Introduction:
My of ascial release can be defined as one of the most potential alternative therapies that effectively manage the immobility of skeletal muscle. This is referred as a non-therapeutic intervention especially in the field of sports or exercise physiology. It is claimed by many of the researchers that
MFR or self my of ascial release, potentially relieves subject with intense pain which has been caused from skeletal muscle injury.
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MFR is an hand-on techniques which intend application of very subtle or gentle amount of pressure on the My of ascial connective tissue restrictions so that the intense pain caused by trauma, inflammatory responses, muscle tension, inactivity or overuse can be eliminated(Zullo et al. 2017). Fascia is the connective tissue which is generally tough, thin and elastics in nature
and surrounds most of the anatomical structure present in the human body including different mus culatures. Researches have shown that fascia plays an important role in protection of the structures it wraps around. Restriction of the fascia is related to diminished blood flow in the
muscles and generation of pain and abnormality of muscle structures including rounded shoulder.
It is believed that MFR helps in improving blood circulation in the affected muscles and surrounding tissues and thereby promote relaxation of the contracted skeletal muscle which is the most prevalent cause of pain (Kalich man and David 2017). Oxygen supply to the muscles is also improved
with this process and results in diminution of fatigue with in the musculature. Along with the accurate implementation of MFR, lymphatic circulation is also improved (Yuan, Mat sutani and Marques 2015). This mechanism is also considered beneficial in terms of stimulating the stretch
reflexes in the body or in the affected muscles. However in the aspects of orthopaedic conditions, the use of MFR as an alternative medicine therapy still lacks quality of evidences. Thereby it is extremely important to research the effectiveness and details of this particular therapy before
implementing it to a greater number of populations and ensuring effectiveness of this treatment procedure.
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Nowadays due to rapid growth of technology and also the amount of computer-based jobs in all the industries, people have to spend a significant amount of time in front of the computer. This patterns of jobs in the office or at home involve a person to a greater risk of musculoskeletal disorders. There are very few people who are aware of the significance of maintaining a good posture in their office hours also. As a result of this ignorance and by pressure of exploitation people suffer through variety of muscle pain or abnormality in musculoskeletal structures which is a serious concern regarding public health. Rounded shoulder is one of the most prevalent outcomes of holding poor or incorrect posture for prolonged working hours among the office workers. Under this clinical condition,anterior muscles of the shoulder which are generally referred as pectoralis major and pectoralis minor appear tighter than its normal condition (Matzkin, Suslavich and Wes 2016.). It has been evidenced that the lengths of these muscles remain shorter at this condition. However, trape zius,rhomboids, and rotator cuff muscles which are located posteriorly appear extended and weak in nature. Hence introduction of an easy and effective approach is necessary in terms of eliminating the rising concern of muscle pain caused by rounded shoulder among the desk-job workers (Dubey et al. 2019).
There are very few researches conducted on the implications of MFR in treating rounded shoulder especially on the correction pectoralis muscles. Since pectoralis major and minor are the most important muscular structures of the shoulder, implementation of a therapy focussing on these two muscles will be of greater benefits. Apart from that since MFR allows considering each patient as unique individual and can be modified depending upon the severity or complexity of the problem.
In this study, the effectiveness of MFR on different muscle structures have been studied through reviewing relevant research articles which have been published within last 5 years. The following section describes the methods of collection of the information and will also discuss the implications
of MFR on rounded shoulder among desk-job workers. Additionally a few clinical recommendations regrading this non-conventional approach will also be incorporated. The purpose of this research is to analyse the effectiveness of MFR and simultaneously increase the acceptance of MFR in general public and clinicians as well for elimination of the clinical issues of rounder shoulder occurred due to desk-job pattern.
Methods:
In order to find most relevant researches on the chosen topic, literature search was done in different databases. The databases which were mostly preferred during this process include Google Scholar,PUBMED and EBSCO. All these databases were searched thoroughly so the maximum number of
evidences in support of effectiveness of MFR could be accumulated. There were certain literature search strategies which were planned beforehand so that the best, relevant, current and most efficient evidences could be found at the end of this research.
First of use of most appropriate keywords were prioritised. Specific keywords which are most relevant in this regard such as myofascial release, massage, round shoulder, muscles,musculoskeletal disorder, pain, anatomy, shoulder pain, desk job worker, exercise, sports, treatment, and pain relief were typed in the search bar of the databases in a different order.
Apart from the use of key terms, there were certain inclusion and exclusion criteria for selection of the research articles. These criteria sum up in appendix 1 were maintained during the literature search procedure. Apparently, it is generally recommend in terms of clinical research that
maintenance of a consistency of certain criteria during review research helps to refrain from irrelevant data and also leads to obtainment of best quality of evidences. In this study, the inclusion criteria which were through implemented for each of the database search include publication year,language of the paper and their accessibility. Similarly application of exclusion criteria was also considered while selecting the papers for the final discussion.
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In regards with the inclusion criteria, it has to be mentioned that firstly the publication time frame of the research articles were strictly maintained in between 2015 to 2021. Secondly, the language of publications was restricted to English only. Thirdly, noted that for economics reason the articles
which had the accessibility to the full text for free were included in this study. On the other hand,accent under the exclusion criteria were put as well. Exclusion criteria for rejected articles were logic above empiric tests were present (like editorials) and those articles which were published in
languages other than English. The publications before 2015 were not selected for reviewing. The objectives of the articles were also examined while selecting them for performing systemic review research. Reference lists of all the chosen studies which met the inclusion criteria were also checked thoroughly to find out relevant studies.
Literature search strategies are considered extremely helpful and can lead to accumulation of a best quality of evidences related to relevant topic. Truncation is the process of addition of variety of suffices at the end of a particular spelling. In this study, during literature search the root word was
typed and at the end of it truncation symbols such as ‘*’ is added up. Similarly, use of BOOLEAN operators is another effective search strategy that promotes maximised outcomes of relevant search results in the databases. AND, OR and NOT are generally referred as BOOLEAN operators that were be used to find several combination of the key words (Coughlan and Cronin 2020).
Results:
After implementing all the search strategies on all of the above-mentioned databases, a total number of 50 articles were found. All of these articles were screened thoroughly. Considering the inclusion and exclusion criteria for research and finally based under details analysis more then under
general reporting, search results 8 articles were included for reviewing the data. The objectives of the studies were prioritised in this idea. All of the studies mostly aimed on evaluation of effectiveness of the MFR. In the appendix section a flow chart has been present in order to give a
clear idea on identification, eligibility and inclusion of the article.
Discussion:
According to Beardsley and Škarabot (2015), self-myofascial release (SMFR) is an effective process in terms of promoting flexibility and enhancement of recovery process for both the general population and the athletes. The authors conducted database search (PubMed and Google Scholar) during
February 2015. They preferred using relevant words related to the topic in order to explore the acute as well as chronic efficacy of SMFR. The result of this particular study concluded that in acute condition, application of SMFR is beneficial for increasing the flexibility of the muscle and reduction
of its soreness; however it does not impede performance of the athletes. They added that application of this therapy may improve the arterial function, vascular endothelial function and activity of the parasympathetic nervous system all of which are extremely important in terms of
obtaining speedy recovery. However the authors could not concluded if the same can be applied for long-term management of similar health issues and enhancement of flexibility.
A tool has been described by Burrell and Arcrollers (2018) in order to perform is chemic compression therapy and treat my of ascial release. In this paper it was mentioned that there is a wide range of people who presently suffer from myofascial pain, tightness or soreness due to corresponding muscle abnormalities. While my of ascial release can be implemented through hand-on techniques,this therapy may also incorporate acupressure. Elongated cylindrical foam rollers are also used in
this therapy. In this paper use of a device is indicated for alleviate muscle contractions and muscle pain and to improve blood flow and lymphatic circulation. Hence this could result in effective management of muscle pain in individuals.
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As per a study conducted by Kalichman and David (2017), current methods of SMFR were investigated. This study also elaborated each of the mechanisms and discussed about the effectiveness of this particular intervention in treating my of ascial pain, flexibility and strength of
affected muscles. This research indicated that fitness professionals are more likely to use form rollers while implementing SMFR and thereby promote recovery in the patients. Significant improvement in range of motion at the muscle joints has been observed by the researchers in
regards with implementation of SMFR technique. Most importantly this study has indicated that SMFR cannot be associated with any kind of decrement in standard muscle force or alteration of performance of the muscles after undergoing this treatment. However, no instances of clinical trial experiment were identified by the authors hence they recommended that future investigation is a highly required in terms of evaluation and understand the effectiveness of the SMFR as an intervention against my of ascial syndrome.
A clinical experiment was conducted Mousavi et al. (2019) in order to compare the effectiveness of 8-week corrective exercises with and without the my of ascial release in order to correct forward shoulder deformity among the male students. In this research a total number of 45 male students who have been diagnosed with structural abnormality of shoulder were included. They were randomly allocated to three different group for corrective exercises, combinational exercises (corrective exercises as well as my of ascial release), and as control respectively. The result of this
study was analysed with ANCOVA test and it was concluded that the group which was assigned to corrective exercises program along with the my of ascial release has experienced better outcomes as compared to the other groups. Shoulder deformity was corrected to a greater extend in this
particular group. In this regard, it has to be mentioned that exercises which were incorporated in this study included stretching of pectoralis major muscle and increased expansiveness of rib cage as well as anterior chest wall.
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Another study conducted by Kaur and Jayaraman (2019), compared between the effectiveness of my of ascial release or MFR with strengthening and stretching exercises. Strengthening focussed on rounded shoulder posture. In this experiment at least 30 subjects between the ages of 20 to 35 years were involved and were divided into two groups of 15 members in each. The treatment plan was continued for 10 days in 2 weeks. The end result reflected that MFR has been effective in strengthening of rounded shoulder and correcting the length of the shoulder muscles among the
subjects. Hence they concluded that MFR can be implemented as an effective non-therapeutic intervention against rounded shoulder posture.
According to a study conducted by Rivera et al. (2020), the effectiveness of self-my of ascial release (SMR) was investigated on the length of pectoralis minor (PM) and glenohumeral total arc of motion(TAM). This was a cohort study which was conducted in laboratory setting. In this experiment 26
healthy participant were included among which 19 were females and 7 were males. However, no significant change in pectoralis minor length was noticed during this experiment. Effectiveness of my of ascial release therapy has also been indicated in terms of correcting forward head posture by a clinical experiment conducted by Kim et al. (2018).
Laudner and Thorson (2019) conducted a research in order to evaluate acute effectiveness of a self-my of ascial release (SMFR) along with movement technique of the pectoralis minor for improving shoulder motion and posture among asymptomatic individuals. It was a randomized controlled trial which was set up in orthopedic rehabilitation clinic. 21 physically active individuals participated in this trial. The main outcomes which were measured in this experint was regarding Glenohumeral
internal rotation, pectoralis minor length, external rotation, and flexion range of motion (ROM) and forward scapular posture. The result of this study indicated that acute self-my of ascial release with movement is beneficial in terms of enhancing glenohumeral flexion ROM as well as length of pectoralis minor, and it has also recommended that implementation of MFR may assist with forward scapular posture correction.
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Conclusions:
After reviewing all of the above mentioned articles, it can be concluded that implementation of MFR or SMFR is effective in terms of correcting rounded shoulder posture of general population. Since MFR includes hand on techniques to be implemented on pectoralis minor and sub clavian muscles as well, correction of shoulder posture can be corrected with this method in a shorter period. Most importantly MFR is such a technique that can be used by self and fitness experts as well. MFR is helpful for health professional in terms of delivering patient-centred care to individuals and can be recommended as an alternative therapy even after care. Both ideas of MFR including direct release and indirect release can be applied depending on individual’s postural condition. Since a great number of world-wide populations spend a significant amount of time in front of the computer due to exploitations in their jobs, they are imposed to greater risk of developing musculoskeletal disorders. An effective intervention is much required in order to improve public health. MFR has been effective in strengthening of rounded shoulder and correcting the length of the shoulder muscles among the subjects involved in several experiments. As a result, they concluded that MFR can be implemented as an effective non-therapeutic intervention against rounded shoulder posture among the desk-job workers.
Recommendations:
1.Implementation of MFR should be effective in terms of providing patient-centred care.
2.Observations of effects of MFR on desk-job workers is necessary in terms of reducing the over-crowding of orthopaedic health professionals.
3.MFR and SMFR can be recommended to the patients since it does not show any negative impact on the length of the shoulder muscles.
4.Range of motion of the shoulder joints is also improved.
5.More research is required in terms of evaluating the effect of MFR on rounded shoulder in the desk-job workers.
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