Abstract
Objective
To provide evidence for the existence of 6 myofascial meridians proposed by Myers
based on anatomic dissection studies.
Data Sources
Relevant articles published between 1900 and December 2014 were searched in MEDLINE
(PubMed), ScienceDirect, and Google Scholar.
Study Selection
Peer-reviewed human anatomic dissection studies reporting morphologic continuity between
the muscular constituents of the examined meridians were included. If no study demonstrating
a structural connection between 2 muscles was found, articles on general anatomy of
the corresponding body region were targeted.
Data Extraction
Continuity between 2 muscles was documented if 2 independent investigators agreed
that it was reported clearly. Also, 2 independent investigators rated methodologic
quality of included studies by means of a validated assessment tool (Quality Appraisal
for Cadaveric Studies).
Data Synthesis
The literature search identified 6589 articles. Of these, 62 article met the inclusion
criteria. The studies reviewed suggest strong evidence for the existence of 3 myofascial
meridians: the superficial back line (all 3 transitions verified, based on 14 studies),
the back functional line (all 3 transitions verified, based on 8 studies) and the
front functional line (both transitions verified, based on 6 studies). Moderate-to-strong
evidence is available for parts of the spiral line (5 of 9 verified transitions, based
on 21 studies) and the lateral line (2 of 5 verified transitions, based on 10 studies).
No evidence exists for the superficial front line (no verified transition, based on
7 studies).
Conclusions
The present systematic review suggests that most skeletal muscles of the human body
are directly linked by connective tissue. Examining the functional relevance of these
myofascial chains is the most urgent task of future research. Strain transmission
along meridians would both open a new frontier for the understanding of referred pain
and provide a rationale for the development of more holistic treatment approaches.
Keywords
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References
- The provision of chiropractic, physiotherapy and osteopathic services within the Australian private health-care system: a report of recent trends.Chiropr Man Therap. 2014; 22: 3
- Manual therapies in myofascial trigger point treatment: a systematic review.J Body Mov Ther. 2005; 9: 27-34
- Chiropractic or osteopathic manipulation for children in the United States: An Analysis of Data from the 2007 National Health Interview Survey.J Alt Complement Med. 2012; 18: 347-353
- Use of osteopathic or chiropractic services among people with back pain: a UK population survey.Health Soc Care Community. 2004; 12: 265-273
- Referrals to chiropractors and osteopaths: a survey of general practitioners in rural and regional New South Wales, Australia.Chiropr Man Therap. 2013; 21: 5
- Detailed microscopic analysis of deep fascia of lower limb and its surgical implication.Indian J Plast Surg. 2010; 43: 135-140
- The fine structure of the fascia cruris with particular attention to epi- and intrafascial nerves [German].Manuelle Medizin. 1996; 34: 196-200
- Pectoral and femoral fasciae: common aspects and regional specializations.Surg Radiol Anat. 2009; 31: 35-42
- Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.J Anat. 2013; 223: 665-676
- Anatomy of the deep fascia of the upper limb. Second part: study of innervation.Morphologie. 2007; 91: 38-43
- Histological study of the deep fasciae of the limbs.J Bodyw Mov Ther. 2008; 12: 225-230
- Sensory innervation of the thoracolumbar fascia in rats and humans.Neuroscience. 2011; 194: 302-308
- Sensory innervation of human thoracolumbar fascia. An immunohistochemical study.Acta Orthop Scand. 1992; 63: 195-197
- Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments.Spine. 2004; 29: 129-138
- Anatomical and mechanical relationship between the proximal attachment of adductor longus and the distal rectus sheath.Clin Anat. 2013; 26: 522-530
- Anatomy trains: myofascial meridians for manual and movement therapists.3rd ed. Churchill Livingstone, New York2014
- Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals.J Bodyw Mov Ther. 2014; 18: 273-281
- The use of dry needling and myofascial meridians in a case of plantar fasciitis.J Chir Med. 2014; 13: 43-48
- The immediate effects of passive hamstring stretching exercises on the cervical spine range of motion and balance.J Phys Ther Sci. 2013; 25: 113-116
- The effect of forward head on ankle joint range of motion and static balance.J Phys Ther Sci. 2012; 24: 925-927
- The effect of kinesio tape application on hamstring and gastrocnemius muscles in healthy young adults.J Bodyw Mov Ther. 2014; 18: 130-138
- Surface electromyographic recordings after passive and active motion along the posterior myofascial kinematic chain in healthy male subjects.J Bodyw Mov Ther. 2013; 18: 452-461
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.Ann Intern Med. 2009; 151: W65-94
- Appraising the quality of cadaveric studies. Validation of the QUACS scale.J Anat. 2015; 226: 440-446
- Updated method guidelines for systematic reviews in the Cochrane collaboration back review group.Spine. 2003; 28: 1290-1299
- Anatomical compartments of the sole of the human foot.Anat Rec. 1961; 140: 57-60
- Anatomy of the Achilles tendon and plantar fascia in relation to the calcaneus in various age groups.Foot Ankle Int. 1995; 16: 418-421
- The variability of the Achilles tendon insertion: a cadaveric examination.J Foot Ankle Surg. 2010; 49: 417-420
- The accessory bands of gracilis and semitendinosus: an anatomical study.Knee. 2003; 10: 325-328
- Clinically significant anatomy of gracilis and semitendinosus tendon insertions.Clin J Sport Med. 1992; 2: 276-278
- Anatomy of the bands of the hamstring tendon: how can we improve harvest quality?.Knee. 2013; 20: 90-95
- The fascial band from semitendinosus to gastrocnemius: the critical point of hamstring harvesting: an anatomical study of 23 cadavers.Acta Orthop. 2007; 78: 361-363
- Pes anserinus: layered supportive structure on the medial side of the knee.Clin Anat. 2004; 17: 50-54
- The origins of the hamstring muscles.J Anat. 1968; 102: 345-352
- Anatomical study of the proximal origin of hamstring muscles.J Orthop Sci. 2012; 17: 614-618
- A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the sacrotuberous ligament.Eur Spine J. 1993; 2: 140-144
- Hamstring muscles: architecture and innervation.Cells Tissues Organs. 2005; 179: 125-141
- The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint.Clin Biomech. 1989; 4: 201-203
- The extensor mechanism of the knee joint: an anatomical study.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 214-220
- Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee.Clin Orthop Relat Res. 2009; 467: 3297-3306
- The sternalis muscle in American whites and negroes.Anat Rec. 1935; 61: 413-426
- The sternalis muscle in the Bulgarian population: classification of sternales.J Anat. 2001; 199: 359-363
- Morphological study of the uncommon rectus sterni muscle in German cadavers.East Afr Med J. 2004; 81: 130-133
- Sternalis. An anatomic variant of chest wall musculature.Neurosciences. 2002; 7: 248-255
- Sternalis muscle: an anatomic variation of the anterior chest wall.J Morphol Sci. 2012; 29: 76-78
- The applied anatomy of the thoracolumbar fascia.Spine. 1984; 9: 164-170
- The morphology of the lumbar erector spinae.Spine. 1987; 12: 658-668
- The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs.Spine. 1995; 20: 753-758
- The anatomical and functional relation between gluteus maximus and fascia lata.J Bodyw Mov Ther. 2013; 17: 512-517
- Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint.Clin Anat. 2014; 27: 234-240
- The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain.Spine. 1996; 21: 556-562
- Anatomical and functional specializations of the human gluteus maximus.Am J Phys Anthropol. 1972; 36: 315-339
- Anatomy and clinical significance of pectoral fascia.Plast Reconstr Surg. 2006; 118: 1557-1560
- Anatomical study of myofascial continuity in the anterior region of the upper limb.J Bodyw Mov Ther. 2009; 13: 53-62
- The pectoral fascia: anatomical and histological study.J Bodyw Mov Ther. 2009; 13: 255-261
- New insights into the proximal tendons of adductor longus, adductor brevis and gracilis.Br J Sports Med. 2012; 46: 871-876
- Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis.Am J Roentgenol. 2007; 188: W440-W445
- The fine connective tissue architecture of the human ligamentum nuchae.Spine. 2000; 25: 5-9
- Clinical anatomy of ligamentum nuchae.Clin Anat. 2003; 16: 484-493
- Muscular attachments along the medial border of the scapula.Surg Radiol Anat. 1986; 8: 71-73
- An anatomic study of structure and innervation of the serratus anterior muscle.Surg Radiol Anat. 2012; 34: 921-928
- Anatomic basis of serratus anterior muscle flap transposition.Surg Radiol Anat. 1988; 10: 173-185
- Anatomy of the scapulothoracic articulation.Clin Orthop Relat Res. 1999; : 237-246
- The anatomy of the lower serratus anterior muscle: a fresh cadaver study.Plast Reconstr Surg. 1995; 95: 93-99
- Abdominal musculature and the transversalis fascia: an anatomical viewpoint.Hernia. 2004; 8: 376-380
- The anatomy of the inguinal and hypogastric regions of the abdominal wall.Anat Rec. 1938; 70: 211-225
- Surgical anatomy of the aponeurotic expansions of the anterior abdominal wall.Ann R Coll Surg Engl. 1977; 59: 313-321
- Composition of the rectus sheath.Anat Rec. 1940; 77: 213-225
- Variations in the pattern of formation of the abdominis rectus muscle sheath among Kenyans.Int J Morphol. 2009; 27: 1025-1029
- A new description of the anterior abdominal wall in man and mammals.J Anat. 1980; 131: 373-385
- The internal oblique muscle flap. An anatomic and clinical study.Plast Reconstr Surg. 1984; 73: 721-723
- Clinical anatomy of the internal oblique muscle.J Reconstr Microsurg. 1986; 2: 117-122
- An anatomic study of the iliotibial tract.Arthroscopy. 2007; 23: 269-274
- The posterolateral aspect of the knee: anatomy and surgical approach.Am J Sports Med. 1996; 24: 732-739
- The anatomy of the iliotibial band and iliotibial tract.Am J Sports Med. 1986; 14: 39-45
- Anatomical variations in the insertion of the peroneus (fibularis) longus tendon.Foot Ankle Int. 2007; 28: 1179-1182
- Variations in the insertion of peroneus longus tendon-a cadaver study.Foot Ankle Surg. 2012; 18: 293-295
- Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus.Clin Anat. 2002; 15: 217-223
- Relations of the common peroneal nerve to the insertion of biceps femoris and origin of peroneus longus.Alex J Med. 2006; 42: 817-828
- Protective mechanisms of the common fibular nerve in and around the fibular tunnel: a new concept.Clin Anat. 2009; 22: 738-746
- The biceps femoris tendon and its functional significance.J Hand Surg [Am]. 1972; 54: 1444-1450
- The functional anatomy of hip abductors.Folia Morphol (Warsz). 2009; 68: 98-103
- Iliotibial band syndrome: an examination of the evidence behind a number of treatment options.Scand J Med Sci Sports. 2010; 20: 580-587
- The superficial inguinal arch. A re-assessment of what has been called the inguinal ligament.J Anat. 1971; 12: 297-304
- The anatomy of the hip abductor muscles.Clin Anat. 2014; 27: 241-253
- Do ribs actually have a bare area? A new analysis.J Comp Hum Biol. 2011; 62: 368-373
- On the anatomy of intercostal spaces in man and certain other mammals.J Anat. 1935; 69: 350-355
- The architecture of the connective tissue in the musculoskeletal system- an often overlooked functional parameter as to proprioception in the locomotor apparatus.Int J Ther Massage Bodywork. 2009; 2: 9-23
- Myofascial pain and dysfunction: the trigger point manual: the lower extremities.Lippincott Williams & Wilkins, Baltimore1992
- Risk factors for the development of low back pain in adolescence.Am J Epidemiol. 2001; 154: 30-36
- Anthropometry, spinal canal width, and flexibility of the spine and hamstring muscles in 45-55-year-old men with and without low back pain.J Spinal Disord. 1992; 5: 245-253
- Low-back pain and straight leg raising in children and adolescents.Spine. 1989; 14: 526-528
- Spinal mobility and trunk muscle strength in 15-year-old schoolchildren with and without low-back pain.Spine. 1992; 17: 405-411
- Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis.Foot Ankle Int. 2013; 34: 42-48
- The role of hamstring tightness in plantar fasciitis.Foot Ankle Int. 2005; 26: 1089-1092
- The role of hamstring tightness in plantar fasciitis.Foot Ankle Spec. 2011; 4: 141-144
- Hip and groin injuries in athletes.Am J Sports Med. 2001; 29: 521-533
- Sportsmen hernia: what do we know?.Hernia. 2010; 14: 5-15
Article info
Publication history
Published online: August 14, 2015
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
