Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury
Musculoskeletal injuries are by far the most common injuries associated with the dental profession. What do we know about the mechanical significance of these injuries? Is the injury isolated to the muscle? What role does the connective tissue play in these injuries? In a systematic review and meta-analysis published December 2019 in the Orthopedic Journal of Sports Medicine the authors aimed to answer some of these questions.1
In the past it has been assumed that the skeletal muscles and their tendons were the main structures transmitting and bearing the stress of the load applied to the skeletal muscles. However, it has been speculated that the myofascial assists the muscles during the absorption of elongating forces. Therefore, muscle strain injuries may not be restricted to the muscle only.
The findings of this study contradict the long-held belief that strains occurring in soft tissue predominantly affect the skeletal muscles. The results showed that only 1 of 8 cases were identified as muscular lesions, the damage was more frequently located at the junction to the collagenous connective tissue. The authors believe the term “muscle strain injury” should be replaced with a more general term that is more encompassing of all the possible tissues that are involved in the injury.
Almost one-third of the injuries assessed for this study affects the fascia and its junctions to the muscle. The most common location of injury was a myotendinous junction. After assessing these results, the authors hypothesize that “the fascial connective tissue mechanically assists the muscle in taking up loads”. There was a small trend in athletes showing injuries that involve fascial damage was associated with longer recoveries, more studies are needed to substantiate this observation.
If future studies find an extended recovery time associated with fascial damage, this may indicate a need for a different approach to rehabilitation that focuses on connective tissue and not just the muscle. A recent study cited by the authors found vitamin C supplements and rope skipping exercises substantially improve collagen synthesis. This shift in treatment may be necessary to reduce recovery time for fascial damage.
Additionally, the authors make mention of the fact that delayed onset muscle soreness (DOMS) has been demonstrated to stem from the fascia and not the muscle. This phenomenon is thought to adjust neural which leads to reduced capacity for maximal voluntary force production.
Though this study focused mainly on sports injuries, the injuries described and assessed are remarkably like those experienced by dental professionals. This area of research may provide alternate therapeutic treatments for injuries that involve fascia damage.
The authors conclude, “Lesions of the collagenous connective tissue are a frequent finding in muscle strain injuries diagnosed through use of imaging methods. However, because of the high heterogeneity of the included studies and mixed evidence concerning the impact of fascial lesions on RTP (return to play) duration, further research is warranted in order to (1) conclusively elucidate the role of fascial damage within sports rehabilitation and (2) develop specific treatment approaches.”
Have you experienced injuries associated with dentistry like the ones described above? Have any therapeutic treatments been recommended by your doctor? Have you experienced improvements from any treatment?
Wilke J, Hespanhol L, Behrens M. Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury. Orthop J Sports Med. 2019;7(12):2325967119888500. Published 2019 Dec 24. doi:10.1177/2325967119888500