Self-Myofascial Release of the Upper Cervical Muscles

The superficial back line is a network myofascial segments that are connected and extend from the plantar foot up through the posterior lower extremity and back, up to the head. These connective tissue and muscular tracks play a role in supporting upright stance and motion. Dysfunction in one segment of the superficial back line can manifest as pain in a different segment of the fascial system. For example, hamstring and gastrocnemius muscle tightness have been associated with altered foot biomechanics and pain. The suboccipital muscles play an important role in head and body posture; therefore, they can influence eye positioning as it relates to head movements and perturbations. Because of this, the suboccipital muscles may have a hierarchical control over the SBFL. Dysfunction in the suboccipital muscles may exert more widespread effects on muscles and tissues at distant regions of the SBFL. Studies have shown that neck pain and forward head posture are associated with altered gait and ankle posture respectively. In addition, stress, anxiety, and poor sleep quality are associated with increased pain sensitivity and disability. How the interconnectedness of the SBFL responds to treatment is not fully understood. Proper treatment of musculoskeletal pain requires a better understanding of the function of myofascial connections and how dysfunction in one segment affects other regions. Also, enhanced understanding of the influence of stress, anxiety, and low sleep quality on response to treatment is needed. This understanding will better inform clinical practice and support the need for a more holistic approach to treating musculoskeletal pain.

The primary objective is to examine the influence of the suboccipital muscles on the superficial back line. Specifically, investigators will measure the following as part of this objective:

• Changes in biomechanical and viscoelastic properties of points within the superficial back fascial train measured by a handheld myotonometer.
• Pain pressure threshold measured by algometry.
• Ankle range of motion.
• Foot plantar pressure changes.

A secondary objective is to demonstrate a relationship between changes within the SBFL and stress, anxiety, sleep quality and non-debilitating pain. To achieve this secondary objective, the investigators will use the following:

• Perceived Stress Scale-10 (PSS-10)
• General Anxiety Disorder-7 (GAD-7)
• Pittsburgh Sleep Quality Index (PSQI)
• Numerical Rating Scale (NRS) will be utilized to record participants' intensity, frequency, and duration of non-debilitating lower extremity pain and back pain.

Inclusion criteria

• Adults 19 years of age and older from VCOM-Auburn and the Auburn area.

Exclusion criteria

• pain that alters gait and/or limits/alters normal daily function
• currently undergoing treatment by a healthcare provider
• loss of function
• use of prescription drugs for muscle or muscle relaxants
• Pregnancy (hormonal changes affecting tissues could be a confounding variable)
• inflammatory arthritis and fibromyalgia
• diabetes or prediabetes
• lumbar radiculopathy or disc pathology
• previous surgery of the spine or lower extremity
• injury to the lower extremity within the past 6 months
• neurological or musculoskeletal diseases
• cancer or blood disorder
• current tobacco use
• other conditions that alter gait