Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Mar 28;26(1):306.
doi: 10.1186/s12891-025-08533-y.

Biomechanical effects of fascial hydrorelease: a cadaveric study

Kousuke Shiwaku  1 , Hidenori Otsubo  2 , Daisuke Suzuki  3 , Carmelo Pirri  4 , Taiki Kodesyo  1 , Tomoaki Kamiya  1 , Keigo Taniguchi  5 , Hirofumi Ohnishi  6 , Atsushi Teramoto  1 , Carla Stecco  4
Affiliations
Comparative Study

Biomechanical effects of fascial hydrorelease: a cadaveric study

Kousuke Shiwaku et al. BMC Musculoskelet Disord. .

Erratum in

Abstract

Background: We aimed to investigate the influence of hydrorelease (HR) on the gliding resistance force between the aponeurotic fascia and epimysial fascia of tibialis anterior and between two epimysial fasciae of tibialis posterior and flexor digitorum longus using a biomechanical testing system.

Methods: In this cadaveric comparative study, 12 paired legs amputated above the knee joint from six fresh-frozen specimens were divided into two groups. The distal insertions of the target tendons of the tibialis anterior and posterior were detached and sutured to a force gauge for tension measurement during tendon pull. These tendons were representatives of the layer between the aponeurotic and epimysial fasciae of the tibialis anterior and between the epimysial fasciae of the tibialis posterior and flexor digitorum longus. For the baseline, the position where the tension of the target tendon was approximately 15 N was determined to eliminate creep. In the HR group, the baseline test position was replicated, and force was measured. The intervention was an HR injection between the specified fascial layers. The main outcome was the gliding resistance force between the aponeurotic and epimysial fasciae and between two epimysial fasciae.

Results: The resistance force between the aponeurotic and epimysial fasciae in the HR group was 6.4% lower than that in the control group (P = 0.02). The resistance force between two epimysial fasciae in the HR group was 4.3% lower than that in the control group (P < 0.01).

Conclusions: The gliding resistance force significantly decreased after HR in the layer between the aponeurotic and epimysial fasciae and between two epimysial fasciae in this cadaveric study.

Keywords: Biomechanics; Cadaver; Fascia; Myofascial pain syndrome; Tendon.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Sapporo Medical University Ethics Board (number 1-2-68). All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(a) Experimental setup with a clamp, manipulator, and force gauge. Downward arrow: target point for (1) the layer between the APF and EPI for the tibialis anterior. Upward arrow: target point for (2) the layer between two EPIs of the tibialis posterior and flexor digitorum longus. (b) Schemas of the layer (1) between the APF and EPI and (2) between two EPIs. Smaller arrow: target point for (1) the layer between the APF and EPI of the tibialis anterior. Larger arrow: target point for (2) the layer between two EPIs of the tibialis posterior and flexor digitorum longus. APF: aponeurotic fascia; EPI: epimysium; HR: hydrorelease; SF: superficial fascia
Fig. 2
Fig. 2
Short-axis ultrasound images of ultrasound-guided injection. (a) Anterolateral aspect of the middle third of the lower leg. (b) Medial aspect of the middle third of the lower leg
Fig. 3
Fig. 3
Dissection after injection between the APF and EPI of the tibialis anterior. (a) Before separation from the leg. (b, c) After separation from the leg. The loose connective tissue of the fascia between the APF and EPI, termed “lubricated fascia,” is found. APF: aponeurotic fascia; EPI: epimysium
Fig. 4
Fig. 4
Results of the tests for (a) tibialis anterior and (b) tibialis posterior. Each result is presented as a percentage of the baseline test. F: force. Vertical arrows: paired t-test; horizontal arrows: unpaired t-test; HR: hydrorelease; F: force
See this image and copyright information in PMC

References

    1. Fukui S, Rokutanda R, Kawaai S, Suda M, Iwata F, Okada M, et al. Current evidence and practical knowledge for ultrasound-guided procedures in rheumatology: joint aspiration, injection, and other applications. Best Pract Res Clin Rheumatol. 2023;37:101832. - PubMed
    1. Neo EJR, Shan NT, Tay SS. Hydrodissection for carpal tunnel syndrome: a systematic review. Am J Phys Med Rehabil. 2022;101:530–9. - PubMed
    1. Courseault J, Kessler E, Moran A, Labbe A. Fascial hydrodissection for chronic hamstring injury. Curr Sports Med Rep. 2019;18:416–20. - PubMed
    1. Simons DG. New aspects of myofascial trigger points: etiological and clinical. J Musculoskelet Pain. 2004;12:15–21.
    1. Giamberardino MA, Tafuri E, Savini A, Fabrizio A, Affaitati G, Lerza R, et al. Contribution of myofascial trigger points to migraine symptoms. J Pain. 2007;8:869–78. - PubMed

Publication types

Grants and funding

LinkOut - more resources