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Dermatologic Surgery : Official... Oct 2020The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of... (Review)
Review
BACKGROUND
The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response.
OBJECTIVE
Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite.
MATERIALS AND METHODS
A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite.
RESULTS
A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite.
CONCLUSION
The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.
Topics: Aponeurosis; Buttocks; Cellulite; Clinical Trials as Topic; Extracorporeal Shockwave Therapy; Humans; Lipectomy; Massage; Microbial Collagenase; Muscle, Skeletal; Phototherapy; Radiofrequency Therapy; Skin; Skin Cream; Subcutaneous Fat; Thigh; Treatment Outcome
PubMed: 32976174
DOI: 10.1097/DSS.0000000000002388 -
Frontiers in Sports and Active Living 2019The foot is a complex system with multiple degrees of freedom that play an essential role in running or sprinting. The intrinsic foot muscles (IFM) are the main local... (Review)
Review
The foot is a complex system with multiple degrees of freedom that play an essential role in running or sprinting. The intrinsic foot muscles (IFM) are the main local stabilizers of the foot and are part of the active and neural subsystems that constitute the foot core. These muscles lengthen eccentrically during the stance phase of running before shortening at the propulsion phase, as the arch recoils in parallel to the plantar fascia. They play a key role in supporting the medial longitudinal arch, providing flexibility, stability and shock absorption to the foot, whilst partially controlling pronation. Much of the foot rigidity in late stance has been attributed to the windlass mechanism - the dorsiflexion of the toes building tension up in the plantar aponeurosis and stiffening the foot. In addition, recent studies have shown that the IFM provide a necessary active contribution in late stance, in order to develop sufficient impedance in the metatarsal-phalangeal joints. This in turn facilitates the propulsive forces at push-off. These factors support the critical role of the foot in providing rigidity and an efficient lever at push-off. During running or sprinting, athletes need to generate and maintain the highest (linear) running velocity during a single effort in a sprinting lane. Acceleration and sprinting performance requires forces to be transmitted efficiently to the ground. It may be of particular interest to strengthen foot muscles to maintain and improve an optimal capacity to generate and absorb these forces. The current evidence supports multiple exercises to achieve higher strength in the foot, such as the "short foot exercise," doming, toes curl, towing exercises or the more dynamic hopping exercises, or even barefoot running. Their real impact on foot muscle strength remains unclear and data related to its assessment remains scarce, despite a recognized need for this, especially before and after a strengthening intervention. It would be optimal to be able to assess it. In this article, we aim to provide the track and field community with an updated review on the current modalities available for foot strength assessment and training. We present recommendations for the incorporation of foot muscles training for performance and injury prevention in track and field.
PubMed: 33344969
DOI: 10.3389/fspor.2019.00046 -
Life (Basel, Switzerland) Jul 2021The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is... (Review)
Review
The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.
PubMed: 34357040
DOI: 10.3390/life11070668 -
Scandinavian Journal of Medicine &... Dec 2020High-resolution ultrasound (US) has helped to characterize the "tennis leg injury" (TL). However, no specific classifications with prognostic value exist. This study...
High-resolution ultrasound (US) has helped to characterize the "tennis leg injury" (TL). However, no specific classifications with prognostic value exist. This study proposes a medial head of the gastrocnemius injury classification based on sonographic findings and relates this to the time to return to work (RTW) and return to sports (RTS) to evaluate the prognostic value of the classification. 115 subjects (64 athletes and 51 workers) were retrospectively reviewed to asses specific injury location according to medial head of the gastrocnemius anatomy (myoaponeurotic junction; gastrocnemius aponeurosis (GA), free gastrocnemius aponeurosis (FGA)), presence of intermuscular hematoma, and presence of gastrocnemius-soleus asynchronous movement. Return to play (RTP; athletes) and return to work (RTW; occupational) days were recorded by the treating physician. This study proposes 5 injury types with a significant relation to RTP and RTW (P < .001): Type 1 (myoaponeurotic injury), type 2A (gastrocnemius aponeurosis injury with a <50% affected GA width), type 2B (gastrocnemius aponeurosis with >50% affected GA width), type 3 (free gastrocnemius aponeurosis (FGA) tendinous injury), and type 4 (mixed GA and FGA injury). The longest RTP/RTW periods were associated with injuries with FGA involvement. Intermuscular hematoma and Gastrocnemius-soleus asynchronous motion during dorsiflexion and plantarflexion were observed when the injury affected >50% of the GA width, with or without associated FGA involvement, and this correlated with a worse prognosis. The proposed classification can be readily applied in the clinical setting although further studies on treatment options are required.
Topics: Adult; Athletic Injuries; Female; Hematoma; Humans; Male; Middle Aged; Muscle, Skeletal; Occupational Injuries; Prognosis; Retrospective Studies; Return to Sport; Return to Work; Ultrasonography
PubMed: 32854168
DOI: 10.1111/sms.13812