EFFECTS ON THE DEEP FASCIA IN THE TFL AND THE G-MED BY PASSIVE MOTION OF THE ANKLE

Sugawara K1,2, Aoki M1,3, Yamane M3, Hayashi T1, Honma H1,4, Sasaki Y11The Health Sciences University of Hokkaido, Tobetsu-cho, Hokkaido, Japan, 2Sapporo Daiichi Hospital, Sapporo-shi,Hokkaido, Japan, 3The Health Sciences University of Hokkaido Hospital, Sapporo-shi,Hokkaido, Japan, 4Sapporo Hachiken Orthopedic Hospital, Sapporo-shi,Hokkaido, JapanBackground: Recently, observation of fresh cadavers has revealed the anatomical connection of the fascia along the long axis of the limbs, and the importance of the continuity of the fascia tissue has been proposed. However, evaluation of the effectiveness of manual techniques is limited to the same segment of the joints and muscles. There are no previous reports of clinical investigation in which the transmission of force via the deep fascia (D-Fascia) is measured due to the anatomical continuity of the facial tissue at a distant site.Purpose: By using ultrasonography, we measured the longitudinal movement distance of the deep fascia (LMDDF), change of the pennation angle (PA), and muscle thickness (MT) in both the tensor fasciae latae muscle (TFL) and the gluteus medius muscle (G-Med) during passive motion of the toe/ankle joints.Methods: Twelve right lower limbs of 12 healthy males (age: 21±0.9) were evaluated in this study. In the lower left lateral position, we measured the LMDDF of the TFL and G-Med by measuring distance between the designated mark (aluminum tape) on the skin and the intersection of the major D-Fascia and the fascial bundle. We also measured changes of the PA and MT to both muscles. The measurement was performed during three manual positions on the toe/ankles; manual holding of the toe and ankle joints in neutral (resting-position), toe flexion and ankle plantar flexion/inversion position (flexion-position), and toe extension and ankle extension/valgus position (extension-position). The existence of muscle contraction of the TFL and G-Med during passive motion of the toe/ankles was monitored by active surface electrodes. Electrical activity during passive motion greater than 2SD of the baseline was designated as positive muscle contraction. Differences of the LMDDF between resting-position and the passive motions were designated as displacement of the D-Fascia. The changes in the PA and MT between resting-position and passive motions were calculated. We conducted one-way repeated measures analysis of variance (ANOVA) and multiple comparisons in each measurement. Statistical analysis was performed by R-ver2.8.Statistical significance was set at 0.05.Results: The LMDDF of the TFL changed significantly in the distal direction (p< 0.01) among resting-position, flexion-position, and extension-position. Multiple comparisons showed a significant difference in the LMDDF values (P = 0.02) between resting-position and flexion-position.No significant difference was found in other areas. In one case, muscle activity was observed in one position in the TFL. This case was not included in this analysis.Conclusion(s): This study confirmed mobility of the D-Fascia in which the TFL's D-Fascia moves in the distal direction during no muscle contraction due to passive flexion motion of toe/ankle joints. This fact suggests the possibility that passive tension on fascia tissue of the ankle extends to the proximal part of the limb, i.e., to the D-Fascia of the TFL. Using ultrasonography, these phenomena were observed in living bodies.Implications: For clinical application of the result of research, it is expected that the treatment approach to the foot may have some influence on cases with dysfunction in the proximal parts of the pelvis and lower limbs.Keywords: The movement distance of the deep fascia, Passive motion of the toe/ankle joint, TFL and G-medFunding acknowledgements: No financial support was obtained from any other sourceTopic: Outcome measurement; Musculoskeletal: lower limbEthics approval required: YesInstitution: the Health Sciences University of HokkaidoEthics committee: Ethics Committee of Graduate School of Rehabilitation ScienceEthics number: 17R069063All authors, affiliations and abstracts have been published as submitted.