Max Roman

Fascia research – A narrative review

This article reviews fascia research from our laboratory and puts this in the context of recent progress in fascia research which has greatly expanded during the past seven or eight years. Some readers may not be familiar with the terminology used in fascia research articles and are referred to LeMoon (2008) for a glossary of terms used in fascia-related articles.

Nonlinear Vibrations of Beams, Strings, Plates, and Membranes Without Initial Tension

The subject of this paper is nonlinear vibrations of beams, strings (defined as beams with very thin uniform cross sections), plates and membranes (defined as very thin plates) without initial tension. Such problems are of great current interest in minute structures with some dimensions in the range of nanometers (nm) to micrometers (μm). A general discussion of these problems is followed by finite element method (FEM) analyses of beams and square plates with different boundary conditions. It is shown that the common practice of neglecting the bending stiffness of strings and membranes, while permissible in the presence of significant initial tension, is not appropriate in the case of nonlinear vibrations of such objects, with no initial tension, and with moderately large amplitude (of the order of the diameter of a string or the thickness of a plate). Approximate, but accurate analytical expressions are presented in this paper for the ratio of the nonlinear to the linear natural fundamental frequency of beams and plates, as functions of the ratio of amplitude to radius of gyration for beams, or the ratio of amplitude to thickness for square plates, for various boundary conditions. These expressions are independent of system parameters-the Youngs modulus, density, length, and radius of gyration for beams; the Youngs modulus, density, length of side, and thickness for square plates. (The plate formula exhibits explicit dependence on the Poissons ratio.) It is expected that these results will prove to be useful for the design of macro as well as micro and nano structures.

Mathematical analysis of the flow of hyaluronic acid around fascia during manual therapy motions.

CONTEXT More research is needed to understand the flow characteristics of hyaluronic acid (HA) during motions used in osteopathic manipulative treatment and other manual therapies. OBJECTIVE To apply a 3-dimensional mathematical model to explore the relationship between the 3 manual therapy motions (constant sliding, perpendicular vibration, and tangential oscillation) and the flow characteristics of HA below the fascial layer. METHODS The Squeeze Film Lubrication theory of fluid mechanics for flow between 2 plates was used, as well as the Navier-Stokes equations. RESULTS The fluid pressure of HA increased substantially as fascia was deformed during manual therapies. There was a higher rate of pressure during tangential oscillation and perpendicular vibration than during constant sliding. This variation of pressure caused HA to flow near the edges of the fascial area under manipulation, and this flow resulted in greater lubrication. The pressure generated in the fluid between the muscle and the fascia during osteopathic manipulative treatment causes the fluid gap to increase. Consequently, the thickness between 2 fascial layers increases as well. Thus, the presence of a thicker fluid gap can improve the sliding system and permit the muscles to work more efficiently. CONCLUSION The mathematical model employed by the authors suggests that inclusion of perpendicular vibration and tangential oscillation may increase the action of the treatment in the extracellular matrix, providing additional benefits in manual therapies that currently use only constant sliding motions.

Design and Fabrication of Electrostatically Actuated Synthetic Microjets

The purpose of this paper is to design and fabricate efficient electrostatically actuated synthetic microjets. For this, special attention is given to the coupling between the electrostatic actuation, the solid deformation of the membrane, and the generated fluid flow. In particular, the motion of the membrane, which is critical in generating the jet flow, is studied using the energy method applied to the large displacement of plates, which, in turn, leads to a relation between the required voltage and the membrane deformation. The flow is then deduced. Finally, we present an efficient method to microfabricate such devices.Copyright

Squeeze film lubrication for non-Newtonian fluids with application to manual medicine

In this paper, we computed fluid pressure and force on fascia sheets during manual therapy treatments using Squeeze Film Lubrication theory for non-Newtonian fluids. For this purpose, we developed a model valid for three dimensional fluid flow of a non-Newtonian liquid. Previous models considered only one-dimensional flows in two dimensions. We applied this model to compare the one-dimensional flow of HA, considered as a lubricating fluid, around or within the fascia during sliding, vibration, and back-and-forth sliding manipulation treatment techniques. The fluid pressure of HA increases dramatically as fascia is deformed during manual therapies. The fluid force increases more during vertical vibratory manipulation treatment than in constant sliding, and back and forth motion. The variation of fluid pressure/force causes HA to flow near the edges of the fascial area under manipulation in sliding and back and forth motion which may result in greater lubrication. The fluid pressure generated in manual therapy techniques may improve sliding and permit muscles to work more efficiently.

Evaluation of the rotational stiffness and visco-elasticity of the low back and improving the low back visco-elasticity

An automated anatomical torsion monitor (A-ATM) is developed to evaluate the stiffness and visco-elasticity of the low back as a static load is applied and removed from the pelvis. The resulting hysteresis loop area (HLA) is used to evaluate the mechanical properties of the low back. Also a technique for improving the low back dysfunction by imparting oscillations to the low back is presented. The before and after HLAs are compared for objective evaluation. It is observed that providing oscillations to the low back for five minutes at a frequency of 20 cycles per minute results in improved elasticity of the low back for those subjects whose BMI is 25 or less and an insignificant change in stiffness for all the subjects. However the correct displacement amplitude, frequency, and duration of treatment will depend upon individual medical and physical conditions.

Influence of Relative Residence Time on Side-Wall Aneurysm Inception

BACKGROUND Relative residence time (RRT) is a marker of disturbed blood flow, marked by low magnitude and high oscillatory wall shear stress (WSS). The relation between solute residence time in proximity to the vascular endothelium and the atherosclerotic process is well appreciated in the literature. OBJECTIVE To assess the influence of RRT on side-wall aneurysm inception to better understand the role of atherosclerosis in aneurysm formation. METHODS Fourteen side-wall internal carotid artery aneurysms from the Aneurisk repository which met criteria for parent vessel reconstruction were reconstructed with Vascular Modeling Toolkit. Computational fluid dynamics analysis was carried out in Fluent. RRT was calculated in MATLAB (The MathWorks Inc, Natick, Massachusetts). We analyzed the results for correlations, defined as presence or absence of local elevations in RRT in specific regions of vasculature. RESULTS RRT was concluded to be negatively correlated with aneurysm inception in this study of side-wall internal carotid artery aneurysms, with 12/14 cases yielding the absence of local RRT elevations within or in close proximity of the removed ostium. Subsequent analysis of WSS showed that 11 of 14 aneurysms were formed in an atheroprotective environment, with only 1 of 14 formed in an atherogenic environment. Two models were found to be of indeterminate environment. CONCLUSION Atherogenesis and atherosclerosis have long been thought to be a major inciting factor responsible for the formation of aneurysms in the cerebral vasculature. We propose that inception of side-wall aneurysms occurs in hemodynamic environments that promote an atheroprotective endothelial phenotype and that the atheroprotective phenotype is therefore aneurysmogenic.

Hemodynamic impingement and the initiation of intracranial side-wall aneurysms:

Objective The natural history intracranial aneurysms (IA) remains poorly understood despite significant morbidity and mortality associated with IA rupture. Hemodynamic impingement resulting in elevations in wall shear stress and wall shear stress gradient (WSSG) has been shown to induce aneurysmal remodeling at arterial bifurcations. We investigate the hemodynamic environment specific to side-wall pre-aneurysmal vasculature. We hypothesize that fluid impingement and secondary flow patterns play a role in side-wall aneurysm initiation. Methods Eight side-wall internal carotid artery aneurysms from the Aneurisk repository were identified. Pre-aneurysmal vasculature was algorithmically reconstructed. Blood flow was simulated with computational fluid dynamic simulations. An indicator of isolated fluid impingement energy was developed by insetting the vessel surface and calculating the impinging component of the fluid dynamic pressure. Results Isolated fluid impingement was found to be elevated in the area of aneurysm initiation in 8/8 cases. The underlying fluid flow for each area of initiation was found to harbor secondary flow patterns known as Dean’s vortices, the result of changes in momentum imparted by bends in the internal carotid artery (ICA). Conclusion Isolated fluid impingement and secondary flow patterns may play a major role in the initiation of side-wall aneurysm initiation. We are unable to determine if this role is through direct or indirect mechanisms but hypothesize that elevations in isolated fluid impingement mark areas of cerebral vasculature that are at risk for aneurysm initiation. Thus, this indicator provides vascular locations to focus future study of side-wall aneurysm initiation.

Effects of the basic multicellular unit and lamellar thickness on osteonal fatigue life

A remodeling cycle sets the size of the osteon and associated lamellae in the basic multicellular unit. Treatments and aging affect these micro-structural features. We previously demonstrated decreased fatigue life with an unexplained mechanism and decreased osteon size in cortical bone treated with high-dose bisphosphonate. Here, three finite element models were examined: type-1: a single osteon, as a homogeneous unit and with heterogeneous lamellae and interlamellae, type-2: a control, interstitial-only tissue and type-3: the osteon with cement line, set within the interstitial tissue. Models were loaded in simulated, sinusoidal bending fatigue. As osteon size was decreased, lamellar number and lamellar thickness were incrementally adjusted for each model. As hypothesized, lamellae within the larger type-1 models attained greater cycles to failure and the addition of an osteon to type-2 models (generating a type-3 model set) yielded increased fatigue life. However, as the osteon size was decreased, the potential for compressive damage nucleation was increased within the lamellae of the osteons versus the interstitium. Also, osteons with fewer, thicker lamellae displayed increased fatigue life. Osteonal microstructure plays a role in damage initiation location, especially when BMU size is smaller. Previous findings by us and others could partially be explained by this further understanding of increased probability for damage nucleation in smaller osteons.