61: Biomechanical Efficacy of Fascial Hydrorelease: A Robotic Cadaveric Analysis of Gliding Resistance

Topic: Basic Science
Subtopic: Non-specific to any diagnosis (including studies in healthy animals), Developing methodology/technology, Non-pharmacological interventions, Assessment and Measurement of Pain/Nociception

Background and Aims: Ultrasound-guided hydrorelease (HR) is increasingly used for myofascial pain. While clinical efficacy is reported, the influence of HR on the gliding resistance force remains unverified. This study aimed to quantitatively measure the gliding resistance force between the aponeurotic fascia and epimysial fascia of the tibialis anterior and between two epimysial fasciae of the tibialis posterior and flexor digitorum longus using a biomechanical testing system. We hypothesized that HR physically reduces the gliding resistance force, thereby validating the treatment for pathological conditions involving these fascial layers.

Methods: Twelve paired legs from six fresh-frozen specimens were utilized. Target tendons were sutured to a force gauge. We analyzed the gliding resistance force at the layer between the aponeurotic fascia and epimysial fascia of the tibialis anterior, and between the epimysial fasciae of the tibialis posterior and flexor digitorum longus. For the baseline, the position where the tendon tension was approximately 15 N was determined to eliminate creep. In the HR group, 2.5 mL of saline was injected under ultrasound guidance. Gliding resistance force was measured under replicated conditions to calculate the rate of change.

Results: HR significantly reduced the gliding resistance force in both anatomical models, whereas no significant change was observed in the control group. Specifically, at the interface between the aponeurotic fascia and epimysial fascia (tibialis anterior), the force decreased by mean 6.4% compared to baseline (p=0.02). Similarly, at the deeper interface between two epimysial fasciae (tibialis posterior/flexor digitorum longus), the force decreased by 4.3% (p<0.01). Macroscopic observation confirmed that the injectate spread within the loose connective tissue. This spread and subsequent lubrication is considered to contribute to the significant reduction in gliding resistance force.

Conclusions: This study provides the first biomechanical evidence that ultrasound-guided HR physically reduces the gliding resistance force between fascial layers. The results suggest that the analgesic effect relies on a mechanical mechanism—restoring lubrication and hydration of the loose connective tissue to facilitate smooth sliding. This may validate the clinical rationale for using HR to treat pain caused by fascial densification and altered hyaluronan viscosity. Consequently, this study elevates the procedure from an empirical technique to a scientifically supported therapy for various myofascial pain syndromes.

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Presenting Author: KOUSUKE SHIWAKU
Submitting Author: Kousuke Shiwaku

Senior Author: Carla Stecco

IASP 2026 Global Year theme of Neuropathic Pain: No

• Hidenori Otsubo: DR - Sapporo sport clinic
• Daisuke Suzuki: PHD - Sapporo Medical University, Orthopedic Surgery
• Carmelo Pirri: MD - Department of Neurosciences, Institute of Human Anatomy, University of Padova
• Tomoaki Kamiya: MD - Sapporo Medica University
• Keigo Taniguchi: PHD - Sapporo Medica University
• Atsushi Teramoto: MD - Sapporo Medica University
• Carla Stecco: MD - Department of Neurosciences, Institute of Human Anatomy, University of Padova