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

Figures & Tables

Summary of Study Outcomes and Statistical Data

Study ID	Outcome	Time	Mean±SD (IG)		Mean±SD (CG)		Change (IG)	p-value
Study ID	Outcome	Time	Per-test	Post-test	Per-test	Post-test	Change (IG)	p-value
Aparicio et al.⁷	SLR test-R	I	59.22 ± 12.16	65.11 ± 12.68	64.50 ± 9.21	64.76 ± 9.77	5.89°	0.001
	SLR test-L	I	58.38 ± 9.96	63.41 ± 9.58	62.29 ± 8.40	63.02 ± 7.48	5.50°	0.001
	Popliteal angle-R	I	31.97 ± 10.22	27.83 ± 10.07	27.29 ± 10.31	26.44 ± 9.58	4.1°	0.05
	Popliteal angle-L	I	32.25 ± 8.34	27.08 ± 9.98	28.23 ± 9.30	27.67 ± 9.23	5.2°	0.001
Hyong et al.⁸	Neck flexion	I	50.06 ± 11.09	55.13 ± 10.12	54.13 ± 9.97	53.53 ± 9.75	5.07°	0.001
	Neck extension	I	58.86 ± 9.68	64.26 ± 10.04	60.33 ± 8.08	61.20 ± 7.56	5.4°	0.001
	Stability test	I	15.27 ± 4.36	13.56 ± 3.78	14.68 ± 4.42	13.82 ± 4.00	−1.71	0.001
Grieve et al.⁹	SRT test	I	17.92 ± 11.62	20.33 ± 11.37	21.58 ± 10.62	22.42 ± 10.37	2.41 cm	0.03
Rodriguez et al.¹⁰	SRT test	I	20.32 ± 7.24	21.93 ± 8.25	21.26 ± 6.46	22.51 ± 6.22	1.61 cm	0.003
	Vertical-mouth opening	I	38.29 ± 7.57	40.12 ± 6.04	39.72 ± 7.13	39.72 ± 9.02	1.83 cm	0.057^*
	ROM LUMB	I	96.78 ± 29.51	103.36 ± 27.43	109.83 ± 33.70	99.28 ± 36.52	6.58°	0.009
Wilke et al.¹¹	Sagittal plane	I					4°	0.03
	Transversal plane	I					3.5°	0.02
	Frontal plane	I					9°	0.001
Jung et al.¹⁴	SRT (Suboccipital)	3-D	22.89 ± 9.44	22.89 ± 9.44			4.06 cm	0.033
	SRT (Hamstring)	3-D	22.61 ± 10.05	26.47 ± 9.27			3.86 cm	0.033
	SRT (Plantar)	3-D	22.08 ± 10.11	25.94 ± 9.85			3.86 cm	0.033
Joshi et al.¹⁵	SRT (Stretching)	2-W	31.7 ± 7.8	36.9 ± 8.2			5.2 cm	0.004
	SRT (remote)	2-W	32.6 ± 6.5	35.6 ± 7.3			3 cm	0.007
	SRT (combination)	2-W	32.4 ± 8.5	39.1 ± 7.7			6.7 cm	0.006
Do et al.¹⁶	Toe Touch test	I	17.88 ± 6.98	13.22 ± 6.91	17.76 ± 9.59	16.28 ± 8.37	−4.66 cm	0.001
	SLR-R	I	45.27 ± 5.99	53.73 ± 8.87	49.93 ± 7.46	48.43 ± 8.64	8.46°	0.001
	SLR-L	I	45.6 ± 7.10	54.13 ± 8.12	51.43 ± 10.25	52.06 ± 10.20	8.53°	0.001
Jeong et al.¹⁷	SLR (SMI) -R	I	72.8 ± 6.7	77.2 ± 4.5			4.4°	0.005
	SLR (SMI)- L	I	75.8 ± 4.0	83.4 ± 5.9			7.6°	0.008
	SLR (CCFE)- R	I	69.1 ± 15.9	78.5 ± 13.5			9.4°	0.008
	SLR (CCFE)- L	I	69.9 ± 14.8	79.3 ± 12.5			9.4°	0.01
Cathcart et al.¹⁸	PPT-L	I					0.24	0.04
	PPT-R	I					0.18	0.1
	ROM	I					5.72°	0.01
Williams et al.¹⁹	SRT (foot)	I	31.06 ± 9.91	32.19 ± 10.2			1.13 cm	-
	SRT (hamstring)	I	30.49 ±11.03	32.76 ± 11.34			2.27 cm	-
	SRT (both)	I	29.19 ± 12.60	31.10 ± 13.15			1.91 cm	.079^*
Martínez et al.²⁰	SRT	I	20.02 ± 3.93	22.52 ± 3.87	21.41 ± 3.23	21.74 ± 3.73	2.5 cm	0.001
	SLR-R	I	75.02 ± 9.97	82.17 ± 11.65	78.32 ± 10.34	79.76 ± 9.19	7.15°	0.001
	SLR-L	I	78.32 ± 10.73	84.55 ± 10.89	79.67 ± 9.55	80.35 ± 9.04	6.23°	0.001
	CROM	I	42.73 ± 6.76	47.44 ± 6.39	45.61 ± 5.48	45.61 ± 6.23	4.71°	0.001
Kang et al.²¹	AROM- 4 min SIT	I	23.0 ± 5.1	29.5 ± 5.6	25.3 ± 4.9	25.6 ± 4.9	6.5°	0.001
	AROM- 8 min SIT	I	25.0 ± 4.1	30.6 ± 5.2	25.0 ± 5.8	25.2 ± 5.8	5.6°	0.001
	LA- 4 min SIT	I	46.1 ± 6.9	51.2 ± 6.7	47.4 ± 5.6	47.2 ± 5.9	5.1	0.001
	LA- 8 min SIT	I	48.4 ± 5.2	52.6 ± 5.8	48.4 ± 5.2	52.6 ± 5.8	4.2	0.001
	SLBT- 4 min SIT	I	81.7 ± 31.1	109.9 ± 42.6	80.1 ± 45.4	86.3 ± 44.5	28.2	0.001
	SLBT- 8 min SIT	I	72.7 ± 33.4	119.5 ± 45.3	91.8 ± 34.5	91.6 ± 35.2	46.8	0.001
Fauris et al.²²	SRT	10m					5.22cm
Fauris et al.²²	DF-lunge	10m					0.65°
Joshi et al.²³	NPRS (SIT)	4-W	5.53 ± 0.9	0.23 ± 0.44			5.3	0.001
	Lumbar Flexion (SIT)	4-W	4.95 ± 0.41	5.76 ± 0.29			0.81°	0.001
	Lumbar Extension (SIT)	4-W	1.23 ± 0.35	1.52 ± 0.25			0.29°	0.046
	ODI (SIT)	4-W	30.90 ± 11.16	3.54 ± 4.73			−27.36	0.001
	SF-36 (SIT)	4-W	58.45 ± 10.51	77.97 ± 9.94			19.52	0.001
Jeong et al.²⁴	SLR (SS)	I	71.8 ± 7.9	84.2 ± 9.9			12.4°	0.007
	SLR (PNF)	I	72.0 ± 2.9	80.3 ± 4.9			8.3°	0.005
	CVA (SS)	I	42.3 ± 9.9	47.8 ± 8.0			5.5°	0.02
	CVA (PNF)	I	45.0 ± 8.2	52.0 ± 7.9			7°	0.007
	CROM (SS)	I	50.5 ± 4.2	53.1 ± 3.9			2.6°	0.008
	CROM (PNF)	I	53.5 ± 5.4	54.9 ± 4.6			1.4°	0.06^*
Tamartash et al.²⁵	NPRS	4-S	5.44 ± 0.62	3.12 ± 0.88	5.50 ± 0.51	3.37 ± 0.80	−2.32	0.001
Tamartash et al.²⁵	Elastic Modulus	4-S	81.11 ± 25.15	38.81 ± 19.41	64.93 ± 34.30	31.06 ± 11.90	42.3	0.001
Ersin et al.²⁶	AKE	4-W	27.33 ± 8.8	17.01 ± 7.81	29.32 ± 7.72	22.93 ± 8.76	10.32°	0.05
Ersin et al.²⁶	VAS	4-W	43.33 ± 22.26	30.22 ± 11.45	50.06 ± 26.55	43.45 ± 15.87	−13.11mm	0.05
Bali et al.²⁷	Cervical Flexion	4-W	4.27 ± 1.75	5.28 ± 1.19	4.88 ± 2.60	3.85 ± 2.23	1.01°	0.013
	NDI	4-W	21.56 ± 7.59	6.94 ± 2.01	16.02 ± 6.66	15.56 ± 8.14	14.62	0.001
	VAS	4-W	6.88 ± 2.93	1.14 ± 1.46	5.87 ± 2.45	4.28 ± 2.65	−5.74 cm	0.001

Characteristics of the studies

First Author	Testing method	Interventions	Subjects (N, sex)	Remote area/ Line	Conclusions
Aparicio et al.⁷	Pre-test-Immediately-post-test Finger-floor test, SLRT Popliteal angle test	IG: 34 (22 ± 4y) SIT CG: 34 (22 ± 3 y) Joint articulation technique of the nose	N: 68 Hamstring shortness M/F: 47/23	Hamstring elasticity Back myofascial Line	The suboccipital inhibition technique increases the flexibility of the hamstrings and may enable the therapist to affect more distant areas with this technique.
Hyong et al.⁸	Pre-test-Immediately-post-test Cervical ROM (goniometer) Balance (Stability test)	IG: 30 (20.66 y) Hamstring and ankle dorsiflexion stretching CG: 30 (20.60y) Same treatment without ankle dorsiflexion	N: 60 Healthy students M/F: 26/34	Cervical ROM SBL	Cervical ROM and balance immediately increased in the IG.
Grieve et al.⁹	Pre-test-Immediately-post-test SAR The Beighton score	IG: 12 SMFR Plantar fascia CG: 12 No therapy	N: 24 Healthy volunteers (28 ± 11 y) M/F: 8/16	Hamstrings Flexibility SBL	SMFR immediately increases the flexibility of the hamstrings and lower back in SBL.
Rodriguez et al.¹⁰	Pre-test-immediately-post-test Vertical mouth opening PPT, suboccipital range of motion, SAR Lumbar forward bending.	IG: 30 (33 ± 9 y) Protocol CG + SIT CG: 30 (36 ± 12 y) Passive stretching Hamstring Neuromuscular technique over the masseter muscles	N: 60 Temporomandibular disorders M/F: 20/40	Vertical mouth opening	The cumulative effect of combining local and distal techniques does not affect mouth opening in subjects with TMD.
Wilke et al.¹¹	Pre-test-immediately-post-test Ultrasonic 3D movement analysis system	IG1: 21 (38 ± 13) Remote stretching of gastrocnemius and hamstrings IG2: 21 (38 ± 13) Local stretching of the cervical CG: 21 (31±13) Inactive	N: 63 Healthy participants M/F: 31/32	Cervical ROM SBL	Remote static stretching may immediately improve flexibility in cervical. The transmission of tension with myofascial pathways is a plausible explanation for the findings of this research. However, the influence of other structures such as peripheral nerves cannot be excluded.
Jung et al.¹⁴	Pre-test-3 days-post-test SRT AROM PROM PPT (algometer)	G1: 22 (22 ± 2) SMFR suboccipital G2: 22 SMFR hamstring G3: 22 SMFR plantar regions	N: 22 Adult subjects M/F: 14/8 Cross-sectional design	Hamstring flexibility SBL	SMFR easily reduces pain and maintains flexibility, and can be performed anytime, anywhere.
Joshi et al.¹⁵	Pre-test-2 weeks-post-test SAR Passive Knee Extension Angle	G1: 19 (23 ± 2 y) Hamstring Static Stretching G2: 20 (22 ± 1 y) MFR Plantar Fascia and Suboccipital G3:19 (21 ± 1 y) Combination	N: 58 Healthy people M/F: 16/42	Hamstring flexibility SBL	A significant improvement in hamstring flexibility was observed in three groups, but more improvement was achieved in the consolidation group.
Do et al.¹⁶	Pre-test-Immediately-post-test Toe Touch test and PSLR	IG: 15 (30±5 y) SMFR to the plantar fascia SG: 16 (23 ± 4 y) Passive mobilization of the ankle joint	N: 31 Healthy adults M/F: 19/12	Hamstring and lumbar spine SBL	The results of this study showed that the release of plantar fascia is immediately effective for improving the flexibility of the lumbar spine and hamstrings.
Jeong et al.¹⁷	Pre-test-Immediately/next day-post-test SLR CROM Popliteal angle Cranio-vertebral angle	G1: 10 (41 ± 13 y) SMI G2: 10 (39 ± 13 y) Cranio-cervical flexion exercise	N: 20 Neck pain M/F:	Hamstring ROM SBL	Both groups improve all of test results and are equally effective in immediately increasing hamstring flexibility, Cranio-vertebral angle, and CROM in subjects with neck pain.
Cathcart et al.¹⁸	Pre-test-Immediately-post-test PPT (Algometer) ROM (Inclinometer) Interoceptive sensitivity (Biopac)	IG: 12 (23±7 y) MFR thoracic erector spinae (T6-T12) CG: 12 Lying supine and unilateral touch SG: 12 Not active touch	N: 12 Healthy subjects M/F: 7/5	Lower limb and cervical	The increase in PPT and ROM (both local and distal) suggests that MFR may have caused a biomechanical change in tissue tension that increases tissue flexibility.
Williams et al.¹⁹	Pre-test-Immediately-post-test SAR	G1: 15 (21 ± 1 y) MFR hamstring G2: 15 MFR plantar G3: 15 Both intervention	N: 15 Collegiate students M/F: 5/10 Crossover Study	Hamstring ROM SBL	SMFR may improve ROM, but one SMR technique does not appear to be superior to another.
Martínez et al.²⁰	Pre-test-immediately/next day-post-test SLR SAR Cervical flexion range of motion (goniometer)	IG: 34 (21 ± 1 y) MFR on posterior thigh CG:34 (20 ± 1 y) (Placebo) Forearm release	N: 68 Female university students	Hamstring and Cervical ROM SBL	MFR immediately increases hamstring ROM locally and neck ROM non-locally. The ROM of the neck decreased one day later. Therefore, more studies are needed.
Kang et al.²¹	Pre-test-immediately/next day-post-test ROM of dorsiflexion Lunge angle Single Leg Balance Test were assessed, and a single leg balance test (SLBT)	G1: 20 (37 ± 7 y) 4-min SMI G2: 20 (36 ± 6 y) 8-min SMI G3: 20 (37 ± 5 y) 4-min sham-SMI G4: 20 (37 ± 5 y) 8-min sham-SMI	N: 80 Healthy adults M/F: 44/36	ROM Ankle joint Lunge angle Balance	The SMI in 4 and 8 minutes, can be an effective tool for improving ROM, Lunge angle and balance.
Fauris et al.²²	Pre-test-0/5, 2, 5 and 10 min-post-test Modified SAR Dorsiflexion lunge test (DF-lunge) VAS	IG 1: 16 (25 ± 7 y) Plantar fascia IG 2: 18 (24 ± 5 y) Sural fascia IG 3: 15 (23 ± 5 y) Crural fascia IG 4: 15 (23 ± 4 y) Thoracolumbar fasciae IG 5: 15 (23 ± 6 y) Epicranial aponeurosis CG: 15 (26 ± 6 y) None	N: 94 Volunteers M/F: 52/42	Hamstring flexibility SBL	The SBL may be considered a functional construct, and SMR to either segment can improve hamstring flexibility and ankle dorsiflexion.
Joshi et al.²³	Pre-test-4 weeks-post-test NPRS Modified Schober’s Test Oswestry Disability Index SF-36 questionnaire	G1: 15 (34 ± 9 y) SIT, interferential therapy and exercise G2: 15 (42 ± 10 y) Interferential therapy and exercise G3: 15 (38 ± 7 y) Exercise	N: 45 LBP M/F: -	Lumbar SBL	SIT combined with interferential treatment and exercises have better than interventional treatment and exercises alone in patients with LBP.
Jeong et al.²⁴	Pre-test-immediately/next day-post-test SLR Cranio-vertebral angle CROM	G1: 32 (35 ± 13 y) Static stretching hamstring G2: 32 (30 ± 9 y) PNF hamstring	N: 64 Neck pain M/F: 34/30	CROM SBL	SLR, Cranio-vertebral angle, and CROM improved significantly within the groups after a one-session intervention.
Tamartash et al.²⁵	Pre-test-4 sessions-post-test Numeric Pain Scale Ultrasonography	IG: 16 (40 ± 5 y) MFR Crural fascia and hamstring CG: 16 (40 ± 4 y) MFR lumbar region	N: 32 Nonspecific LBP M/F: 16/16	Changes in the Elastic Modulus and Pain Severity of lumbar. SBL	Remote MFR is effective in patients with chronic nonspecific LBP.
Ersin et al.²⁶	Pre-test-4 Weeks-post-test AKE Self-reported hamstring pain intensity was evaluated with a VAS	IG: 60 (26 ± 5 y) Home-based thoracic mobilization exercise for 4 weeks CG: 60 (25 ± 5 y) Active-assisted stretching of the hamstring	N: 120 Healthy subjects M/F: 37/83	Hamstring flexibility SBL	Thoracic mobilization exercises may increase hamstring flexibility and decrease pain intensity during hamstring stretching exercises.
Bali et al.²⁷	Pre-test-4 Weeks-post-test PPT, Muscle strength, Cervical ROM, pain and Disability variables	IG: 17 (43 ± 8 y) MFR four fascia lines of the arm CG: 17 (46 ± 10) Exercise (stretching and strengthening)	N: 34 Cervical radiculopathy M/F: 10/24	Cervical Four fascia lines of the arm	Cervical radiculopathy symptoms may improve after using myofascial release techniques.

Evaluation of studies based on the PEDro scale_ Yes (Y), No (N)

Author, year	Eligibility criteria specification	Proper random allocation	Allocation was concealed	Similar at baseline	Subjects blinding	Therapists blinding	Assessor blinding	Initially allocated to groups	Intention to treat	Between group	Point estimate and variability	PEDro scale	Quality
Aparicio et al.⁷	Y	Y	N	Y	N	N	Y	N	N	Y	Y	5	Poor
Hyong et al.⁸	Y	Y	N	Y	N	N	N	N	N	Y	Y	4	Poor
Grieve et al.⁹	Y	Y	Y	N	N	N	Y	Y	Y	Y	Y	7	Good
Rodriguez et al.¹⁰	Y	Y	Y	Y	N	Y	Y	Y	N	Y	Y	8	Good
Wilke et al.¹¹	Y	Y	N	Y	N	N	N	Y	Y	Y	N	5	Poor
Jung et al.¹⁴	Y	Y	N	Y	N	N	N	Y	N	Y	Y	5	Poor
Joshi et al.¹⁵	Y	Y	N	Y	N	N	Y	Y	Y	Y	Y	7	Good
Do et al.¹⁶	Y	Y	N	N	N	N	N	Y	N	Y	Y	4	Poor
Jeong et al.¹⁷	Y	Y	Y	Y	Y	N	Y	Y	N	Y	Y	8	Good
Cathcart et al.¹⁸	Y	Y	N	Y	N	Y	Y	Y	Y	Y	Y	8	Good
Williams et al.¹⁹	Y	Y	N	Y	Y	N	N	Y	N	Y	Y	6	Good
Martínez et al.²⁰	Y	Y	Y	Y	Y	N	Y	Y	N	Y	Y	8	Good
Kang et al.²¹	Y	Y	Y	Y	N	N	Y	Y	Y	Y	Y	8	Good
Fauris et al.²²	Y	Y	Y	Y	N	Y	Y	Y	N	Y	Y	8	Good
Joshi et al.²³	Y	Y	N	Y	Y	N	N	N	N	Y	Y	5	Poor
Jeong et al.²⁴	Y	Y	Y	N	Y	N	Y	Y	Y	Y	Y	8	Good
Tamartash et al.²⁵	Y	Y	N	Y	N	N	N	Y	Y	Y	Y	6	Good
Ersin et al.²⁶	Y	Y	N	Y	N	Y	Y	Y	N	Y	Y	7	Good
Bali et al.²⁷	Y	Y	Y	Y	N	N	Y	Y	N	Y	Y	7	Good

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

Figures & Tables

Summary of Study Outcomes and Statistical Data

Characteristics of the studies

Evaluation of studies based on the PEDro scale_ Yes (Y), No (N)

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