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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 3  |  Issue : 2  |  Page : 117-120

Tissue-level ultrasonographic evaluation of hamstring muscle with matrix rhythm therapy (MaRhyThe©)


Department of CVTS Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission07-Dec-2021
Date of Decision14-Dec-2021
Date of Acceptance17-Dec-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Varun Naik
KAHER Institute of Physiotherapy, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_73_21

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  Abstract 


Ideal hamstring muscle length plays a very important role in maintaining posture. Preserving hamstring length or by treating for the tightness of hamstring is crucial to prevent hamstring muscle strain or low back pain. Matrix rhythm therapy (MRT, MaRhyThe©) is one of the novel approaches which is gaining popularity recently for improving function and flexibility, as well as alleviating pain in various musculoskeletal conditions such as frozen shoulder and plantar fasciitis. However, evidence is lacking where the effect of matrix at tissue level is researched. Therefore, the current study aims to determine the immediate and 24-h carry-over effect of MRT on hamstring muscle length, tissue thickness, and regional blood flow using diagnostic ultrasonography that was carried out on an apparently healthy 22-year-old female volunteer. MaRhyThe© was applied to bilateral hamstring muscles. The study concludes that MRT is an effective tool in improving the length, blood flow, and tissue thickness of the hamstring muscle. Thus, MRT can be considered as a treatment modality for muscle and fascia tightness.

Keywords: Hamstring muscle, Matrix rhythm therapy, Ultrasonography


How to cite this article:
Naik V, Parekh V, Patil S. Tissue-level ultrasonographic evaluation of hamstring muscle with matrix rhythm therapy (MaRhyThe©). Indian J Phys Ther Res 2021;3:117-20

How to cite this URL:
Naik V, Parekh V, Patil S. Tissue-level ultrasonographic evaluation of hamstring muscle with matrix rhythm therapy (MaRhyThe©). Indian J Phys Ther Res [serial online] 2021 [cited 2022 Jan 25];3:117-20. Available from: https://www.ijptr.org/text.asp?2021/3/2/117/335672




  Introduction Top


Flexibility is a physical training characteristic that is often assessed by a joint range of motion. The length of muscle tissue is thought to play a key role in the quality and efficacy of human activity. Hamstring injuries are prevalent, and a lack of flexibility in the hamstrings can make them more susceptible to damage.[1],[2] Ideal hamstring muscle length plays a very important role in maintaining posture and reducing the prevalence of low back ache (LBA).[3] If hamstring flexibility and strength are risk factors for hamstring injury, they should be linked to optimum hamstring length.[4] Hence, treating the hamstring tightness should be considered to prevent further injury. Matrix rhythm therapy (MRT), MaRhyThe©, developed by Dr. Ulrich Randoll in Germany in the 1990s, is a Class IIA medical device that works on the concept of mechanomagnetically synchronizing the body's intrinsic vibrations via the neuromuscular system in the alpha rhythm (8–12 Hz). The principle of MRT is to regulate the extracellular conditions back to normal, using physiological rhythms to normalize the metabolism by optimization of cellular logistics.[5] MRT is one of the novel approaches which is gaining popularity recently for improving function and flexibility, as well as alleviating pain in various musculoskeletal conditions such as frozen shoulder and plantar fasciitis. However, evidence is lacking where the effect of matrix at tissue level is researched. Thus, the current study aims to determine the immediate and 24-h carry-over effect of MRT on hamstring muscle length, tissue thickness, and regional blood flow using diagnostic ultrasonography.


  Case Report Top


A 22-year-old apparently healthy female with no history of LBA actively volunteered to participate in the study with bilateral hamstring tightness presenting with inability to forward bend and touch the fingertips to the floor. She was objectively assessed for potential hamstring tightness in both limbs using an active knee extension test (AKET) with initial presentation of 40°. Written informed consent for participation and publication in the study was obtained. After recruitment, she was assessed using an AKET and color Doppler ultrasound (two-dimensional imaging), for hamstring muscle length, thickness, and blood flow at immediate and 24-h posttreatment.

Procedure

The ultrasonographic assessment was recorded in a dark, closed environment with controlled temperature and humidity by the same radiologist using the same instrument [Figure 1]. In the anteroposterior cross-section, the artery's diameter was measured. The peak systolic maximum velocity (Vmax) was measured to determine the velocity of blood flow through the artery. During the velocity measurements, the Doppler insonation angle was kept below 60°. The average speed (Vmean) was computed as the average of three Vmax readings taken in a row. The vessel's radius and cross-sectional area were calculated (the vessel was assumed to be circular). The amount of blood flow through the vessel (ml/min) was calculated using the following formula: arterial blood flow = mean blood velocity × πr2, where mean blood velocity (cm/s) was the average of three consecutive Vmax values, π is the constant value of 3.14, and r is the radius of the cross-sectional area of the vessel in millimeters.[6]
Figure 1: Ultrasonographic assessment

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For MRT session, the participant was asked to lie comfortably in a prone position. The muscle area was exposed, and to avoid the friction created by the Matrix Mobil®, talcum powder was applied to the treatment area [Figure 2]. The treatment with Matrix Mobil® included longitudinal strokes given with the probe of the device. The session was delivered for 60 min, with 30 min on each side of hamstring muscles.
Figure 2: Matrix rhythm therapy (MaRhyThe©) treatment for hamstring muscle

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  Results Top


Pre–post-interventional scores for AKET and ultrasonographic parameters demonstrated measurable improvement. The AKET angle reduced by 50%, length improved by 16.67% bilaterally, thickness reduced by 11.54% on the right side and 20.00% on the left side, and blood flow increased by 10.96% on the right side and 15.13% on the left side of the hamstring muscle [Figure 3], [Figure 4], [Figure 5]. The percentage of change in the tested parameters remained unchanged after 24 h of evaluation [Table 1].
Figure 3: Pre- and post-ultrasonographic hamstring length assessment

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Figure 4: Pre- and post-ultrasonographic hamstring thickness assessment

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Figure 5: Ultrasonographic blood flow assessment

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Table 1: Comparison of pre- and postintervention outcome measure values

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  Discussion Top


MaRhyThe has received relatively little research as a newly invented therapeutic tool. It has shown its effectiveness in improving joint range of motion and muscle flexibility, reducing pain, and improving functions in activities of daily living. Currently, there is limited evidence of improving the peripheral blow flow in circulation. MaRhyThe© enhances blood circulation, according to the findings of this study. The therapist utilizes MaRhyThe© to provide longitudinal stroking to the soft tissues by pushing the probe of the device toward soft tissue. By the influence of the vibration, the compression effect caused by the use of MaRhyThe© might produce additional soft tissue mobilization and afferent impulses. Callaghan[7] has suggested that the primary effect of mechanical vibration massage is to improve blood circulation, and the tonic vibration reflex in mechanical vibration causes active muscular contraction. Blood flow may have increased as a result of the muscle contraction.

Furthermore, we believe that MaRhyThe© is similar to connective tissue massage (CTM), a soft tissue manual therapy technique. The therapist uses his or her fingertips to apply soft tissue mobilization in CTM. A comparable technique is carried out with the device's probe in MaRhyThe©. CTM can increase blood circulation through its effects on the autonomic system, independent of physiologic effects, according to experimental findings. The MaRhyThe© device's vibration frequency is assumed to be compatible with the muscle's natural vibration frequency, which is expected to contribute to MaRhyThe© therapeutic effectiveness. In prior investigations, after using various mechanical vibratory devices,[8],[9],[10] saw increases in blood flow of 20%, 26%, and 46%, respectively. Applying a mechanical vibration level to the bloodstream, according to Button et al.,[9] causes an increase in the bloodstream that peaks at 22 min. Increased blood flow to the hamstring muscle must have helped to raise the muscular temperature, allowing muscles to relax and relieve tension. Muscle tightness and tension are relieved, allowing a muscle to expand to its full length without restriction, enhancing range of motion. As a result, the current case report shows a 50% change in the AKET.

Because of the presumed health benefits of being able to promote blood flow, the effect of vibration on muscle perfusion has recently received a lot of study. The size of the increase in muscle perfusion caused by vibration appeared to be proportional to the vibratory load applied. Thus, manipulating the vibratory load may be able to generate desired improvements in muscle perfusion to reduce inflammation, decrease pain, and enhance muscle tissue recovery after an acute injury or in chronic circulation disorders, such peripheral vascular disease.[11] The mechanism responsible for vibration-induced increases in muscle perfusion is frequently characterized as reflexive muscular contractions.[12],[13] This could be attributed to increased blood viscosity and arterial diameter, which leads to better microcirculation, which results in more blood supply, oxygen, and metabolite exchange at the tissue site.[7] This aids tissue healing by promoting fibroblastic activity, which improves soft tissue function and leads to enhanced range of motion. In a prior study employing IASTM on plantar fasciitis, similar results on tissue healing were seen.[14]

Previous researches have shown that increased tissue thickness translates to increased thickness, resulting in a loss of flexibility due to thickening fascia. Increased AKE readings may be caused by increased tissue stiffness, which leads to a lack of normal flexibility.[15] The use of MaRhyThe© results in a decrease in thickness, which improves flexibility by enhancing the fascial layer. Hence, it can be hypothesized that MaRhyThe© can be an effective tool in treating myofascial disorders, thus reducing tissue stiffness and improving flexibility.


  Conclusion Top


The current case study reports substantial improvement in length and blood flow and decreased tissue thickness of hamstring muscle following the application of MaRhyThe©. The results are also suggestive that the changes were maintained for 24 h after the treatment which establishes the carry-over effect of the therapeutic application of the device. MaRhyThe© can be considered as a treatment modality for muscle and fascia tightness.

Acknowledgment

I sincerely thank my colleagues Dr. Peeyoosha Gurudut and Aarti Welling for their help in drafting and language editing the manuscript. I also would like to extend my gratitude to the radiology department for performing the ultrasonographic analysis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hatano G, Suzuki S, Matsuo S, Kataura S, Yokoi K, Fukaya T, et al. Hamstring stiffness returns more rapidly after static stretching than range of motion, stretch tolerance, and isometric peak torque. J Sport Rehabil 2019;28:325-31.  Back to cited text no. 1
    
2.
Wan X, Qu F, Garrett WE, Liu H, Yu B. Relationships among hamstring muscle optimal length and hamstring flexibility and strength. J Sport Health Sci 2017;6:275-82.  Back to cited text no. 2
    
3.
Radwan A, Bigney KA, Buonomo HN, Jarmak MW, Moats SM, Ross JK, et al. Evaluation of intra-subject difference in hamstring flexibility in patients with low back pain: An exploratory study. J Back Musculoskelet Rehabil 2015;28:61-6.  Back to cited text no. 3
    
4.
Koli BK, Anap DB. Prevalence and severity of hamstring tightness among college student: A cross sectional study. International Journal of Clinical and Biomedical Research. 2018;15:65-8.  Back to cited text no. 4
    
5.
Naik V, Singh M. Effects of matrix rhythm therapy (MaRhyThe) in plantar fasciitis – An experimental study. Ind J Phys Ther Res 2019;1:105.  Back to cited text no. 5
    
6.
Taspinar F, Aslan UB, Sabir N, Cavlak U. Implementation of matrix rhythm therapy and conventional massage in young females and comparison of their acute effects on circulation. J Altern Complement Med 2013;19:826-32.  Back to cited text no. 6
    
7.
Callaghan MJ. The role of massage in the management of the athlete: A review. Br J Sports Med 1993;27:28-33.  Back to cited text no. 7
    
8.
Zhang Q, Ericson K, Styf J. Blood flow in the tibialis anterior muscle by photoplethysmography during foot-transmitted vibration. Eur J Appl Physiol 2003;90:464-9.  Back to cited text no. 8
    
9.
Button C, Anderson N, Bradford C, Cotter JD, Ainslie PN. The effect of multidirectional mechanical vibration on peripheral circulation of humans. Clin Physiol Funct Imaging 2007;27:211-6.  Back to cited text no. 9
    
10.
Stewart JM, Karman C, Montgomery LD, McLeod KJ. Plantar vibration improves leg fluid flow in perimenopausal women. Am J Physiol Regul Integr Comp Physiol 2005;288:R623-9.  Back to cited text no. 10
    
11.
Fuller JT, Thomson RL, Howe PR, Buckley JD. Effect of vibration on muscle perfusion: A systematic review. Clin Physiol Funct Imaging 2013;33:1-10.  Back to cited text no. 11
    
12.
Yamada E, Kusaka T, Miyamoto K, Tanaka S, Morita S, Tanaka S, et al. Vastus lateralis oxygenation and blood volume measured by near-infrared spectroscopy during whole body vibration. Clin Physiol Funct Imaging 2005;25:203-8.  Back to cited text no. 12
    
13.
Lythgo N, Eser P, De Groot P, Galea M. Whole-body vibration dosage alters leg blood flow. Clin Physiol Funct Imaging 2009; 29:53-9.  Back to cited text no. 13
    
14.
Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: Mechanisms and practical application. J Exerc Rehabil 2017;13:12-22.  Back to cited text no. 14
    
15.
Wilke J, Macchi V, De Caro R, Stecco C. Fascia thickness, aging and flexibility: Is there an association? J Anat 2019;234:43-9.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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Abstract
Introduction
Case Report
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Conclusion
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