Self-Myofascial Vibro-Shearing: a Randomized Controlled Trial of Biomechanical and Related Changes in Male Breakdancers
Gordon et al. Sports Medicine - Open
Self-Myofascial Vibro-Shearing: a Randomized Controlled Trial of Biomechanical and Related Changes in Male Breakdancers
Christopher-Marc Gordon 0
Sophie Manuela Lindner 0
Niels Birbaumer 2
Pedro Montoya 1
Rachel L. Ankney
0 CIT Research Institute , Ahorn Str. 31, 70597 Stuttgart , Germany
1 Research Institute on Health Sciences , IUNICS
2 Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen , Tübingen , Germany
Background: This randomized controlled trial explored the practicality and effectiveness of a novel tool-assisted self-help device, one that combines vibrational oscillation, leverage, and the shearing effect from the edges, for promoting meaningful changes in key biochemical tissue indices and related parameters. Methods: One hundred and thirteen male breakdancers were randomized to an intervention or control group. Individuals assigned to the intervention group performed the self-help treatment on the quadriceps and the iliotibial band of their right thighs for 8 min, while individuals assigned to the control condition merely sat quietly during this period. Various primary outcome measures (e.g., elasticity, stiffness, range of motion, pain pressure threshold sensitization, and blood flow) were assessed before and after the intervention for each participant, with position and posture being standardized throughout. Subjective sensations and a measure selected to assess for potential experimental demand effects, serving as secondary measures, were also administered pre- to post-treatment. Results: Stiffness was significantly reduced for both structures (p < 0.001), elasticity and flexibility of the quadriceps were increased significantly (p < 0.001 for each), sensitization was significantly lessened (p < 0.001), and local temperatures increased to a significant degree as well (p < 0.001) when comparing change scores following application of the self-help tool on the treated thighs to those on the untreated thighs. Participants using the self-help tool reported their treated leg as being more relaxed, light, and stable. Conclusions: The vibro-shearing manipulation with a muscle-fascia tool resulted in significant improvements in various objective mechanical tissue properties, range of motion, and pain desensitization in healthy, well-conditioned dancers. These promising effects for a new tool-assisted self-treatment indicate further basic investigations are warranted, as are pilot investigations with patient populations.
Tool-assisted self-myofascial release; Fascia-ReleaZer®; Tissue stiffness; Tissue elasticity; Range of motion; Pain pressure threshold; Breakdancer; IASTM
Vibro-shearing self-manipulation with the
Fascia-ReleaZer® is a technique that reduces myofascial stiffness
and pain sensitization.
The self-manipulation tool increases microcirculation,
elasticity, and range of movement.
The subjective parameters of lightness and relaxation
increased significantly through the treatment.
Self-myofascial release (SMR) is becoming increasingly
popular both in the amateur and professional sports field.
SMR is a type of myofascial release that is performed by
individuals themselves, most often using a foam roller [
or a roller massager [
]. SMR appears to have a wide
range of effects, most typically increasing flexibility acutely
] and chronically [
] with respect to changes in joint
range of motion (ROM), although it has also been utilized
to reduce delayed onset muscle soreness (DOMS) [
2, 6, 9
affect arterial and vascular endothelial function , and
modulate autonomic nervous system activity [
More recently, therapeutic myofascial and soft tissue
manipulation tools have incorporated devices that have
firmer edges to increase leverage and/or vibration features
to enhance effects. An evidence-based form of
instrumentassisted soft tissue mobilization, called the Graston®
Technique (GT), utilizes a stainless-steel tool to localize
and treat soft tissue restrictions. Developers of the GT
recommend that the edges of the instrument be prepared
at a 30° to 60° angle to more effectively and efficiently
address soft tissue lesions and fascial restrictions. Studies
utilizing the GT have reported producing a localized
inflammatory response, reducing scar tissue, and
breaking down existing scar tissue in people with soft tissue
Vibration features have been used extensively since
the beginning of the twentieth century in
instrumentassisted techniques to mechanically stimulate myofascial
]. Low-intensity vibratory massage (VM),
with a 15–50-Hz frequency band, has been shown to
increase oxygen uptake, blood and muscle oxidation, local
and general blood circulation, local temperature in
massaged tissues, and muscle enzyme activation. Other effects
include marked general relaxation, relaxation of
myofascial tissues, decrease of emotional tension, and a general
sedative effect .
To date, no studies have investigated the value of adding
a vibration component to the shearing effect of SMR tools.
Shearing is defined as a mechanical force that acts on an
area of skin in a direction parallel to the body’s surface.
Shearing is affected by the amount of pressure exerted,
the coefficient of friction between the materials contacting
each other, and the extent to which the body makes
contact with the support surface [
]. This study was
designed to assess the clinical utility of a new self-help
tool for treating myofascial tissue that combines a number
of the aforementioned features—vibrational oscillation,
leverage, and the vibro-shearing effect—in a novel self-help
instrument called the Fascia-ReleaZer® (FR). This tool has
the potential added advantage of having the user apply the
desired pressure in the absence of external support, unlike
foam rolling and related approaches that require the device
to be pressed against a firm object.
The specific aim of this study was to explore the
practicality and preliminary effectiveness of this new self-help
tool by examining biomechanical tissue changes and other
associated effects when this device is used. We selected a
sample of individuals, experienced breakdancers, known
to be particularly well fit. This was done to minimize
potential biasing effects and thus provide a strong test
of the value of FR. In this investigation, we selected the
quadriceps muscle (QM) and the iliotibial band (ITB)
as our test targets (see below why these targets were
Breakdancers, referred to as B-Boys within this
community, were further specifically selected for participation
in this exploratory investigation because the movement
patterns in this dance style involve extremely strenuous
physical activities, such as splits, spins, handstands, and
tumbling, all varying in velocity, quality, and planes using all
parts of the body fascia. Kicking of the legs and recruiting
the myofascial tissues from the QM, as well as the ITB and
the tensor fascia latae, produces the high velocity for
the acrobatic maneuvers in breakdancing. All dance
movements, such as jumping, spinning on the floor, or
lifting, demand the perfect timing of the impulse,
momentum, and rebound: the optimal timing in releasing the
preloaded fascia [
]. For an energetic and elastic
movement, which is required in breakdancing, a dynamic
catapult effect of the fascial fibers is necessary. Therefore,
the elasticity of the fascial tissue is the key to its high
capacity to store kinetic energy .
By addressing the inner body perspective, dance
(breakdancing in particular) stimulates both the proprioception
and interoception of the body. The highest density of
proprioceptive and interoceptive receptors are found within
the fascial tissue, because the fascial net plays an important
role in the perception of inner sensations [
Overview of Study
Male breakdancers were randomly assigned to one of
two experimental conditions: no-treatment control or a
brief self-applied intervention using a specially designed
myofascial manipulation tool. Various primary measures
were taken from the right thighs of all dancers, with the
intervention being applied to the right thigh only to the
dancers assigned to the intervention group. A variety of
primary outcome measures, described below, were
collected from all dancers before and after intervention.
Two final secondary measures were collected at pre- and
One hundred thirteen (N = 113) male breakdancers were
recruited and randomized into an intervention (n = 56)
and a control group (n = 55). All participants fulfilled the
following criteria: (1) healthy condition, (2) no physical
preloading or physical execution, (3) skinfold measures
of body fat at the ITB with a maximum of 10 mm, (4)
dancing breakdance for a minimum of 1 year, and (5)
age over 18 years. Exclusion criteria consisted of the
presence of acute or chronic injuries concerning the legs
and the hip area, pain in the treatment area, and acute
inflammation and degenerative neurological illnesses or
scars in the measuring area. Inspection of Table 1 reveals
the groups were comparable with respect to all measures
used for study inclusion. Written informed consent was
obtained for all procedures, with participants being free
to withdraw at any time without penalty. Of the total
who consented to participate, two withdrew (one from
each condition), reporting they became dizzy while
sitting for an extended period. The study was conducted
in a manner consistent with the Declaration of Helsinki
and was granted for approval by the Ethics Committee
of the University of Tübingen.
All participants were assessed with a common set of
measures both prior to and following the time during
which participants either received a brief intervention or
sat and rested quietly for the same amount of time (control
Dancers assigned to receive the intervention performed
an 8-min self-help treatment on their right thighs with the
Fascia-ReleaZer®. The right thigh was first lightly lubricated
with a vaseline-neutral oil. The opposite side was not oiled
as this might have effected changes in the tissue. A
standardized protocol was developed for the self-help treatment,
which consisted of three short and three long linear strokes
on the quadriceps muscle (QM) followed by three short and
three long linear strokes on the iliotibial band (ITB). This
procedure was repeated until 8 min had elapsed, gauging
the time by a stopwatch placed on the wrist of the
participant. The intervention tool was held and applied at a
45° angle to the treated tissue (see Fig. 1f ). Patients
were instructed to apply a pressure intensity that they
subjectively perceived to be equivalent to a rating ranging
from 3 to 5 on a numerical scale where 10 was the
Dancers assigned to the control condition were instructed
to sit quietly in the standardized position and refrain from
moving during the 8-min period when those in the
intervention group applied the myofascial tool.
Position and Marking of the Measuring Points
Position and posture were standardized for both groups,
with participants being instructed to maintain the specified
position and posture throughout. When necessary (which
rarely occurred), they were corrected by the study
examiners. Study position was controlled by having participants
sit in a specific manner on a four-legged stool (58 cm
length, 42 cm width, 43 cm height, UTTER IKEA). The
back of the stool had contact with a flat wall. The lumbar
spine of the participants had full contact with the wall, the
pelvis was in a neutral position, and the participants were
instructed to retain a straight posture. Both feet
maintained full contact with the floor and were taped to the
floor to help restrict any involuntary movement. The inside
of the knees had full contact with the lateral sides of the
stool. Both lower legs were attached with a strap to the
front legs of the stool (see Fig. 1f ).
A standardized protocol for marking the measuring
points was performed by the same study examiner (the
second author). A line was drawn from the epicondylus
lateralis parallel to the femur on the strongest
embossment of the ITB. The area revealing the highest level of
stiffness was palpated and marked in the most anterior
quarter of the ITB. A vertical line was drawn over the QM
to this measuring point of the ITB. From the middle of
the patellae, a line was drawn parallel to the rectus femoris
muscle. The crossing of the two lines was the measuring
point of the QM.
Primary Outcome Measures
Objective measures were taken within multiple domains
throughout the investigation in order to more fully
explore and identify changes in response to our
intervention, and these served as our primary measures. Assessors,
all credentialed physical therapists, received 6 weeks of
intensive training over the course of 14 pilot studies prior
to conducting the assessments, with ongoing supervision
by the first author provided throughout the investigation.
All assessments were performed by the same study
examiner (second author) and two further well-trained assessors,
who met frequently during data collection to ensure
continuity and prevent measurement drift.
Biomechanical Tissue Changes
Key measures within this domain were collected with
the MyotonPRO (Myoton AS; Estonia) [
measurement probe (D = 3 mm) was placed
perpendicularly on the pre-marked skin areas above the muscle being
measured, QM and the ITB (see Fig. 1c). The device was
then lowered into the measurement position and held
steady while it automatically performed the predefined
measurement series (five single measurements with a
recording interval of 1 s for each measuring point, using
the average for data analysis). The method of myometry
developed for measuring superficial skeletal muscles
consists of (a) creating a constant pre-compression
0.18 N over the area of 7.1 mm2, followed by a brief
(15 ms) mechanical impulse of 0.4 N to the contact surface
of the skin; (b) recording the response of the tissue in a form
of damped oscillation that is registered by an accelerometer
in a form of an oscillation acceleration graph; and (c)
subsequently conducting signal processing and computing for the
variables of interest. Of the five available variables, we chose
the two most pertinent to our study aims—elasticity
and dynamic stiffness.
The logarithmic decrement of a tissue’s natural oscillation
characterizes its elasticity, but more directly, it reflects the
dissipation of the mechanical energy within an oscillation
cycle, when tissues recover their shape after being deformed.
Said another way, elasticity is the biomechanical property of
a muscle that characterizes the ability to recover its initial
shape after a contraction or removal of an external force of
deformation. Elasticity is inversely proportional to the
decrement. Therefore, as the decrement of a muscle decreases,
the muscle elasticity increases. In theory, a decrement of 0
(zero) represents absolute elasticity. Elasticity is reported as
the logarithmic decrement, while the inverse of elasticity is
Dynamic stiffness [N/m] is the biomechanical property
of a muscle that characterizes the resistance to a
contraction or to an external force that deforms its initial shape. In
the case of overly high stiffness, a greater effort is required
from the agonist muscle to stretch a stiff antagonist,
which leads to an inefficient economy of movement
(see Additional file 1, relationship of the displacement
oscillation and oscillation velocity in relation to the
Range of Motion
Three measures were collected with respect to this
domain—the Modified Passive Thomas Test, Modified
Thomas Test with Pressure—using a goniometer (KaWe
Kirchner & Wilhelm, Germany), and the Modified
Finger-Floor Distance Test—using a measuring tape.
Modified Passive Thomas Test (MPTT) and Modified Thomas
Test with Pressure (MPrTT)
A standardized protocol was performed in order to
obtain a value from the modified Thomas test. Study
participants were asked to lie down on a table, with the
left leg in knee flexion and then pulling this leg towards
the chest. Participants were instructed to push the leg
they were holding so far that the upper leg remained in
full contact with the table. The angle of the knee was
measured with a goniometer, providing a measure of
the MPTT (see Fig. 1b). While in the same position, a
measurement was taken with pressuring the lower leg
into flexion until the first resistance was noticed, yielding
scores for the MPrTT. All measurements taken with the
goniometer were performed according to the technique
described by Norkin and White [
Modified Finger-Floor Distance Test (MFFD)
A MFFD test was applied according to the procedures
developed by Magnusson et al. [
]. Participants were
asked to stand on a footstool (34 cm length, 19 cm
weight, 23 cm height), grab a wooden stick with both
hands while keeping both thumbs closed and both knees
completely extended, and, from there on, flex the trunk
towards the floor, with head and arms relaxed (see
Fig. 1a). The participants were instructed to bend one leg
after each other. Final flexion position was indicated by a
sensation of muscular tension that caused initial hamstring
discomfort. Finger-floor distance (in centimeter) was
quantified using a measuring tape, yielding the MFFD value.
Pain Pressure Threshold
The PainTest™ FPN 100 Algometer (Wagner Instruments,
Greenwich, USA) is a device that measures deep pain
pressure threshold (PPT) or tenderness resistance. More
specifically, the algometer measures the pain pressure threshold
when a particular site of the body is pressed with a rubber
disk having an area of 1 cm2 [
]. In the present study,
the unit “kilogram” was used for quantifying PPT. The
pressure algometer was placed over the marked measuring
points of the QM only (see Fig. 1d). Study participants were
extensively trained and instructed to verbally indicate the
point at which point the pressure pain threshold that was
steadily increased became “uncomfortable.” Higher
pressure values thus indicate reduced pain pressure threshold
Measurement of Tissue Temperature
Two distinct measures of temperature were collected
over the ITB to serve as proxies for superficial blood
flow—ITB thermography and ITB thermometer. As little
is known about the preferred approach for assessing this
aspect, we opted to collect both for comparability and to
provide a measure of quality control.
The FLIR ONE™ thermography camera (FLIR Systems,
Gmbh, Frankfurt, Germany) is used to take thermographic
pictures and differentiates the temperature with a color
scale. A normal daylight photograph, simultaneously taken
with every thermographic picture, is used for
documentation purposes. The device consists of an attachment for
the iPhone 5 and is used together with the FLIR ONE™
App. Its measuring sector ranges from − 20 to 120 °C,
with a sensitivity of ± 0.1 °C (the smallest absolute amount
of change that can be reliably detected).
Changes in superficial temperature were recorded with
this thermography camera, while aimed at the ITB
measuring point. The position of the thermography camera
was standardized by positioning the camera on a chair at
a height of 48 cm (approximately at the position of the
participant’s ITB) at a distance 60 cm away from the
measuring chairs. Strips of tape were placed on the floor
to mark the position of the chairs as well as the table for
the thermography camera in order to standardize the
distance. The sensor of the camera was directed towards
the measuring point on the ITB in order to perform a spot
measurement, and a calibration was performed before
taking a picture (see Fig. 1e). The measuring values were
recorded by the scientific assistant.
A non-contact clinical thermometer (FT 90, Beurer, Ulm,
Germany) was used to measure the superficial temperature
for control of the thermography camera. Temperature
values between 22 and 80 °C can be recorded with a
sensitivity of ± 0.3 °C temperature units with this device. The
thermometer was placed 2 to 3 cm in front of the measuring
points at the ITB. The measuring values were recorded by
the scientific assistant.
Secondary Outcome Measures
Two secondary measures (Physical Sensations
Questionnaire and Modified Profile of Mood States) were
administered pre- to post-treatment in order to assess reactions to
the brief treatment and preliminarily determine if demand
(or reactivity) effects might have influenced the findings.
Physical Sensations Questionnaire (PSQ)
This questionnaire was constructed by the investigators
to inquire about the physical sensations experienced by
participants pre- to post-intervention and was completed
while standing on the right leg alone. All participants
were asked to rate their subjective sensations of
relaxation, lightness, strongness, and stability, on a scale that
ranged from zero (“does not apply”) to ten (“does apply”)
for each item. (No analyses were conducted to examine
the psychometric properties of this investigator-created
Modified Profile of Mood States (POMS) Questionnaire
The modified POMS was administered to all participants
pre- to post-trial to permit us to assess potential influences
due to mere participation alone (e.g., demand or reactivity
effects). We selected a modified German short version [
of the original “Profile of Mood States” [
], a standardized
psychological test formulated to assess momentary mood
states. The 19 items contained within the version we used
inquire about varied momentary feelings of respondents,
with each being rated on a numeric scale, from 1 to 7, with
the values described as “Not at All” (1), “Very Poor,” “Poor,”
“A Little,” “Moderately,” “Quite a Lot,” or “Extremely” (7).
Five subscales are computed for analysis—sadness, despair,
tiredness, positive mood, and anger. This measure has
acceptable psychometric support (Cronbach’s alpha ranges
from α = .83 to .94; factorial, differential, and construct
validity are reported as acceptable as well).
Overview of Data Analysis
A series of t tests for independent groups was conducted
for all 11 primary pre-treatment (baseline) values to assess
equivalency of the two groups prior to intervention.
This was followed by a multivariate analysis of variance
(MANOVA) comparing the intervention (treated) and
control groups with respect to all primary outcome
measures (biomechanical tissue measures, range of
motion, pain pressure threshold, and bloodflow) in one
integrated analysis, using change scores (post-treatment
minus pre-treatment values) as the unit for analysis in
order to provide the most sensitive test of effects. A
second MANOVA was conducted to address group
differences with respect to the secondary outcome measures
pertaining to perception of physical sensations and mood
states, both collected prior to and at the end of the study
(again using change score). MANOVA was chosen based
on the recommendations of both Pallant [
Tabachnick and Fidell [
] that it is the most appropriate
procedure to use when conducting analyses of variance with
multiple dependent variables (DVs) as it can be used to
detect which DVs are influenced by the manipulation.
Multivariate analysis also protects against inflated type I
error due to multiple tests, especially when DVs are
correlated (which was the case here). The inclusion of
covariates was judged unnecessary because only one
primary outcome measure revealed a significant difference
between groups (to be discussed later).
Prior to the MANOVA analyses, data were screened in
SPSS 24 to ensure that the assumptions for this approach
were met, following recommendations by Pallant [
Tabachnick and Fidell [
]. Univariate outliers were
screened by variable, with outliers classified as those
falling above or below 3 standard deviations of the
mean. Multivariate outliers were screened separately for
each planned analysis by conducting a linear regression
with participant ID as the independent variable (IV) and
all primary outcome dependent variables (DVs) for the
planned analysis as the regression DVs. Outliers were
classified as those with Mahalanobis’ distances falling outside
of the chi-square threshold, consistent with the
recommendations of Pallant [
] and Tabachnick and Fidell [
Both univariate and multivariate outliers were removed
from analysis by applying these tests, and the resulting
sample size is reported separately for each MANOVA
analysis. As identified outliers varied as a function of each
major analysis, the sample sizes reported per condition in
the data table summaries vary somewhat.
Table 2 presents the findings when comparing
pretreatment values for all primary dependent measures for
those serving as controls versus those receiving treatment.
All but one test (that for the thermography measure)
revealed no significant differences. A follow-up two-way
ANOVA (period: pre- versus post-test × experimental
condition: control versus intervention) for this measure
revealed the difference at pre-treatment, although statistically
significant, was substantially smaller in magnitude than the
difference at post-treatment. Consequently, we opted not to
employ any corrections for this, such as covariate analyses.
Results for both MANOVAs demonstrated significant
multivariate differences based on Pillai’s trace, as reported
in Table 3. Pillai’s trace is reported in lieu of Wilks’ lambda
as recommended when assumptions, in this case a
Table 2 Means, standard deviations (within parentheses), t test
values, and significance levels comparing control versus
intervention groups for all dependent measures at pre-treatment
Thermography ITB 29.18 (1.57)
Thermometer ITB 31.70 (.94)
(N = 55)
(N = 50)
60.18 (11.06) 58.86 (9.96)
104.55 (8.98) 104.28 (9.67)
26.86 (10.39) 25.76 (9.40)
455.35 (74.50) 463.38 (103.77) − .452 .653
428.58 (69.98) 424.30 (51.95) .358
significant Box’s test, are violated [
]. Given significant
findings were obtained for both multivariate tests, tests
of between-participant effects were then investigated
for each MANOVA to determine more precisely the
sources of the significance.
The first MANOVA revealed a significant difference
between groups for all of the primary outcome post-test
minus pre-test difference scores, aside from elasticity in
the ITB. Effect sizes based on partial eta squared, using
] benchmarks of .01, .06, and .14 for small,
medium, and large effects, respectively, indicated large
effects for biomechanical tissue changes (with the exception
of elasticity in the ITB), large effects for range of motion,
medium to large effects for PPT, and large effects for blood
flow (see Table 4, group differences in right thigh change
from pre- to post-test by condition).
The second and final MANOVA, again using change
scores as the DV, revealed a significant difference between
groups on PSQ relaxation and lightness, with partial η2
indicating large effect sizes for both measures. Results
were not significant for either stability or strongness,
although mean differences, along with a p value of .06,
indicate a potential difference between groups on stability.
Minimal differences were found for the POMS measures,
with only POMS tiredness demonstrating a significant
small to medium effect (see Table 5, group differences
in secondary outcome measures from pre- to post-test
comparing those assigned to the control condition versus
the intervention condition).
The main aim of the present study was to determine
whether meaningful changes would occur in objective
Control n = 51, intervention n = 44; all p values < .001 for all measures, with the sole exception being elasticity ITB (p = .49)
mechanical tissue properties and related measures when
young, healthy breakdancers applied a self-help treatment
with a muscle fascia tool. After 8 min of use, elasticity
increased in the quadriceps, stiffness (for the QM and the
ITB) and pain sensitivity decreased, ROM improved for
the QM and hamstrings, and local temperature values
increased (reflecting improved blood flow). Although the
intervention was very brief in duration, some differences
were found with respect to perceived sensations, all of
which favored those receiving the intervention. The
absence of major differences on the POMS between
those dancers assigned to the intervention condition
and those assigned to the control condition suggests
the observed findings are unlikely to have occurred due
to participants’ awareness of them being observed or
taking part in an experiment (i.e., demand or reactivity
effects). Our findings are further strengthened by the
fact that the demographic data of both groups were
similar and comparable. The standard deviations for
age, size, weight, training experience, training intensity, and
training duration were small. Further, measurements of
improvement were fairly consistent across all parameters
for the treated legs only, with the control (untreated) legs
basically remaining unchanged.
Stiffness reduced, while elasticity increased in the treated
thigh. Elasticity of the ITB of the right thigh, however, did
not change. The failure to find a change in the elasticity of
the ITB is not surprising given that a certain level is
required for lateral knee stabilization. The ITB serves
to reinforce the fascia lata and divides the QM from the
hamstring. Its inner side is in continuity with the lateral
intermuscular septum, while on its posterior side, the
majority of collagen fibers of the ITB are in continuity
with the intramuscular septa [
]. The myofascial force
transmission between gluteus maximus and lower leg
muscles via the fascial lata shows the important role of the
ITB in the movement patterns of the lower extremities.
An increased range of movement was achieved in the
treated QM (MPTT, MPrTT). Bradbury-Squires et al. [
also found increases, ranging from 10 to 16%, for
kneejoint ROM with applying a roller massager for 20 and 60 s
on the QM. Although the ischiocrural muscles (MFFD)
were not treated by the participants, a significant change
pre- to post-treatment in ROM was found. A coherence
between the ITB and the ischicrurale muscles was also
observed by Kwak et al. [
]. Hence, loading the ITB alters
the kinematics and contact pattern of the tibiofemoral
joint similarly to loading the hamstrings.
The intervention tool, the Fascia-ReleaZer®, with its
combination of vibrational oscillation, leverage, and specific
edges for a shearing manipulation of the myofascial tissue,
thus seems useful. However, as all features were combined,
it is not possible to determine which component
contributed most to the effects observed.
Possible Effects Due to Vibrational Oscillation
The physiological mechanism of vibrational oscillation that
decreases stiffness and increases elasticity in myofascial
tissues is uncertain. Several studies have pinpointed the
mechanoreceptors, mainly the Pacinian corpuscles in
connective tissues, ligaments, and joints, and the primary
endings of the muscle spindles that are particularly
sensitive to vibration [
]. The restorative effect of rhythmic
low-frequency mechanical oscillations is frequently
attributed to improvements in circulation, enhanced capillary
permeability, and the transport of metabolites accumulated
during previous work. Some have hypothesized that
vibration-induced increased ROM could be due to reduced
passive muscle stiffness through a decreased number of
residual cross-bridges, some of them being broken by the
mechanical vibratory stimulation [
Some researchers have reported anesthetic effects due
to the vibrational massage [
]. Our findings of pain
desensitization, manifested as decreased subjective pain
threshold pre- to post-self-treatment on the treated leg,
corroborate these findings in the literature.
The PSQ values describing the treated leg as more
relaxed, light, and stable are consistent with the findings
of other studies describing a general relaxation, relaxation
of myofascial tissues, a decrease of emotional tension, and
general sedative effect through application of a roller
Possible Effects Due to Leverage
Participants were able to apply the pressure using their
own hands. An individual modification of the pressure
could be moderated according to the perceived subjective
pain pressure. Comparing the present self-help tool with
other SMR tools, such as foam rolling, the entire body
weight has to be applied and modification of weight is
more difficult to regulate. Consequently, in order to hold
one’s own body weight over the treatment duration in
other SMR tool applications, such as foam rolling, proper
shoulder and core muscle stabilization and sufficient
strength in the upper extremities are required [
Instrument-assisted soft tissue mobilization (IASTM) is
a popular treatment for myofascial restriction. IASTM uses
specially designed instruments to provide a mobilizing
effect to scar tissue and myofascial adhesions. Several
IASTM tools and techniques are available, such as the
Graston® technique (GT). In comparison to the self-help
methodology of the Fascia-ReleaZer®, the GT needs to be
applied by a trained clinician and, as yet, has not been
adapted for self-application [
]. The GT treatment is
thought to stimulate connective tissue remodeling through
resorption of excessive fibrosis, along with inducing repair
and regeneration of collagen secondary to fibroblast
recruitment. This, in turn, results in the release and
breakdown of scar tissue, adhesions, and fascial restrictions.
The Fascia-ReleaZer® tool may operate in a similar manner,
as it is also applied with pressure and incorporates specific
edge features. As these tools differ in a number of key
respects (i.e., material, technique, and treatment protocol),
comparative analyses will need to be designed in a way that
takes these differences into account.
Possible Effects Due to The Specific Edges
The Fascia-ReleaZer® tool has four different edges in order
to reach different parts of the myofascial tissue depending
on the desired technique, fast versus slow. Clinicians may
consider the fast shearing technique of the Fascia-ReleaZer®
a form of gua sha, but the treatment rationale, goals, and
application differ. Gua sha, therapeutic surface frictioning that
intentionally raises transitory petechiae and ecchymosis, is a
traditional East Asian healing technique. A smooth, rounded
edge is press-stroked into the flesh enough to contact the
fascial layer but not so firm that it causes pain or discomfort.
Modern studies confirm a thermoregulatory function
involving surface microcirculation, wherein increased skin blood
flow in subpapillary tissue layers effectively conducts away
]. Our hypothesis assumes that increased blood
circulation is stimulated in order to improve the metabolism
and blood flow of the treated structures. The significant
thermometer temperature increases as well as our
thermography findings support this notion.
The vibro-shearing manipulation with a muscle-fascia tool
resulted in significant improvements in the objective
mechanical tissue properties. Pain desensitization, range
of movement, and thermography improved significantly as
well. The fact that mood states remained relatively
constant suggests that reactivity or demand effects were not
in operation. Tool-assisted self-treatment with the Fascia
ReleaZer® shows preliminary evidence of being an effective
treatment modality, one that warrants further research,
with a possible next step being application with a clinical
population. Assuming effectiveness within a clinical
setting, another further direction might involve a component
or dismantling design to help pinpoint the relative
contributions of the various features of the device. Investigations
aimed at providing greater understanding of effects on the
cellular level seem worthy of pursuit as well. Finally,
although not feasible in this study, use of assessors blind
to condition would add increased rigor in future studies.
Additional file 1: Relationship of the displacement oscillation (S) and
oscillation velocity (V) in relation to the oscillation acceleration (a). After
the single mechanical impulse is delivered and quick-released under
constant precompression, the tissue being measured responds immediately
in the form of a damped oscillation, causing the co-oscillation of: a) a
tissue being measured, b) the pre-compressed subcutaneous tissue
layers above the tissue (i.e., superficial skeletal muscle), c) the testing-end, d)
measurement mechanism, and e) accelerometer attached to the measurement
mechanism. Damped oscillation of a soft biological tissue is registered in the
form of an acceleration graph (a). (DOCX 133 kb)
ANOVA: Analysis of variance; B-Boys: Breakdancers; DOMS: Delayed onset
muscle soreness; DV: Dependent variable; FR: Fascia-ReleaZer®; GT: Gaston®
Technique; IASTM: Instrument-assisted soft tissue mobilization; ITB: Iliotibial
band; IV: Independent variable; MANOVA: Multivariate analysis of variance;
MFFD: Modified Finger-Floor Distance Test; MPrTT: Modified Thomas Test
with Pressure; MPTT: Modified Passive Thomas Test; POMS: Profile of Mood
States; PPT: Pain pressure threshold; PSQ: Physical Sensations Questionnaire;
QM: Quadriceps muscle; ROM: Range of motion; SMR: Self-myofascial release;
VM: Vibratory massage
The authors would like to acknowledge Jens Nonnenmann and Daniel
Schuster for their invaluable assistance with completing aspects of the study.
We also express our gratitude to the Urban Dance Health Organization for
assisting with recruitment and all the B-Boys for their willingness to participate.
The authors would like to acknowledge the following organizations for their
important financial support—Damus-Donata Foundation and Mahle Foundation.
Availability of Data and Materials
C-MG designed the study, oversaw collection of all of the data, assisted with
the analysis of the data, drafted the manuscript, and had final veto on the
submission. SML oversaw collection of all of the data, assisted with the
analysis of the data, drafted the manuscript, and had veto on the submission.
NB assisted with drafting the manuscript and had veto on the submission. PM
assisted with drafting the manuscript and had veto on the submission. RLA
conducted the statistical analysis, assisted with drafting the manuscript, and
had final veto on the submission. FA assisted with analysis and interpretation of
the data, drafted the manuscript, and had final veto on the submission. All
authors read and approved the final manuscript.
Consent for Publication
Ethics Approval and Consent to Participate
The study was conducted in a manner consistent with the Declaration of Helsinki
and was granted for approval by the Ethics Committee of the University of
Tübingen. All participants provided informed consent to participate in this study.
Christopher-Marc Gordon is the inventor of the Fascia-ReleaZer®, but he does
not hold the product patents. However, he receives license fees from the
product company. All other authors (Sophie Manuela Lindner, Niels
Birbaumer, Pedro Montoya, Rachel L. Ankney, and Frank Andrasik) declare that they
have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
University of Balearic Islands, Palma, Spain. 4Department of Psychology,
University of Memphis, Memphis, TN, USA.
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