authors and Speakers: Tiffany Farley, Michelle Chait, Erin Eaton, George Tomlin
PURPOSE: The purpose of this study is to investigate the effectiveness of myofascial release (MFR) to increase functional outcomes in adults with upper extremity orthopedic or peripheral nerve conditions compared to therapeutic exercises, other manual therapy techniques, and/or modalities.
DESIGN: A systematic review was performed to analyze articles published in or translated into English between 2000-2017, included adult participants (18 years and older) with orthopedic or peripheral nerve conditions of the upper extremity, used interventions involving therapist-administered myofascial release, and intervention occurring in any practice setting. Articles were excluded based on the following criteria: participants under the age of 18, participants with central neurological disorders, interventions involving self-myofascial release or instrument-assisted myofascial release, and articles not published in peer reviewed journals.
METHOD: Three reviewers independently searched eight databases for articles published between 2000-2017. Key search words included: myofascial release, orthopedic, musculoskeletal, and adult. Articles were identified as relevant based on whether the keywords were identified in the abstract; orthopedic had to be accompanied by myofascial release or an identified synonym to be considered relevant. Each reviewer then created a reference list of selected articles and these lists were reviewed as a group. Full text articles were collected after the group determined that an article met the inclusion criteria. Researchers also performed citation and reference tracking to uncover further articles that met criteria.
Twenty-three articles addressing the effectiveness of MFR were determined to meet the inclusion criteria. Articles were analyzed for similarities and the following themes were identified: MFR without treatment comparison, MFR treatment alone compared to other treatment, MFR combined therapies compared to other combined therapies, and MFR in systematic reviews.
RESULTS: Based on the number of articles and level of rigor, there is currently moderate evidence to suggest that MFR may lead to positive, functional outcomes in the treatment of orthopedic and peripheral nerve conditions. Apart from the systematic reviews, in the remaining 17 studies, all found positive outcomes in treatments that included MFR. Nine of 11 studies that directly compared MFR to other forms of treatment found more significant outcomes among the groups that received MFR. Only two articles within a systematic review showed no effect following MFR treatment, while only one article across all studies showed mild, transient soreness after the initial MFR treatment.
CONCLUSION: While there is limited high quality evidence existing to support the use of MFR when treating upper extremity and cervical orthopedic or peripheral nerve conditions, studies classified as having moderate rigor on the PEDro scale found positive results in regards to decreased pain and disability, and increased range of motion and quality of life. Further high quality Level I research is needed to determine the efficacy of MFR when used to treat upper extremity orthopedic and peripheral nerve conditions, such as carpal tunnel syndrome and lateral epicondylitis. This research would fill a gap regarding the limited number of studies currently available that address the upper extremity, and that would be beneficial specifically for hand therapists.
References
Ajimsha, M., Chithra, S., & Thulasyammal, R. P. (2012). Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Archives of Physical Medicine and Rehabilitation, 93, 604-609. doi:10.1016/j.apmr.2011.10.012
McKenney, K., Elder, A. S., Elder, C., & Hutchins, A. (2013). Myofascial release as a treatment for orthopaedic conditions: A systematic review. Journal of Athletic Training, 48, 522-527. doi:10.4085/1062-6050-48.3.17
Rodriguez-Fuentes, I., De Toro, F. J., Rodriguez-Fuentes, G., Machado de Oliveira, I., Meijide-Failde, R., & Fuentes-Boquete, I. M. (2016). Myofascial release therapy in the treatment of occupational mechanical neck pain. American Journal of Physical Medicine Rehabilitation, 95, 507-515. doi:10.1097/PHM.0000000000000425
Rodriguez-Huguet, M., Gil-Salú, J. L., Rodriguez-Huguet, P., Cabrera-Afonso, J. R., & Lomas-Vega, R. (2017). Effects of myofascial release on pressure pain thresholds in patients with neck pain: A single-blind randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. Advance online publication. doi:10.1097/PHM.000000000000079
