Can myofascial interventions have a remote effect on ROM? A Systematic Review and Meta-Analysis

Context: Anatomical and in vivo studies suggest that muscles function synergistically as part of a myofascial chain. A related theory is that certain myofascial techniques have a remote and clinically important effect on range of motion (ROM).
Objective: To determine if remote myofascial techniques can effectively increase range of motion at a distant body segment.
Evidence Acquisition: In November 2018, we searched three electronic databases (CENTRAL, MEDLINE, PEDro) and hand searched journals and conference proceedings. Inclusion criteria were: Randomized controlled trials (RCT) comparing remote myofascial techniques with: passive intervention (rest/sham), or a local treatment intervention. The primary outcome of interest was ROM. Quality assessment was performed using the PEDro Scale. Three authors independently evaluated study quality and extracted data. RevMan software was used to pool data using a fixed-effect model.
Evidence Synthesis: Eight RCTs, comprising n=354 participants were included (mean age range 22-36y; 50% female). Study quality was low with PEDro scores ranging from 2 to 7 (median scores 4.5/10). None of the studies incorporated adequate allocation concealment and just two used blinded assessment of outcomes. In all studies, treatments and outcomes were developed around the same myofascial chain (superficial back line). Five studies included comparisons between remote interventions to sham or inactive controls; pooled results for ROM showed trends in favor of remote interventions (SMD 0.23 [95% CIs -0.09 to 0.55], 4 studies) at immediate follow ups. Effects sizes were small, corresponding to mean differences of 9% or 5 degrees in cervical spine ROM, and 1-3 cm in sit and reach distance. Four studies compared remote interventions to local treatments, but there were few differences between groups.
Conclusions: Remote exercise interventions may increase ROM at distant body segments. However, effect sizes are small and the current evidence base is limited by selection and measurement bias.