Effect of remote myofascial intervention on musculoskeletal health and functional performance: a systematic review

Behrouz Jafari; Homan Minoojejad; Rahman Sheikhhoseini; Reza Rajabi

doi:10.5114/areh.2025.149605

Abstract

Objectives

Fascia plays a crucial role in maintaining bodily function and life. It transmits mechanical stresses faster than muscles. This paper reviews recent randomized controlled trials (RCTs) concerning range of motion (ROM), pain and function with the aim of evaluating the effectiveness of remote myofascial intervention (RMI).

Methods

A systematic search was conducted in PubMed, CINAHL, EMBASE, Scopus, and Web of Science until September 2024. Studies were screened using PRISMA guidelines. Data extracted included sample size, participant age, intervention type, treatment area, outcome measure and results.

Results

Nineteen RCTs and cross-over trials met the inclusion criteria. Study quality was assessed using PEDro scores. Intervention durations ranged from 30 seconds to four minutes across one to three sets, with evaluations conducted from pre-test to up to four weeks post-test. Variables measured included ROM, Pain Pressure Threshold (PPT), tissue elasticity, and interceptive sensitivity. The review was registered in PROSPERO (CRD42024589547).

Discussion

RMI appears effective for improving flexibility and pain, but optimal implementation remains uncertain. Most studies highlight the role of viscoelastic properties and neural receptor stimulation in force transmission through myofascial chains; however, their relative contributions remain unclear. Further research is needed to assess the impact of RMI on musculoskeletal conditions, exploring a broader range of outcome variables.

References

Myers T. Anatomy Trains. forth edit. Elsevier; 2020.
Search in Google Scholar Back to article
Behm DG, Alizadeh S, Anvar SH, Drury B, Granacher U, Moran J. Non-local Acute Passive Stretching Effects on Range of Motion in Healthy Adults: A Systematic Review with Meta-analysis. Sports Med. 2021; (51): 945–959. doi: 10.1007/s40279-020-01422-5.
Open DOI Search in Google Scholar Back to article
Bordoni B, Myers T. A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains. Cureus. 2020. doi: 10.7759/cureus.7092.
Open DOI Search in Google Scholar Back to article
Behm DG, Wilke J. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Sports Med. 2019; 49(8): 1173–81. doi: 10.1007/s40279-019-01149-y.
Open DOI Search in Google Scholar Back to article
Krause F, Wilke J, Vogt L, Banzer W. Intermuscular force transmission along myofascial chains: A systematic review. J Anat. 2016; (228): 910–8. doi: 10.1111/joa.12464.
Open DOI Search in Google Scholar Back to article
Morton RW, Oikawa SY, Phillips SM, Devries MC, Mitchell CJ. Self–Myofascial Release: No Improvement of Functional Outcomes in Tight HamstringsInt. J Sports Physiol. Perform. 2016; 11(5): 658–63. doi: 10.70252/GOXI7904.
Open DOI Search in Google Scholar Back to article
Aparicio ÉQ, Quirante LB, Blanco CR, Sendín FA. Immediate Effects of the Suboccipital Muscle Inhibition Technique in Subjects With Short Hamstring Syndrome. J Manipulative Physiol Ther. 2009; 32(4): 262–9. doi: 10.1016/j.jmpt.2009.03.006.
Open DOI Search in Google Scholar Back to article
Hyong IH, Ho Kang J. The Immediate Effects of Passive Hamstring Stretching Exercises on the Cervical Spine Range of Motion and Balance. J Phys Ther Sci. 2013; (25): 113–6. doi: 10.1589/jpts.25.113.
Open DOI Search in Google Scholar Back to article
Grieve R, Goodwin F, Alfaki M, Bourton AJ, Jeffries C, Scott H. The immediate effect of bilateral self myofascial release on the plantar surface of the feet on hamstring and lumbar spine flexibility: A pilot randomised controlled trial. J Bodyw Mov Ther. 2015; 19(3): 544–52. doi: 10.1589/jpts.25.113.
Open DOI Search in Google Scholar Back to article
Rodriguez-Blanco C, Cocera-Morata FM, Heredia-Rizo AM, Ricard F, Almazán-Campos G, Oliva-Pascual-Vaca Á. Immediate effects of combining local techniques in the craniomandibular area and hamstring muscle stretching in subjects with temporomandibular disorders: A randomized controlled study. J. Altern. Complement. Med. 2015; 21(8): 451–9. doi: 10.1016/j.jbmt.2014.12.004.
Open DOI Search in Google Scholar Back to article
Wilke J, Vogt L, Niederer D, Banzer W. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci. 2017; 35(20): 2021–7. doi: 10.1080/02640414.2016.1251606.
Open DOI Search in Google Scholar Back to article
de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust. J. Physiother. 2009; 55(2): 129–33. doi: 10.1016/s0004-9514(09)70043-1.
Open DOI Search in Google Scholar Back to article
Matos AP, Pegorari MS. How to Classify Clinical Trials Using the PEDro Scale? J Lasers Med Sci. 2020;11(1):1–2. doi: 10.15171/jlms.2020.01
Open DOI Search in Google Scholar Back to article
Jung J, Choi W, Lee Y, Kim J, Kim H, Lee K, et al. Immediate effect of self-myofascial release on hamstring flexibility. PTRS. 2017 30; 6(1): 45–51. doi: 10.14474/ptrs.2017.6.1.45.
Open DOI Search in Google Scholar Back to article
Joshi DG, Balthillaya G, Prabhu A. Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals – A randomized clinical trial. J Bodyw Mov Ther. 2018; 22(3): 832–7. doi: 10.1016/j.jbmt.2018.01.008.
Open DOI Search in Google Scholar Back to article
Do K, Kim J, Yim J. Acute effect of self-myofascial release using a foam roller on the plantar fascia on hamstring and lumbar spine superficial back line flexibility. Phys Ther Rehabil Sci. 2018; 7(1): 35–40. doi: 10.14474/ptrs.2020.9.2.113.
Open DOI Search in Google Scholar Back to article
Jeong ED, Kim CY, Kim SM, Lee SJ, Kim HD. Short-term effects of the suboccipital muscle inhibition technique and cranio-cervical flexion exercise on hamstring flexibility, cranio-vertebral angle, and range of motion of the cervical spine in subjects with neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2018; 31(6): 1025–34. doi: 10.3233/BMR-171016.
Open DOI Search in Google Scholar Back to article
Cathcart E, McSweeney T, Johnston R, Young H, Edwards DJ. Immediate biomechanical, systemic, and interoceptive effects of myofascial release on the thoracic spine: A randomised controlled trial. J Bodyw Mov Ther. 2019; 23(1): 74–81. doi: 10.1016/j.jbmt.2018.10.006.
Open DOI Search in Google Scholar Back to article
Williams W, Selkow N. Self-myofascial release of the hamstring improves sit-and-reach distance. J Sport Rehabil. 2019; 29(4): 400–4. doi: 10.1123/jsr.2018-0306.
Open DOI Search in Google Scholar Back to article
Martínez-Lema D, Guede-Rojas F, González-Fernández K, Soto-Martínez A, Lagos-Hausheer L, Vergara-Ríos C, et al. Immediate effects of a direct myofascial release technique on hip and cervical flexibility in inactive females with hamstring shortening: A randomized controlled trial. J Bodyw Mov Ther. 2021; 26: 57–63. doi: 10.1016/j.jbmt.2020.12.013.
Open DOI Search in Google Scholar Back to article
Kang HS, Kwon HW, Kim DG, Park KR, Hahm SC, Park JH. Effects of the suboccipital muscle inhibition technique on the range of motion of the ankle joint and balance according to its application duration: A randomized controlled trial. Healthcare (Switzerland). 2021; 9(6): 646. doi: 10.3390/healthcare9060646.
Open DOI Search in Google Scholar Back to article
Fauris P, López-De-celis C, Canet-Vintró M, Martin JC, Llurda-Almuzara L, Rodríguez-Sanz J, et al. Does self-myofascial release cause a remote hamstring stretching effect based on myofascial chains? A randomized controlled trial. Int J Environ Res Public Health. 2021; 18(23). doi: 10.3390/ijerph182312356.
Open DOI Search in Google Scholar Back to article
Joshi S, Yadav R, Pawalia A. Can a cervical muscle inhibition technique reduce chronic low back pain? Adv. Rehabil. 2021; 35(4): 38–46. doi: 10.5114/areh.2021.111112.
Open DOI Search in Google Scholar Back to article
Jeong ED, Kim CY, Kim NH, Kim HD. Immediate effects of static and proprioceptive neuromuscular facilitation stretching of hamstring muscles on straight leg raise, craniovertebral angle, and cervical spine range of motion in neck pain patients with hamstring tightness: A prospective randomized controlled trial. J Back Musculoskelet Rehabil. 2022; 35(2): 429–38. doi: 10.3233/BMR-201840.
Open DOI Search in Google Scholar Back to article
Tamartash H, Bahrpeyma F, Dizaji MM. Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial. J Chiropr Med. 2023; 22(1): 52–9. doi: 10.1016/j.jcm.2022.04.002.
Open DOI Search in Google Scholar Back to article
Ersin A, Kaya M. Effect of thoracic mobilization exercises on hamstring flexibility: a randomized controlled trial. Turk J Med Sci. 2023; 53(5): 1293–300. doi: 10.55730/1300-0144.5695.
Open DOI Search in Google Scholar Back to article
Bali F, Bayram GA. Effects of myofascial release technique in patients with unilateral cervical radiculopathy: A single blind-randomized clinical trial. Explore (NY). 2024; 20(5): 102981. doi: 10.1016/j.explore.2024.01.007.
Open DOI Search in Google Scholar Back to article
Hyong IH, Kang JH. The immediate effects of passive hamstring stretching exercises on the cervical spine range of motion and balance. J Phys Ther Sci. 2013; 25(1): 113–6. doi: 10.1589/jpts.25.113.
Open DOI Search in Google Scholar Back to article
Gan XP, Tan DQ, Chen ZQ, Fang HH, Song HF, Liu X, et al. Comparative efficacy of self-myofascial release and stretching exercise on hamstring muscle flexibility and physical performance: a systematic review and meta-analysis. Gazz Med Ital Arch Sci Med. 2024; 183(1–2). doi: 10.23736/S0393-3660.23.05276-2.
Open DOI Search in Google Scholar Back to article
Kuruma H, Takei H, Nitta O, Furukawa Y, Shida N, Kamio H, et al. Effects of Myofascial Release and Stretching Technique on Range of Motion and Reaction Time. J Phys Ther Sci. 2013; 25(2): 169–71. doi: 10.1589/jpts.25.169.
Open DOI Search in Google Scholar Back to article
Kage V, Basti A, Tashildar A, Jain A. Combined effect of myofascial release and passive stretching on plantar pressure in individual with hamstring tightness- an experimental study. J Bodyw Mov Ther. 2024; 37: 412–6. doi: 10.1016/j.jbmt.2023.12.004.
Open DOI Search in Google Scholar Back to article
Hamzeh Shalamzari M, Minoonejad H, Seidi F. The Effects of a Self-Myofascial Release Program on Isokinetic Hamstrings-to-Quadriceps Strength Ratio and Range of Motion of the Knee Joint Among Athletes With Hamstring Shortness. J Sport Rehabil. 2022; 31(4): 391–7. doi: 10.1123/jsr.2020-0487.
Open DOI Search in Google Scholar Back to article
Patel G, Bathia K, Kanase S, Pawar A, Deshpande V, Jain P. Effectiveness of Self Myofascial Release, Static Stretching and Neural Tissue Mobilization on Hamstring Flexibility in Athletes. Indian J Public Health Res Dev. 2019; 10(4): 6. doi: 10.5958/0976-5506.2019.00656.9.
Open DOI Search in Google Scholar Back to article
Coons JM, Gould CE, Kim JK, Farley RS, Caputo JL. Dynamic stretching is effective as static stretching at increasing flexibility. J. Hum. Sport Exerc. 2017; 12(4). doi: 10.14198/jhse.2017.124.02.
Open DOI Search in Google Scholar Back to article
Lim KI, Nam HC, Jung KS. Effects on Hamstring Muscle Extensibility, Muscle Activity, and Balance of Different Stretching Techniques. J Phys Ther Sci. 2014; 26(2): 209–13. doi: 10.1589/jpts.26.209.
Open DOI Search in Google Scholar Back to article
Hatano G, Suzuki S, Matsuo S, Kataura S, Yokoi K, Fukaya T, et al. Hamstring Stiffness Returns More Rapidly After Static Stretching Than Range of Motion, Stretch Tolerance, and Isometric Peak Torque. J Sport Rehabil. 2019; 28(4): 325–31. doi: 10.1123/jsr.2017-0203.
Open DOI Search in Google Scholar Back to article
Ozyurek S, Aktar B, Kosova A, Aydin E, Turedi R, Ozunlu Pekyavas N. Effect of hamstring flexibility on cervical range of motion and deep neck flexor endurance in healthy young adults: A study to explore myofascial tensegrity network. J Bodyw Mov Ther. 2024; 40: 662–8. doi: 10.1016/j.jbmt.2024.05.025.
Open DOI Search in Google Scholar Back to article
Jafari B, Rajabi R. The effect of myofascial interventions on range of motion and stress transfer in other part of the body: a systematic review article. J. Res. Sport Rehabil. 2023. doi: 10.22084/rsr.2023.26204.1639.
Open DOI Search in Google Scholar Back to article
Burk C, Perry J, Lis S, Dischiavi S, Bleakley C. Can myofascial interventions have a remote effect on ROM? A systematic review and meta-analysis. J Sport Rehabil. 2020; 29(5): 650–6. doi: 10.1123/jsr.2019-0074.
Open DOI Search in Google Scholar Back to article
Russo L, Montagnani E, Pietrantuono D, D’Angona F, Fratini T, Di Giminiani R, et al. Self-Myofascial Release of the Foot Plantar Surface: The Effects of a Single Exercise Session on the Posterior Muscular Chain Flexibility after One Hour. Int J Environ Res Public Health. 2023; 20(2). doi: 10.3390/ijerph20020974.
Open DOI Search in Google Scholar Back to article
Zügel M, Maganaris CN, Wilke J, Jurkat-Rott K, Klingler W, Wearing SC, et al. Fascial tissue research in sports medicine: From molecules to tissue adaptation, injury and diagnostics: Consensus statement. Br J Sports Med. 2018; 52(23): 1497. doi: 10.1136/bjsports-2018-099308.
Open DOI Search in Google Scholar Back to article
Wilke J, Vogt L, Niederer D, Banzer W. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci. 2017; 35(20): 2021–7. doi: 10.1080/02640414.2016.1251606.
Open DOI Search in Google Scholar Back to article