Experimental Study Comparing Release in Stretch Position, Myokinetic Releases, and MFR to Increase Muscle Extensibility

Introduction

The term “flexibility of muscle” can be defined as the joint’s ability to develop a range of movement with regard to the extensibility of the musculature involved. This means that the loss of muscle flexibility is due to its reduced ability to elongate. Muscle’s fixation in shortened position causes a decrease in the number of sarcomeres. Since muscle is a mutable tissue, the shortening is reversible.¹ The treatment for this is stretching and not strengthening which would result in increased tightness and would result in a more evitable weakness. Functional resting length of muscle changes in response to the length that the muscle generally uses or is positioned in.² If a musculature is immobilized in a non-optimal length position, then it increases the stiffness of muscle and reduces its elasticity.

While stretching, the fascia is most likely the fundamental goal of static stretching.¹ Fascia is the simplest tissue that can modify consistency during pressure application and the capability to regain its elasticity when put to manipulation. The fascia and muscle tissues act as support for holding the body vertically.³ When fascia is allowed to sit for a longer period with no or little movement, its ground substances solidify leading to the loss of the ability of the collagen fibers to slide across each other and leading to the development of adhesions. This leads to a sequence of dysfunction. Therefore, it is the fascia of the myofascial unit that ultimately determines the length and function of its muscular component.⁴

Many studies concluded that there is no effective technique that individually stretches Tensor Fascia Latae (TFL) or pectoralis minor. Soft tissue manipulation techniques can be used to treat the shortening of these muscles. Myofascial release is a type of treatment protocol in which low long period stretch is applied to the muscle-fascia complex that intends to bring optimal muscle length, reduce aches and enhances function. Myokinetic active release therapy is also a soft tissue release method that utilizes tensile, shear, and compressive forces applied by manual touching to provide repetitive strain, trauma injury, constant pressure and tension lesions. Shear force is achieved by tissue shortening via active or passive method with manual pressure application from the therapist. Pressure between the therapist and the patient has to be maintained while the patient elongates the tissue actively.⁵

The study aimed to determine which among the three techniques was better to gain the optimal muscle length.

Materials and Methods

This experimental study included 30 participants with Tensor fascia latae tightness and 30 participants with pectoralis minor tightness. They were selected using random sampling. Inclusion criteria for the study were any person with the tightness of pectoralis minor or tensor fascia latae, aged between 18-40 years with no pain for three weeks and can understand commands. Exclusion criteria included a person suffering from an acute injury, fever, having undergone recent surgery, or having arthritic changes in the hip or shoulder joint. Subjects with height less than 5.3 feet, having an active lifestyle, or having a hard articular end feel were also excluded.

An informed consent form was signed. Pre-treatment length was tested.

Testing of Muscle Tightness

Pectoralis minor: The subject was asked to lie supine with the shirt removed or wearing sleeveless sportswear. Acromion process was palpated and the distance between acromion process and the bed surface was measured using a measuring tape.

Tensor fascia latae: The subject was asked to lie in a side-lying position with the testing side facing up with hip and knee flexed and the other side facing down with knee and hip extended. The patient was instructed to adduct the shoulders while elbows were flexed and was asked to rotate the upper body towards the researcher. Medial border of patella was palpated and measurement between the bed surface and the medial border was measured.

Distance more than three inches indicates muscle tightness. The participants were split into three groups, namely group 1, group 2, and group 3. Each group consisted of 10 participants with pectoralis minor muscle tightness and 10 participants with tensor fascia latae muscle tightness. For group 1, myokinetic active release therapy was given. For group 2, muscle release in stretched position was done and for group 3, the conventional myofascial release was given.

Myofascial release

Pectoralis Minor: Using the pads/ tips of fingers to contact ribcage immediately inferior to pectoralis minor, sink in medially and make communication as wide as attainable. Move the fingers below the pectoralis major.

Tensor Fascia Latae: The patient must be in a sidelying position with hip and knee flexion and the side to be treated should face upwards. Use elbow at an area just anterior to gluteus maximus to descend into it. Wait without increasing pressure. On obvious tone change, move inferiorly by adding a tension line for 2-3 cm.

Muscle release in stretch position

Pectoralis Minor: Patient should be in supine position with shoulder abducted and laterally rotated, with elbow flexed, and palm beneath the head. Perform 10 strokes using fingertips, at lateral chest wall just underneath the pectoralis major.

Tensor Fascia Latae: The patient was instructed to be in side-lying with the testing hip and knee facing up and extended and opposite side hip and knee flexed. At the area just anterior to gluteus maximus, release tensor fascia latae using fingertips.

Myokinetic active release:

Pectoralis Minor: Patient should be in supine position with shoulder abducted and laterally rotated with elbow flexed, with palm beneath the head. Perform 10 strokes using the fingertips, at the lateral chest wall between axilla and pectoralis major while the participant is instructed to move the shoulder in horizontal adduction and abduction.

Tensor Fascia Latae: The patient was asked to remain in a side-lying position with the testing knee and hip facing up and extended and opposite side hip and knee flexed. In the area just anterior to gluteus maximus, tensor fascia latae was released using fingertips inclined at an angle of 60-70 degrees, while the patient was asked to flex and extend hip and knee.

After treatment, post-treatment length was tested. The intra-tester reliability of measuring muscle length using measuring tape was r=0.94.⁶ All the readings were taken three times to minimize the chance of error.

Results

The results of the present study proved that all the treatment techniques were effective on both the muscles. The results obtained from all the groups showed a statistical significance value of <0.05. But on comparison between the groups, the result was non-significant. After analysis, our study showed that there was a decrease in muscle shortness post the treatment session. The mean and standard deviation was calculated for each group pre-and post the treatment session (Figure 1 and 2). Paired t-test was used to compare within the group which showed that the results were significant (Table 1 and 2). ANOVA was used to compare the groups and the results were non-significant (Table 3 and 4).

Discussion

This was an experimental study that compared the effectiveness of myofascial release, myokinetic active release therapy, and muscle release in a stretched position. According to the results, all the three techniques were equally effective. Any of these techniques can be used to gain optimal muscle length to bring about proper contraction of muscle fibers by releasing the muscle. By “release” we mean minimizing or letting off the resistances and the tissue is allowed to relax and elongate.⁷

When the muscle holds itself in a shortened position for a prolonged duration, the muscle ultimately shortens. With the shortening of the muscle, muscle spindle and fibre binds closely to the constricted area causing toughening of fibres making it non-breakable.⁸

Previous studies demonstrated the change in the muscle pre-and post-manual therapeutic intervention which inhibits taut band, causes a change in interstitial fluid, and reduces pain and contracture.⁹ Muscular release techniques like myokinetic active release, myofascial release therapy, etc help to break adhesions, increases blood supply and lymphatic drainage that increases the extensibility of soft tissue, and improves range of motion and muscular strength. Myokinetic active release is a technique in which deep tension over the tender area is applied while the patient actively moves the tissue from the shorten to lengthen position causing adhesion breakage.¹⁰ The myofascial release technique can be used to release the restricted or pathological fascial structures.¹¹ It works through a change in the thickness of the intracellular substance from a more solid to a gel state.¹² This change is said to influence the elastic, viscoelastic property of connective tissue. Hence myofascial release technique can be used to release the restricted fascial structures and gain the optimal muscle length for efficient muscle contraction.

Conclusion

The results showed that the muscle length improved significantly with the use of each technique. However, on comparing different groups, it was observed that all the three techniques were equally effective in achieving optimum muscle length.

Conflict of Interest

Nil