Hi everyone, my name is Sanjana Davaluri. I'm a second year medical student at Rowan Virtua SOM. Today I'll be discussing my project entitled Establishing the Dose Response Effect of Myofascial Release on Muscle Physiology. This slide has our static poster and some key takeaways from the study. I'll be discussing this in more depth shortly but just wanted to give you a brief overview. My co-authors are Seth Spicer and Dr. Tyler Piggott. If you'd like to learn more about the authors you can follow the QR code on the bottom right. So to start us off with some background, MFR is a commonly used modality in osteopathic manipulative medicine. It's often indicated for back pain due to its tolerability and post-treatment improvement in pain and functionality which has been previously reported on. While it has been hypothesized that MFR reduces symptoms present with myofascial dysfunction and decreases muscle tone and stiffness while increasing elasticity, there hasn't been much quantifiable data published on this until recently. Myotonometry is a relatively novel method of objectively quantifying digital palpation data including tone, stiffness, and elasticity of the tissue. In this study we sought to establish the dose response effect of various myofascial horizontal force and duration parameters on the pre- and post-tissue characteristic values as assessed by myotonometry. Our primary study objective was to determine if there is a significant difference in the paraspinal musculature following MFR at different treatment doses and forces and whether this effect is modulated by time or force. We also hope to establish the physiological effect of MFR through objectively measurable outcomes and to correlate horizontal displacement based on horizontal force. Lastly, we aim to determine whether MFR still results in tissue changes when performed over clothing and without the indirect portion. The null hypothesis is that there will be no difference between groups. The alternative hypothesis is that a greater total tension delivered would result in a greater decrease in tissue tone and stiffness and greater increase in tissue elasticity. Essentially we predicted the trends that you see in the three graphs in the middle panel for tone, stiffness, and elasticity. So in the study we recruited 41 healthy osteopathic medical students from years one through four aged 18 and over. We excluded participants with a BMI greater than 30 to maintain validity considering that having greater than 20 millimeters of subcutaneous fat over the target muscle can have an effect and skew the data as per our device user manual. We also excluded participants with a medical or surgical history of musculoskeletal or neurological diseases or if they were taking certain medications as all of these can also alter muscle tone. Participants were randomly assigned to one of six treatment groups of 30 or 90 seconds of MFR at half, normal, or one and a half times the physician's normal force. A skin safe marking pin was then used to mark a spot about one to two inches lateral to the T1 spinous process because this is the preferred location to take measurements of the perpendicular fibers of the trapezius muscle. We then recorded pre- and post-treatment measurements of muscle tone, stiffness, and viscoelasticity. The device that we used to measure muscle characteristics was the Myoton Pro digital palpation device which you'll see here in figure A. This is a fairly new device that's been found to be highly reliable and convenient. It has a superficial probe that you'll see at the bottom that exerts a short mechanical impulse followed by a quick release. This causes oscillations of the muscle that are recorded, measured, and calculated providing the parameters that we were looking to measure. Then once we got into our treatment groups we needed to come up with a way of measuring and applying varying levels of force. We therefore built a device that you'll see in figures B and C consisting of a spring scale attached to a frictionless platform on which the provider stood to exert the required horizontal force on the patient. A member of the study team monitored this force throughout each treatment to ensure that it remained constant throughout. Once data was collected statistics were performed using JASP and significance was established as P is less than 0.05. Here we have our results and conclusions. So in a global comparison of pre- and post-differences we did see that both tone and stiffness showed statistically significant differences with very small effect sizes. Elasticity was not significantly different. Due to violations of normality a Wilcoxon paired t-test was also used. Both tone and stiffness saw small decreases following MFR over clothing while only using direct MFR which would involve engaging the myofascial barriers. We then performed a comparison between treatment groups but we found no between group differences. The graphs in the left panel here show tone stiffness and elasticity changes for each of our six treatment groups. So as you'll remember we initially hypothesized that as we increased force and dose we would see a greater decrease in tone and stiffness and a greater increase in elasticity. Trends in our data do seem to suggest that greater force did result in greater reductions in tone and greater increases in elasticity with some exceptions that may have been affected by early outliers. Here in the graph for tone you'll see that greater decreases do seem to occur with increased dose except in group six. We do speculate that these trends will become more clear with a greater sample size. The study has also validated previous findings that MFR decreases tone and stiffness even when applied without the indirect aspect and over clothing. So the study is still in progress and we're actively recruiting participants and collecting data. Our calculation of statistical power called for a sample size of 66 participants but the study currently includes only 41 which is our primary limitation. This means that the current results are underpowered and subject to a fair amount of outlier bias. So regardless preliminary results in favor of a dose-response relationship are hopeful. We intend to recruit more subjects in the coming months to further explore a dose-response relationship and to objectively validate MFR as an effective treatment choice for musculoskeletal pain. If you're interested we have our references in this bottom right corner which you can scan with your QR code. Thank you so much for your time. We appreciate the opportunity to present our preliminary findings and we look forward to expanding upon them in the future. Thank you again.

Myofascial Release

muscle physiology

Myoton Pro

muscle tone and stiffness

musculoskeletal pain