The Use of Electromagnetic Forces of the Earth in Manual and Physiotherapy

Physiotherapists usually ignore the electric polarization of human bodies that occurs under the influence of the electromagnetic forces of the Earth.This is irrational,since the positive or negative electrification of human tissues has the opposite effect on both their properties and functional activity.How physiotherapists must take into account the polarizing effect of the electromagnetic forces of the Earth when analysing the functional states of the tissues of the human body is shown here.It also shows how these electromagnetic forces can be used by manual and physiotherapists.

Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Creatine Kinase is mandatory, and lastly’ acute kidney injury needs to be treated urgently. Also, reducing the risk of infection is one of the management objectives to achieve recovery.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

Management of Spinal Osteochondrosis Rehabilitation Process

Background： Osteochondrosis of spine is the one of the most prevalent diseases among the all musculoskeletal conditions. Osteochondrosis is not a curable condition and its treatment/rehabilitation is a long-term process. The present work aims to assess clinical effectiveness and duration of outcomes of rehabilitation that includes complex and consequent methods （algorithm） of treatment. The pilot study has been continuing several years and now is going on. Methods： The subject were 220 patients, 122 females and 98 males, aged 50-65 （adherence to treatment 100%） with as reflex as well radicular syndromes in subacute phase. Informed consent was obtained from all patients. Rehabilitation process continued 2.5-3 months and its management included the following consequent methods： waist fixation, pain control with medication （NSAIDs and in some cases steroidal drugs）, iontophoresis with karipazim-20-25 sessions, after 8-10 sessions of the latter manual therapy was added-10-12 sessions, and kinesiotherapy （3 times per week） after 5 procedures. After pain management recommendation of daily life activity was given. Oral chondroprotectors after completion of a treatment were administered. Dynamic evaluation of subjective and objective symptoms, mobility and functional state of spine were done. Parameters were assessed before treatment, after 3 month and 1-3 years upon its completion. Results： Data were analyzed using SPSS program. Obtained results showed that after the first course of treatment （3 months） positive outcomes were observed in 198 patients （90%）, 22 （10%） of patients required the second course of rehabilitation. Stable outcome of treatment was maintained after 1 year in 204 patients （92.7%） and after 3 years in 196 patients （89%）. Conclusion： Approbated complex of treatment is established to be effective in rehabilitation of patients with lumbar osteochondrosis.

Appropriateness of a Physiotherapic Treatment Protocol for the Axillary Web Syndrome, Applied in a Territorial Rehabilitation Service: Description of a Clinical Case

The “Axillary web syndrome” (AWS) is an early complication following breast cancer surgery with axillary lymph nodes dissection. Case Report: The patient is a 69-year-old woman, retired ex-employee, with outcome surgery right axillary lymphadenectomy with shoulder pain and functional limitation with diagnosis AWS it where it was recommended the physiotherapy. The patient had improvement in terms of shoulder function and pain and quality of life. Conclusions: The description of the clinical case afflicted with AWS and the treatment protocol applied, highlighted the good performance of the results, notably as concerns patient’s quality of life. This result could represent a starting point for creating clinical trials aimed at building appropriate rehabilitation route in territorial rehabilitation services.

Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain

Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52;95% CI -14.72 to 7.44) or long-term at one year (p = 0.37;95% CI -17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.

Research on clinical application of manual therapy to tumor-related adverse reactions

Objective To analyze the clinical application of manual therapy(MT)to tumor-related adverse reactions via summarizing the research at home and abroad,in order to provide more theoretical evidence for the clinical promotion of MT.Methods We searched 7 Chinese and English databases,including China National Knowledge Infrastructure(CNKI),Wanfang Academic Journal Full-text Database(Wanfang),Chongqing VIP Database(CQVIP),PubMed,Excerpta Medica Database(EMBASE),Ovid and EBSCO.The publication date was between the establishment date of the database and December 31,2020.We screened the literature according to the inclusion and exclusion criteria,and then sorted and analyzed the selected information.Results A total of 46 papers were analyzed.Most studies focused on the adverse reactions in breast cancer patients.MT interventions demonstrated the best efficacy for fatigue,followed by pain,depression and anxiety.In different MT interventions,Tuina(Chinese therapeutic massage)was mainly adopted for fatigue,pain,anxiety,depression,and limb dysfunctions.Acupoint pressing was mainly adopted for gastrointestinal and psychological problems such as abdominal bloating,insomnia,depression and anxiety.The application of reflexotherapy was similar to that of Tuina.Conclusion MT can alleviate various adverse reactions by effectively relieving patients’somatic symptoms and improving their psychological states and overall functions.It can be popularized as a significant non-drug therapy.Currently,however,the clinical application of MT is neither extensive nor has sufficient basic research.Consequently,we should attach importance to this application.

Symptoms of spinal dysfunction mimicking systemic diseases(Ogundana Syndrome):a review of 35 cases treated with manual therapy over 30 years

Objective and Method:Symptoms manifesting in other parts of the body signaling the existence of spinal dysfunction(Ogundana Syndrome)in patients(N=35,age range 20-56yrs;mean age 36yrs)diagnosed to have systemic diseases but treated with manual therapy were identified after a 30 year case note review.Results:Incipient parkinsonism(general edema and expressionless mask face),stroke(weakness of one side of the body),tinnitus(headache with noise in one or both ears),breast cancer(breast pain)and dyspnea(difficulty in breathing)were some physician diagnoses and clinical symptoms presented.One percent rate occurrence was noted affecting significantly more females(74%)than males(26%,P<0.001).This involved people with family history of back pain(66%)engaged in low income occupations(farming 40%,trading 25%,artisans 15% and civil servants 20%).Symptoms got better after vertical oscillatory pressure therapy to appropriate spinal regions.Duration of treatment was influenced by duration of spinal dysfunction prior to therapy and age of younger patients.Conclusion:One percent of patients with spinal dysfunction misdiagnosed to have systemic diseases due to misleading symptoms are finally referred for physiotherapy of manifesting symptoms.Manual therapy to the appropriate vertebro-geographic region(s)relieves the symptom(s)without prejudice to existing diagnosis.

Muscle energy technique for chronic obstructive pulmonary disease:A feasibility study

Objective:This study aimed to investigate the feasibility of implementing a manual therapy technique(muscle energy technique,MET)protocol in a hospital pulmonary rehabilitation(PR)program for patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods:Participants aged 40 years and over,with moderate to severe COPD,were recruited into this 12-week study.The primary outcome measures were feasibility(acceptability of the intervention and attendance/adherence to the trial)and safety(adverse events,AEs).All participants received the MET and PR therapies.Participants and assessors were unblinded.Semi-standardized MET was delivered on 6 occasions(a maximum of once per week)at the hospital directly before a PR session.Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks.Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.Results:Thirty-three participants were enrolled,with a median age of 74 years(range 45-89 years).The median number of MET sessions that participants attended was 5(range O-6)out of a possible 6 sessions(83%attendance).At follow-up,participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing.There were no major AEs related to the intervention,with the majority of AEs classified as expected events related to COPD exacerbations.Conclusion:It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting.Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.

Therapeutic efficacy observation of warm needling moxibustion plus spine subtle adjusting manipulation for cervical radiculopathy

Objective To observe the clinical efficacy of warm needling moxibustion plus spine subtle adjusting manipulation for cervical radiculopathy.Methods A total of 70 patients with cervical radiculopathy were randomized into an observation group and a control group,with 35 cases in each group.The observation group was treated with warm needling moxibustion plus spine subtle adjusting manipulation,while the control group was treated with warm needling moxibustion alone.The treatments were performed three times a week,and for four weeks in total.The visual analog scale(VAS)was scored before and after treatment.And the clinical efficacy of the two groups was compared after treatment.Results The total effective rate was 97.1%in the observation group,versus 88.6%in the control group.The difference between the two groups was statistically significant(P<0.05).After treatment,the VAS scores in both groups significantly decreased(P<0.01),and the score in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Warm needling moxibustion plus spine subtle adjusting manipulation has a better effect in the treatment of cervical radiculopathy than warm needling moxibustion alone.

Effects of sinew-regulating bone-setting manipulations on chondrocytes,IL-1βand NO in rabbits with knee osteoarthritis

Objective To observe the therapeutic effect of sinew-regulating bone-setting manipulations for knee osteoarthritis(KOA)model rabbits and its impacts on the chondrocyte apoptosis rate and the levels of interleukin(IL)-1βand nitric oxide(NO).Methods According to the random number table method,30 New Zealand white rabbits were divided into a normal group(n=9)and a modeling group(n=21).Rabbits in the modeling group were used to establish KOA models with the modified Hulth method.At the 8th week,three rabbits were sacrificed to verify the model and the remaining 18 rabbits were randomly divided into a model group(n=9)and an intervention group(n=9).Rabbits in the normal group and model group were bred routinely without any intervention.Rabbits in the intervention group were treated with the sinew-regulating bone-setting manipulations,10 min/time,once every other day for a total of 20 times.The Lequesne MG knee function rating was used to evaluate the behavioral differences of the rabbits in each group.The Pelletier score was used to evaluate the general changes of the rabbits.The Mankin score was used to evaluate the pathology of knee cartilages.The enzyme-linked immunosorbent assay and nitrate reductase methods were used to determine the levels of IL-1βand NO in serum and synovial fluid of each group,respectively.In situ terminal deoxynucleotidyl transferase-mediated nick and labeling method was used to determine the apoptosis of chondrocytes in each group.Results Compared with the normal group,the scores of Lequesne MG,Pelletier and Mankin,and the levels of IL-1βand NO in the model group were increased(P<0.05),which indirectly indicated the success of the model.Compared with the model group,the scores of Lequesne MG,Pelletier and Mankin,IL-1βand NO levels,and chondrocyte apoptosis rate of the intervention group were decreased,and the differences were statistically significant(P<0.05).Conclusion The sinew-regulating bone-setting manipulations can reduce the levels of IL-1β,NO,and chondrocyte apoptosis rate,and delay the articular cartilage degeneration,therefore,having a good therapeutic effect on KOA.

Clinical efficacy observation of spine subtle adjusting manipulation for postpartum low back pain

Objective To explore the clinical efficacy of spine subtle adjusting manipulation for postpartum low back pain(PLBP).Methods A total of 76 patients with PLBP were randomized into a control group and a treatment group,with 38 cases in each group.The control group was treated with core muscle strengthening exercises,and the treatment group was treated with spine subtle adjusting manipulation.After 3 weeks of treatment,the clinical efficacy was observed,and the visual analog scale(VAS)score and Oswestry disability index(ODI),and the changes of lumbar Cobb angle and pelvic rotation were compared between the two groups.Results The total effective rate of the treatment group was 92.1%,and that of the control group was 78.9%.The difference between the two groups was statistically significant(P<0.05).After treatment,the VAS score and ODI in both groups decreased,and the intra-group differences were all statistically significant(P<0.05).There were no intra-group statistical differences in the lumbar Cobb angle or pelvic rotation in the two groups(P>0.05).After treatment,there were no statistical differences in the lumbar Cobb angle or pelvic rotation between the two groups(P>0.05);the VAS score and ODI in the treatment group were significantly lower than those in the control group(P<0.05).Conclusion Spine subtle adjusting manipulation can effectively relieve the pain for patients with PLBP,and improve their daily activity function.

Protocol-optimizing study of combining Tuina and horse-riding squat exercise for knee osteoarthritis

Objective To evaluate the efficacy of Tuina(Chinese therapeutic massage)manipulation plus horse-riding squat exercise in treating knee osteoarthritis(KOA)and optimize the combining protocol.Methods Based on a 2×2 factorial design,120 eligible KOA patients were randomized into a manipulation group(group A1B2),a manipulation plus horse-riding squat group(group A1B1),a sitting knee-adjustment group(group A2B2 group),and a sitting knee-adjustment plus horse-riding squat group(group A2B1),with 30 cases in each group.The intervention was conducted three times a week,lasting for four weeks.The Western Ontario and McMaster Universities osteoarthritis index(WOMAC)was taken as the major measure for efficacy evaluation(including three component scores,pain,stiffness,and daily function,and total score).Results The three component scores(pain,stiffness,and daily function)and the total score of WOMAC showed significant differences after the intervention in the four groups(P<0.05).There were significant inter-group differences in the WOMAC stiffness score amongst the four groups after the intervention(P<0.05).In group A1B1,the step length,stride,walking speed,and knee joint flexion angle changed significantly after treatment(P<0.05).After the intervention,the step length changed significantly in group A1B2(P<0.05),and the walking speed changed significantly in group A2B1(P<0.05).There were no significant differences in the step length,stride,walking speed,or knee joint flexion angle among the four groups(P>0.05).The extensor peak torque at 180°/s changed significantly in group A1B2 after treatment(P<0.05).Neither the intra-group nor the inter-group comparisons of the four groups revealed significant differences in the other isokinetic muscle strength parameters(P>0.05).The main effect of manipulation showed significant in affecting the WOMAC pain and total scores(P<0.05).The main effect of horse-riding squat exercise showed significant in affecting the WOMAC pain and stiffness scores(P<0.05).Conclusion The four treatment protocols all can improve the symptoms of KOA,for instance,relieving pain and stiffness,and enhancing daily function.Group A2B1 produces the most eminent effect in relieving joint stiffness.The main effects of both manipulation and horse-riding squat exercise are significant in reducing pain.Besides,the main effect of horse-riding squat exercise is significant in relieving joint stiffness.

Clinical observation of acupuncture combined with sitting-position knee-adjustment manipulations for patellofemoral arthritis

Objective To observe the efficacy of acupuncture combined with sitting-position knee-adjustment manipulations in treating patellofemoral osteoarthritis.Methods Ninety-two patients with patellofemoral osteoarthritis were randomized into an observation group and a medication group,with 46 cases in each group.The observation group received acupuncture and sitting-position knee-adjustment manipulations,and the medication group received oral celecoxib capsules.After 8-week treatment,changes in the short-form McGill pain questionnaire(SF-MPQ)and Lysholm knee scoring scale(LKSS)scores were observed,and the clinical efficacy was compared.Results The total effective rate was 87.0%in the observation group and 63.0%in the control group;the between-group difference was statistically significant.Before treatment,there were no significant differences in the SF-MPQ score or LKSS score(P>0.05).After 8-week treatment,the SF-MPQ[including pain rating index(PRI),visual analog scale(VAS),and present pain intensity(PPI)]and LKSS scores showed notable changes in both groups(P<0.05);the SF-MPQ and LKSS scores in the observation group were significantly different from those in the control group(P<0.05).Conclusion Combining acupuncture and sitting-position knee-adjustment manipulations can reduce pain and ameliorate joint function in patients with patellofemoral osteoarthritis,producing more significant efficacy than oral celecoxib capsules.

Effects of Tuina on serum creatine kinase and skeletal muscle mitochondria in delayed onset muscle soreness model rats

Objective To observe the effect of Tuina(Chinese therapeutic massage)on creatine kinase(CK),mitochondrial Ca^(2+)concentration,and ultrastructure of skeletal muscle in delayed onset muscle soreness(DOMS)model rats.Methods A total of 130 healthy male Sprague-Dawley rats were randomly divided into a blank group,an exercise control group,a pre-exercise Tuina group,and a post-exercise Tuina group.According to the time points for sample collection,the exercise control group was divided into a 0 h exercise control group,a 24 h exercise control group,a 48 h exercise control group,and a 72 h exercise control group;the pre-exercise Tuina group was further divided into a 0 h pre-exercise Tuina group,a 24 h pre-exercise Tuina group,a 48 h pre-exercise Tuina group,and a 72 h pre-exercise Tuina group;and the post-exercise Tuina group was divided into a 0 h post-exercise Tuina group,a 24 h post-exercise Tuina group,a 48 h post-exercise Tuina group,and a 72 h post-exercise Tuina group.Rats in all groups except for the blank group received DOMS modeling.Professionals performed Nie-Pinching manipulation and finger Nian-Twisting manipulation on the lower limbs of the rats.The samples were collected at 0 h,24 h,48 h,or 72 h after exhaustive exercise for each pre-exercise Tuina group.The samples were collected at 0 h,24 h,48 h,or 72 h after Tuina for each post-exercise Tuina group.The changes in serum CK,skeletal muscle mitochondrial Ca^(2+)concentration,and Ca^(2+)-adenosine triphosphatase(ATPase)were determined.The ultrastructure changes of skeletal muscles in each group were observed by a transmission electron microscope.Results The electron microscope showed that compared with the exercise control group,the skeletal muscle structures of the pre-exercise Tuina group and the post-exercise Tuina group were significantly improved,and the overall performance of skeletal muscle in the pre-exercise Tuina group was more similar to that of the blank group.The level of serum CK in the pre-exercise Tuina group and the post-exercise Tuina group was significantly lower than that in the exercise control group(P<0.01).The Ca^(2+)concentration of skeletal muscle in the 24 h,48 h,and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point(P<0.01).The Ca^(2+)-ATPase concentration of skeletal muscle in the 24 h and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point(P<0.05).Conclusion Tuina effectively prevents muscle damage caused by heavy exercise and long-term exercise,which may be related to the increase of skeletal muscle Ca^(2+)-ATPase activity and mitochondrial Ca^(2+)transport.

Observation of the efficacy and safety of the Song-Relaxing and Zhen-Vibrating abdomen manipulation for patients with prediabetes

Objective:To observe the safety of the Song-Relaxing and Zhen-Vibrating abdomen manipulation in treating patients with prediabetes and its effects on blood glucose and lipid metabolism.Methods:One hundred and two patients with prediabetes were divided into a manipulation group and a control group according to the random number table method,with 51 cases in each group.All patients received the general behavioral intervention for prediabetes,with additional Song-Relaxing and Zhen-Vibrating abdomen manipulation in the manipulation group and oral metformin hydrochloride tablets in the control group.Both groups received the intervention for six months.Results:Fourteen patients dropped out during the treatment,and a total of 88 patients completed the trial,including 45 cases in the manipulation group and 43 cases in the control group.After the treatment,the prediabetes control rate was 93.3%in the manipulation group and 74.4%in the control group,and the difference between the two groups was statistically significant(P<0.05);no patient in the manipulation group progressed to diabetes,while the rate of conversion to diabetes in the control group was 6.9%,with a significant difference between the two groups(P<0.05).After the treatment,the body mass index(BMI),glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),2-hour postload plasma glucose(2hPG)level during an oral glucose tolerance test(OGTT),fasting insulin(FINS),homeostasis model assessment-2 of insulin resistance(HOMA2-IR),total cholesterol(TC),and triglycerides(TG)decreased in both groups versus baseline,with significant differences within the groups;the levels of all indicators were lower in the manipulation group than in the control group(P<0.05),and the differences between the two groups were more prominent at the sixth month(P<0.01).At the sixth month,the high-density lipoprotein cholesterol(HDL-C)in the manipulation group was increased,while there was no significant change in the control group.In the control group,three patients reported mild gastrointestinal reactions at the initial dosing,which improved after medication adjustment.No other adverse events were observed in either group.Conclusion:Both metformin hydrochloride tablets and the Song-Relaxing and Zhen-Vibrating abdomen manipulation can improve blood glucose and lipid metabolism and reduce insulin resistance and clinical discomfort in patients with prediabetes,but the Song-Relaxing and Zhen-Vibrating abdomen manipulation has higher efficacy and safety.

The indeterminable resilience of the fascial system

The most recent information on fascial tissue indicates that there are not fascial layers, but polyhedral microvacuoles of connective tissue, which connect the body systems and, by hosting specialized cells, permit several functions, such as motor, nervous, vascular and visceral. These microvacuoles（a repetition of polyhedral units of connective fibrils） under internal or external tension change shape and can manage the movement variations, regulating different body functions and ensuring the maintenance of efficiency of the body systems. Their plasticity is based on perfect functional chaos： it is not possible to determine the motion vectors of the different fibrils, which differ in behavior and orientation; this strategy confers to the fascial continuum the maximum level of adaptability in response to the changing internal and external conditions of the cell. The present commentary deals with this concept, providing clinical examples of different disease patterns, providing contrary examples in which this adaptability does not occur, and lastly suggesting considerations for the approach to manipulative therapy of the fascial tissue. The fascial continuum is like a flock of birds flying together without a predetermined logic and maintaining their individuality at the same time.