The Study Question
Previous studies examining mechanisms of myofascial approaches have proposed potential mechanisms, including activation of the autonomic nervous system, enhanced circulation to areas of fascial restriction and increased blood flow to nervous tissue. However, no prior studies have examined the effect of myofascial techniques on the immune system. Do two commonly used myofascial techniques—suboccipital muscle release and CV-4 compression—have any effect on immune response?
Here, we describe the results of a 2013 Spanish study conducted at the University of Granada. Because the craniocervical region is connected to neighboring organs and viscera, the investigators proposed that myofascial techniques applied to this area could affect autonomic nervous system activity, which in previous studies has been shown to modify immunological function.
The goal of the study was to determine whether myofascial therapy had any immediate effect on common immune markers CD3, CD4, CD8 (T-lymphocytes), CD19 (B-lymphocytes) and natural killer (NK) cells in the blood of healthy young adult males.
The 20-minute study intervention consisted of four minutes of suboccipital release, followed by six minutes of CV-4 compression, and then 10 minutes of myofascial therapy on the anterior cervical fascia in the neck and pectoral area, as described by Pilat.
The Study Methods
Participants were 39 volunteers recruited from graduate and undergraduate students enrolled in health sciences or physical education courses, aged 18 to 25.
Inclusion criteria were male sex, physical sports activity for a minimum of one hour at least three times a week and no prior experience of myofascial therapy. Females were excluded to eliminate the influence of reproductive hormones on outcome measures. Other exclusion criteria included medication use; current circulatory, bone, skin or inflammatory disorders; and diagnosed anxiety or depressive disorders.
Participants were randomly assigned to receive the myofascial therapy intervention or a control intervention that consisted of simply resting in a supine position for an equal amount of time under identical temperature, humidity and light conditions. All participants were instructed to avoid strenuous activity for 24 hours before the intervention, and they fasted during the morning of the intervention. The State-Trait Anxiety Inventory and Beck Depression Inventory were used to assess for baseline mood states that might have influenced measures of immune cells.
Venous blood was drawn immediately before and after the intervention and control conditions, and processed within three hours. Flow cytometry was used to count the numbers of CD3, CD4, CD8, CD19 and NK cells. Repeated measures analysis of variance was used as the method of statistical analysis.
The two groups were comparable in terms of existing sociodemographic variables and baseline mood states; no significant differences were observed. At baseline, no differences between the two groups in numbers of immune cells were observed. Post intervention, the number of CD19 cells increased in the group that received the myofascial intervention, while no change was observed in the control group. No differences were observed in the numbers of the other immune cells measured.
Limitations of the Study
This investigation was the first to examine effects of myofascial therapy on immune function. The study sample did not include women, lacked a comparison group that employed any type of unstructured touch and only looked at immediate effects. The results are suggestive of an immediate effect on immune function and warrant further study, but are not widely generalizable.
Implications for Evidence-informed Practice
It is difficult to draw any implications for clinical practice from this study due to its narrow focus and necessary limitations. The known relationship between autonomic nervous system activation and immunomodulation suggests that the increase in the CD19 B-lymphocytes, which originate and mature in the bone marrow and are stored in lymph nodes, could be due to autonomic nervous system response. A previous trial demonstrated decreased heart rate and systolic blood pressure in response to myofascial therapy.
More research is needed that includes both men and women, involves touch as a comparison group, includes people with specific disease conditions as well as healthy normal people, and assesses longer-term effects of myofascial therapy on immune function.