Body Balance After Fascial Therapy in Athletes with Soft Lower Limb Muscle Injuries
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S S symmetry Article Body Balance after Fascial Therapy in Athletes with Soft Lower Limb Muscle Injuries Łukasz Pawik 1 , Malwina Pawik 2,* , Magdalena Karwacka 3, Emilia Wysocza ´nska 1, Aleksandra Schabowska 1, Natalia Kuciel 4 , Karolina Biernat 4 , Agnieszka D˛ebiec-B˛ak 1, Joanna Lewandowska 2 and Felicja Fink-Lwow 2 1 Department of Physiotherapy in Motor Disorders and Dysfunctions, University School of Physical Education in Wrocław, 51-612 Wrocław, Poland; [email protected] (Ł.P.); [email protected] (E.W.); [email protected] (A.S.); [email protected] (A.D.-B.) 2 Faculty of Physiotherapy, University School of Physical Education in Wrocław, 51-612 Wroclaw, Poland; [email protected] (J.L.); [email protected] (F.F.-L.) 3 Galen Rehabilitacja Sp z o.o., 43-510 Bieru´n,Poland; [email protected] 4 Department nad Division of Medical Rehabilitation, Wrocław Medical University, 50-367 Wrocław, Poland; [email protected] (N.K.); [email protected] (K.B.) * Correspondence: [email protected] Abstract: Background: Most injuries in competitive sports are due to overstrain and excessive muscular and fascial tension. This study aimed to assess the effects of a single session of fascial Citation: Pawik, Ł.; Pawik, M.; therapy on balance and lower limb weight-bearing in professional athletes following a lower limb Karwacka, M.; Wysocza´nska,E.; soft-tissue injury. Methods: A pedobarographic platform was used to assess the weight-bearing Schabowska, A.; Kuciel, N.; on both lower limbs and corporal balance. A total of 41 athletes with an acute soft-tissue injury Biernat, K.; D˛ebiec-B˛ak,A.; involving the quadriceps femoris muscle were included in the study. Each patient underwent Lewandowska, J.; Fink-Lwow, F. myofascial therapy in the injured limb only. The therapy was intended to release tension and Body Balance after Fascial Therapy in improve proprioception. Results: The injured and healthy limbs showed significant asymmetry in Athletes with Soft Lower Limb body weight distribution. Before treatment, the patients bore less weight on the injured limb than on Muscle Injuries. Symmetry 2021, 13, the healthy limb. After fascial therapy, eyes-closed tests showed an improved weight distribution 1586. https://doi.org/10.3390/ symmetry between the two lower limbs. There were no significant differences in the values of the sym13091586 evaluated balance parameters between those measured at baseline and those measured after the Academic Editors: Piotr Morasiewicz, therapy, measured after the rehabilitation session. Conclusions: A single fascial therapy session has a Nejc Šarabon, Jarosław Filipiak, beneficial effect on corporal balance in runners with an injured lower limb. Paweł Reichert and Daniel Kotrych Keywords: balance; myofascial therapy; athletics; sport injury Received: 28 June 2021 Accepted: 26 August 2021 Published: 28 August 2021 1. Introduction Publisher’s Note: MDPI stays neutral Professional sports, including athletics, may lead to injuries during training sessions with regard to jurisdictional claims in and competitions. Physical training requires repetitively executing a particular act, which published maps and institutional affil- may lead to overstraining. The risk of overstraining increases in top-tier athletes since iations. competing at the highest levels does not only require a rigorous training schedule but is also associated with pressure from the trainer, and the drive to achieve very high performance. Myofascial injuries continue to be very common among athletes [1]. Injuries in athletes are most commonly associated with cumulative microtrauma, which leads to Copyright: © 2021 by the authors. musculoskeletal strain. The disorders most commonly reported in the literature are the Licensee MDPI, Basel, Switzerland. iliotibial band syndrome, patellofemoral pain syndrome, ‘shin splints’, Achilles tendonitis, This article is an open access article and plantar fasciitis [1,2]. According to some authors, one important factor in developing distributed under the terms and pain due to overstraining is the formation of the so-called ‘trigger points’, which may cause conditions of the Creative Commons a pain that progressively intensifies with muscle tension and radiates to other regions Attribution (CC BY) license (https:// of the body, irritating the fascia and subcutaneous tissue [3]. The term ‘myofascial pain creativecommons.org/licenses/by/ syndrome’ is, in fact, inextricably associated, and sometimes used interchangeably, with 4.0/). Symmetry 2021, 13, 1586. https://doi.org/10.3390/sym13091586 https://www.mdpi.com/journal/symmetry Symmetry 2021, 13, 1586 2 of 12 the term ‘myofascial trigger points’. However, it is not entirely clear if the presence of myofascial trigger points should define myofascial syndrome [4]. Most injuries in athletes are due to overstrain and excessive myofascial tension, hence the importance of fasciae in treatment and prevention efforts in this group. A fascia, composed of a variety of intertwined collagen fibers of varied thickness, is a type of internal connective tissue divided into three layers: superficial layer, potential space layer, and deep layer [5–7]. Because fibers of the fascia run in many directions, it can change with the surrounding tissues. The fascia is considered to be one continuous piece of tissue that functions in linked “chains” to create a tonus in the body [8]. The function of individual fascial components ensures the body’s integrity. This may involve controlling the orientation of muscle fibers by reflecting the force vector and facili- tating a smooth resolution of muscle tension [9,10]. Apart from their protective function and ensuring adequate gliding of adjacent structures, fasciae play a role in neurosensory mechanisms and are closely associated with the autonomic nervous system, all of which help maintain balance [6,11,12]. The structure and histological anatomy of myofascial tissue shows “tensegritive” properties. They enable the transfer of gravity, creating a structure capable of supporting body weight and significantly reducing the neuromuscular effort required to maintain the center of mass [13,14]. When controlling posture, the fascia acts as a kind of spring without hysteresis and plays a crucial role in maintaining balance and supporting an upright posture [13,14]. The role of fascia (which is made up of connective tissue) is not only to transfer the strain generated by training but also to accumulate energy. This is achieved by fascial elasticity [12]. The role of fasciae in maintaining balance is associated with the phenomenon of proprioception. Fascial tissue is rich in proprioceptors, which allow it to detect stimuli from the external environment and control motor responses by initiating the movement or tensing of tissues. This helps in being aware of the position of individual parts of the body in space even without visual control [15]. Fasciae control entire muscle chains, e.g., the bi-layered fascia of the large muscles of the torso is continuous with the deep fasciae of the lower limbs; also, the connective tissue of the latissimus dorsi muscle is continuous with that of the gluteus maximus muscle [16]. Fascial therapy plays an important role in ensuring the normal functioning of the body. Currently, many publications have emphasized the more active role of connections due to the innate ability to contract actively. From their clinical experiences, manual therapists also have observed changes in the tension of the fascia in response to its manipulation [17,18]. Static and dynamic strains, inappropriately selected physical activity, long-term stress, injuries, or immobilization may alter the connective tissue structure. Piezoelectric dis- charges generated by long-lasting shortening or excessive stretching of a muscle stimulate fibroblasts to overproduction of collagen, which leads to muscular band thickening, re- duced elasticity, and dysfunction. These, in turn, lead to diminished muscle strength, connective tissue adhesiveness (densification), and increased muscle soreness [3,19,20]. The purpose of this study was to assess the effect of a single fascial therapy session on the balance and body weight distribution between the lower limbs in professional athletes following lower limb soft-tissue injury. 2. Materials and Methods The study assessments were conducted at a laboratory of Physiotherapy for Mus- culoskeletal Functional Disorders, University School of Physical Education in Wrocław, in the years 2018 and 2019. The study group comprised 41 athletes, specifically runners, of both sexes (26 men and 15 women) from the Poland National Team, with a history of an incident involving lower limb soft tissues, particularly the quadriceps femoris muscle. The study groups had an acute lower limb soft-tissue injury and a training experience (in running) of at least 2 years. The study inclusion criteria were history of a lower limb muscle injury 7–8 weeks prior to the study, no lower limb surgery for at least 9 months previously, a minimum of 12 weeks after the completion of treatment for any other lower Symmetry 2021, 13, 1586 3 of 12 limb injuries, no lower limb length discrepancy, and no neurological, cardiological, or psychiatric disorders. Study recruitment was conducted based on a custom questionnaire involving basic personal information, anthropometric parameters, training experience, and current or past history of musculoskeletal injuries. The athletes’ height was