Effect of Remote Myofascial Release on Lower Limb
Condition: Flexibility; Balance; Muscular Endurance
Study type: Interventional

Summary: 
      In general, the strength training on unstable surfaces has a positive impact on strength
      performance, power and stability compared to not training. As described above, previous
      studies have shown that self-myofascial release has a positive effect by improving
      flexibility, but its effect on balance is still debated.

      Myofascia contains numerous sensory nerves related to proprioceptive and mechanical receptors
      such as Golgi receptors or Pacini receptors. Therefore, the pressure applied during the
      self-myofascial release intervention can stimulate these mechanoreceptors and enhance the
      proprioceptive information integrated by the central nervous system to adjust the activation
      level of motor units. The aim of this study is to examine the effects of myofascial release
      applied to the thoracolumbar fascia on flexibility, muscular endurance and balance in healthy
      young adults.
    

Detailed description: 
      Fascia, muscles, bones, organs, nerves, it refers to all fibrous ligament tissue under stress
      that both encompasses and surrounds blood vessels and other structures, and stretches from
      head to foot in a continuous, three-dimensional network. Fascia is the most sensitive and
      vital structure in our bodies, linked to systems in the whole body, as vital as blood. This
      structure is a system of a single tissue fiber that is located directly below the skin.
      Fascia stretches through the whole body in lines for a locked-in feel. Thoracolumbar fascia
      (TLF) is an important structure that connects the lower extremity to the gluteus maximum and
      the upper extremity to the latissimus dorsi. The thoracolumbar fascia allows trunk
      stabilization in kinetic chain activities including movements such as throwing. The
      thoracolumbar fascia surrounds different trunk muscles, such as the multifidus, erector
      spines, and quadratus lumborum and provides support when these muscles contract. It also
      attaches to the internal oblique, transversus abdominis, latissimus dorsi aponeurosis and
      serratus anterior inferior muscle. Contraction of these muscles increases tension along the
      fascia and stabilizes the trunk by providing 3-dimensional support to the lumbar spine.

      The fasciae of the transversus abdominis, internal oblique and quadratus lumborum muscles are
      surrounded by the thoracolumbar fascia. The transversus abdominis muscle stabilizes the
      lumbo-pelvic region by stretching the thoracolumbar fascia and increasing intra-abdominal
      pressure. Thoracolumbar fascia, lower extremity and upper extremity acts as part of a pulley
      around the body, which provides a connection. Fascia disorders are often associated with
      adaptive misuse of muscles. For this reason, myofascial treatment is usually supported by
      appropriate exercises that the person will do. In this way, while creating a conscious
      awareness of the normal function of the patient in that muscle, it can reprogram the
      brainstem to incorporate the newly restored full-scale muscle capacity into the patient's
      daily activities.

      In recent years, the popularity of training has increased with the foam roller, which is one
      of the myofascial treatment methods. Foam roller massage is a relatively new technique and a
      common form of self-myofascial training performed by participants themselves and not by a
      clinician. The foam roller is a solid foam cylinder available in different stiffness and
      size. Athletes or patients are encouraged to rotate their body weights to operate each muscle
      group and loosen tight areas of the muscle. A possible effect is better moisturizing of
      tissues. While applying the foam roller massage, the soft tissue is squeezed like a sponge
      and then wetted with liquid, which improves the movement between the different layers of the
      fascia. This method, which affects the muscle and myofascial structures by increasing the
      compatibility and extensibility of the fascia, reduces passive muscle stiffness. It can also
      reduce delayed onset muscle soreness after intense exercise. Self-myofascial release has been
      shown to provide a wide range of positive gains in physical performance. The best-known
      positive effect of self-myofascial release is a gain in flexibility as assessed by increased
      range of motion in sports and rehabilitation contexts. Scientifically, many positive effects
      of foam roller massage are assumed, but in most cases unproven. Most studies of
      self-myofascial release techniques address the acute effects, while there is limited clinical
      research on the training effects of foam roller massage. The sample will be adults between
      the ages of 18-40. Investigators will announce the research via social media and invite
      volunteers to work. Participants who are willing to participate will be explained the study
      and participants who agree to participate and who meet the work criteria will be included in
      the study. Participants will be divided into 3 groups as Myofascial Release and Exercise
      Group, Exercise Group, and Control Group using the computerized randomization method. Since
      the study is pilot operation, no power analysis has been performed to determine the sample
      size. Investigators aim to have at least 12 people in each study group. The first evaluation
      of the participants will be made before starting the 4-week program. Final assessments will
      be made within 2-3 days after the 4-week training ends. Evaluations will include flexibility
      measurements, muscular endurance measurements, balance evaluations. The study will have a
      single-blind design. The investigator making the evaluation will not know which group the
      participant is in.
    

Intervention name(s): Myofascial Release and Exercise Group; Exercise Group
Intervention type(s): Other; Other
Intervention description(s): The exercise program will be applied 3 days a week for 4 weeks. Participants will warm up by walking for 5 minutes before exercise. Stretching exercises - Reach forward with sitting and hamstring (3 reps*30 sec).
First 2 weeks:
Squat exercise (3 sets of 10 reps). Standing on one leg with knee flexed and hip-knee flexed at 90 degrees (30 seconds).
Star Excursion balance training (2 rounds to be applied). Foam Roller massage will apply to thoracolumbar posterior chain (1 set of 30 seconds will be applied with a rolling period of 2-4 seconds).
Last 2 weeks:
Squat exercise (3 sets of 15 reps). Standing on one leg with knee flexed and hip-knee flexed at 90 degrees (40 seconds).
Star Excursion balance training (3 rounds to be applied). Foam Roller massage will apply to thoracolumbar posterior chain (2 sets of 30 seconds will be applied to each area with a rolling period of 2-4 seconds).; The exercise program will be applied 3 days a week for 4 weeks. Participants will warm up by walking for 5 minutes before exercise. Stretching exercises- Reach forward with sitting and hamstring (3 reps*30 sec).
First 2 weeks:
Squat exercise (3 sets of 10 reps). Standing on one leg with knee flexed and hip-knee flexed at 90 degrees (30 seconds).
Star Excursion balance training (2 rounds to be applied).
Last 2 weeks:
Squat exercise (3 sets of 15 reps). Standing on one leg with knee flexed and hip-knee flexed at 90 degrees (40 seconds).
Star Excursion balance training (3 rounds to be applied).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment