Background:
Myofascial therapies are widely researched with regards to their effects on pain, disability
and range of motion. The benefits of such therapies are attributed to the mechanical changes
that myofascial therapies are proposed to have on the fascial and myofascial structures.
Breakthrough imaging and laboratory techniques, have allowed the in vivo study of these
structures, resulting in new hypotheses regarding the roles that connective tissues might play
in proprioception.
Objectives:
The purpose of this investigation was to assess the effects of two myofascial therapies, in
terms of immediate changes in navicular pronation, great toe extension measurements and
balance tests, as indicated by the postural stability (eyes open and closed) and limits of
stability tests. Pre-, post-intervention analysis was used to determine if there were significant
changes between the groups.
Aim:
The myofascial interventions aimed to reduce myofascial restriction and adhesions, within
the plantar and crural fasciae’s of individuals with bilateral pronation.
Methods:
The study recruited 45 subjects with bilateral pronation (2 or more degrees) and randomly
allocated them into a placebo ultrasound, ischaemic compression or myofascial release
group. Each subject underwent a case history, physical examination, foot, ankle and knee
regional examinations, as well as screened for contraindications. A blinded assistant
examiner helped measured and record the baseline measurements for navicular position and
great toe extension, using a standard two arm goniometer. The researcher then tested
participants for postural stability (eyes open, eyes closed) and limits of stability, on the
Biosway Portable Balance System. Subjects were then examined and treated bilaterally, for
myofascial restrictions in the foot, lower leg and ankle, related or unrelated to the pronation
present. Pre- and post-intervention measurements were recorded within a 20 minute window
immediately before and after the relevant intervention.
Statistical analysis:
Repeated measures ANOVA testing was used to compare the rate of change (between preand
post-intervention measurements) amongst the three groups, and a p-value <0.05 was
considered statistically significant. Post hoc Bonferroni adjusted tests were done to compare
all pair wise groups, as well as identify trends between groups.
Results and Discussion:
The data showed that both myofascial groups, significantly improved in postural stability
(eyes closed) overall, post hoc testing showed the ischaemic compression group (p=0.004)
and myofascial release group (p=0.031), compared to changes in the placebo ultrasound
group.The overall changes were predominantly found in the anterior-posterior axes, with
significant improvements in ischaemic compression (p=0.007) and myofascial release group
(p=0.053) axes compared to placebo.
For the other outcome variables, statistically significant treatment effects were not consistant
bilaterally between the groups. Significant (p=0.051) time*group differences for changes in
right navicular position. Post hoc testing revealed a borderline significant (p=0.056)
improvement in pronation for the myofascial release group in comparison to the ischaemic
compression group, which on average got worse. With regards to passive non-weight
bearing great toe extension left, significant (p=0.067) improvements for the ischaemic
compression group were shown compared to placebo, although this was not consistent for all
the great toe extension tests. A borderline significant (p=0.059) time*group effect for postural
stability (eyes open) medial-lateral test was obtained. Post hoc Bonferroni adjusted testing
showed a non-significant (p=0.063) correlation between the myofascial release group and
placebo ultrasound group.
Conclusion:
The results of this study, rejects the Null hypothesis for changes in balance measurements
and suggests that both myofascial interventions had a significant positive outcome for
postural stability, compared to placebo. The postural stability (eyes closed) test gave an
indication of positive or negative changes in centre of pressure displacement, about the
centre of gravity. It is noted that the sham ultrasound, used as a placebo intervention may
have produced a treatment effect and is therefore not a reliable placebo measure for this
type of investigation.
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