The effect of fascial manipulation therapy on lower limb spasticity and ankle clonus in stroke patients

Submitted: 11 December 2023
Accepted: 29 May 2024
Published: 3 July 2024
Abstract Views: 1746
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Lower limb spasticity and clonus are common sequelae after cerebral stroke. An important part of their etiopathogenesis has been related to the peripheral component of spasticity. Rheological properties of the tissues seem to be involved. Several studies highlighted anatomical and functional changes in the connective structures. The fasciae might be implicated in the pathological process. Thus, this study intends to investigate the effect of the Fascial Manipulation (FM) technique on triceps surae in stroke patients through a clinical randomized controlled trial, to provide a reference for clinical treatment of lower limb spasticity and ankle clonus. A total of 40 patients with post-stroke ankle clonus were selected and divided into a control group and an observation group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation therapy, while the FM group received Fascial Manipulation based on conventional rehabilitation therapy. Before the first treatment and after 3 weeks of treatment, the Comprehensive Spasticity Scale (CSS), the Passive Range Of Motion (PROM), the simplified Fugl-Meyer motor function score (FMA), and the Modified Ashworth Scale (MAS) were used to assess the degree of ankle clonus, ankle passive range of motion, and lower limb motor function of the two groups of patients. Before treatment, there was no statistically significant difference between the control group and the FM group in terms of CSS, PROM, FMA, and MAS of the affected lower limbs (P>0.05). After 3 weeks of treatment, the CSS and MAS of the affected lower limbs in the control group and FM group decreased, while PROM and FMA increased compared to pre-treatment evaluation, with statistically significant differences (P<0.05). Moreover, the FM group showed a statistically significant decrease in CSS and MAS, as well as an increase in PROM and FMA, compared to the control group (P<0.05). Conclusions: Fascial manipulation in addition to conventional therapy can effectively reduce spasticity and ankle clonus in stroke patients in a short time, and improve the passive range of motion of the ankle joint and the function of lower limbs.

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Lance JW. The control of muscle tone, reflexes, and movement: Robert Wartenbeg Lecture. Neurology 1980;30:1303-13. DOI: https://doi.org/10.1212/WNL.30.12.1303
Zeng H, Chen J, Guo Y, Tan S. Prevalence and risk factors for spasticity after stroke: a systematic review and meta-analysis. Front Neurol 2021;11:616097. DOI: https://doi.org/10.3389/fneur.2020.616097
Luo WY, Tang YM. Expert consensus on fall risk assessment and comprehensive intervention after stroke. J Clin Intern Med 2022;39:63-8.
Bethoux F. Spasticity management after stroke. Phys Med Rehabil Clin 2015;26:625-39. DOI: https://doi.org/10.1016/j.pmr.2015.07.003
Trompetto C, Marinelli L, Mori L, et al. Pathophysiology of spasticity: implications for neurorehabilitation. Biomed Res Int 2014;2014:354906. DOI: https://doi.org/10.1155/2014/354906
Azzollini V, Dalise S, Chisari C. How does stroke affect skeletal muscle? State of the art and rehabilitation perspective. Front Neurol 2021;12:797559. DOI: https://doi.org/10.3389/fneur.2021.797559
Chinese Medical Association. Diagnostic points of various cerebrovascular diseases. Chin J Neurol 1996;6:60-1. DOI: https://doi.org/10.1016/S1052-3057(96)80003-6
Stecco C, Day JA. The fascial manipulation technique and its biomechanical model: a guide to the human fascial system. Int J Ther Massage Bodywork 2010;3:38. DOI: https://doi.org/10.3822/ijtmb.v3i1.78
Yan TB. Study on the reliability of comprehensive spasm scale. Chin J Rehabil Med 2002;5:263-5.
Yan GB. Range of motion, ROM. Chin J Joint Surg Electron Ed 2014;8:409.
Lu ZY. Application of Fugl-Meyer scale in stroke rehabilitation assessment. J Clin Med 2016;3:2032-4.
Blackburn M, Van Vliet P, Mockett SP. Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. Phys Ther 2002;82:25-34. DOI: https://doi.org/10.1093/ptj/82.1.25
Katz RT, Rymer WZ. Spastic hypertonia: mechanisms and measurement. Arch Phys Med Rehabil 1989;70:144-55.
Li S, Francisco GE. New insights into the pathophysiology of post-stroke spasticity. Front Hum Neurosci 2015;9:192. DOI: https://doi.org/10.3389/fnhum.2015.00192
Mirbagheri MM, Tsao C, Settle K, et al. Time course of changes in neuromuscular properties following stroke. In: 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Piscataway: IEEE; 2008, pp 5097-5100. DOI: https://doi.org/10.1109/IEMBS.2008.4650360
Arasaki K, Igarashi O, Ichikawa Y, et al. Reduction in the motor unit number estimate (MUNE) after cerebral infarction. J Neurol Sci 2006;250:27-32. DOI: https://doi.org/10.1016/j.jns.2006.06.024
Kesikburun S, Yaşar E, Adıgüzel E, et al. Assessment of spasticity with sonoelastography following stroke: a feasibility study. PM R 2015;7:1254-60. DOI: https://doi.org/10.1016/j.pmrj.2015.05.019
Jalal NIM, Gracies JM, Zidi M. Mechanical and microstructural changes of skeletal muscle following immobilization and/or stroke. Biomech Model Mechanobiol 2020;19:61-80. DOI: https://doi.org/10.1007/s10237-019-01196-4
Stecco A, Stecco C, Raghavan P. Peripheral mechanisms contributing to spasticity and implications for treatment. Curr Phys Med Rehabil Rep 2014;2:121-7. DOI: https://doi.org/10.1007/s40141-014-0052-3
Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther 2017;21:173-7. DOI: https://doi.org/10.1016/j.jbmt.2016.11.003
McCombe D, Brown T, Slavin J, Morrison W. The histochemical structure of the deep fascia and its structural response to surgery. J Hand Surg 2001;26:89-97. DOI: https://doi.org/10.1054/jhsb.2000.0546
Rasool G, Wang AB, Rymer WZ, Lee SS. Shear waves reveal viscoelastic changes in skeletal muscles after hemispheric stroke. IEEE Trans Neural Syst Rehabil Eng 2018;26:2006-14. DOI: https://doi.org/10.1109/TNSRE.2018.2870155
Wang AB, Perreault EJ, Royston TJ, Lee SS. Changes in shear wave propagation within skeletal muscle during active and passive force generation. J Biomech 2019;94:115-22. DOI: https://doi.org/10.1016/j.jbiomech.2019.07.019
Pavan PG, Stecco A, Stern R, Stecco C. Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep 2014;18:441. DOI: https://doi.org/10.1007/s11916-014-0441-4
Menon RG, Raghavan P, Regatte RR. Quantifying muscle glycosaminoglycan levels in patients with post-stroke muscle stiffness using T1ρ MRI. Sci Rep 2019;9:14513. DOI: https://doi.org/10.1038/s41598-019-50715-x
Menon RG, Oswald SF, Raghavan P, Regatte RR, Stecco A. T1ρ-mapping for musculoskeletal pain diagnosis: Case series of variation of water bound glycosaminoglycans quantification before and after fascial manipulation® in subjects with elbow pain. Int J Environ Res Public Health 2020;17:708. DOI: https://doi.org/10.3390/ijerph17030708
Raghavan P, Lu Y, Mirchandani M, Stecco A. Human recombinant hyaluronidase injections for upper limb muscle stiffness in individuals with cerebral injury: a case series. EBioMedicine 2016;9:306-13. DOI: https://doi.org/10.1016/j.ebiom.2016.05.014
Raghavan P. Emerging therapies for spastic movement disorders. Phys Med Rehabil Clin 2018;29:633-44. DOI: https://doi.org/10.1016/j.pmr.2018.04.004
Hughes E, Koenig JM, Lee RS, McDermott K, Freilicher T, Pitcher MH. Pilot study assessing the effect of Fascial Manipulation on fascial densifications and associated pain. Eur J Transl Myol 2022;32:10369. DOI: https://doi.org/10.4081/ejtm.2022.10369
Arumugam K, Harikesavan K. Effectiveness of fascial manipulation on pain and disability in musculoskeletal conditions. A systematic review. J Bodyw Mov Ther 2021;25:230-9. DOI: https://doi.org/10.1016/j.jbmt.2020.11.005
Morley J, Fan C, McDermott K, Fede C, Hughes E, Stecco C. The crural interosseous membrane re-visited: a histological and microscopic study. Eur J Transl Myol 2019;29:8340. DOI: https://doi.org/10.4081/ejtm.2019.8340
Mirbagheri MM, Alibiglou L, Thajchayapong M, Rymer WZ. Muscle and reflex changes with varying joint angle in hemiparetic stroke. J Neuroeng Rehabil 2008;5:6. DOI: https://doi.org/10.1186/1743-0003-5-6
Hara T, Abo M, Hara H, Sasaki N, Yamada N, Niimi M, Shimamoto Y. The effect of repeated botulinum toxin A therapy combined with intensive rehabilitation on lower limb spasticity in post-stroke patients. Toxins 2018;10:349. DOI: https://doi.org/10.3390/toxins10090349
Zhang ZQ, Li KP, Zhu Y, Zhou P, Hu CD, Hu XS, Feng W. Preliminary observation on clinical efficacy of Feng’s fascia point on relieving hand spasm after stroke. Shanghai J Tradit Chin Med 2018;52:66-8.
Liu BG, Wu J, Li ZY, You QZ, Le S. Current situation and treatment of myofascial injury in stroke patients. Med Forum 2021;25:2375-7.

How to Cite

Li, W., Liu, X., Wen, Y., Wu, J., Giordani, F., & Stecco, C. (2024). The effect of fascial manipulation therapy on lower limb spasticity and ankle clonus in stroke patients. European Journal of Translational Myology, 34(3). https://doi.org/10.4081/ejtm.2024.12172