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