What Is Evidence-Based About Myofascial Chains: A Systematic Review

Arch Phys Med Rehabil. 2016 Mar;97(3):454-61. doi: 10.1016/j.apmr.2015.07.023. Epub 2015 Aug 14.


Objective: To provide evidence for the existence of 6 myofascial meridians proposed by Myers based on anatomic dissection studies.

Data sources: Relevant articles published between 1900 and December 2014 were searched in MEDLINE (PubMed), ScienceDirect, and Google Scholar.

Study selection: Peer-reviewed human anatomic dissection studies reporting morphologic continuity between the muscular constituents of the examined meridians were included. If no study demonstrating a structural connection between 2 muscles was found, articles on general anatomy of the corresponding body region were targeted.

Data extraction: Continuity between 2 muscles was documented if 2 independent investigators agreed that it was reported clearly. Also, 2 independent investigators rated methodologic quality of included studies by means of a validated assessment tool (Quality Appraisal for Cadaveric Studies).

Data synthesis: The literature search identified 6589 articles. Of these, 62 article met the inclusion criteria. The studies reviewed suggest strong evidence for the existence of 3 myofascial meridians: the superficial back line (all 3 transitions verified, based on 14 studies), the back functional line (all 3 transitions verified, based on 8 studies) and the front functional line (both transitions verified, based on 6 studies). Moderate-to-strong evidence is available for parts of the spiral line (5 of 9 verified transitions, based on 21 studies) and the lateral line (2 of 5 verified transitions, based on 10 studies). No evidence exists for the superficial front line (no verified transition, based on 7 studies).

Conclusions: The present systematic review suggests that most skeletal muscles of the human body are directly linked by connective tissue. Examining the functional relevance of these myofascial chains is the most urgent task of future research. Strain transmission along meridians would both open a new frontier for the understanding of referred pain and provide a rationale for the development of more holistic treatment approaches.

Keywords: Connective tissue; Fascia; Meridians; Myofascial pain syndromes; Rehabilitation.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cadaver
  • Connective Tissue / anatomy & histology*
  • Fascia / anatomy & histology*
  • Humans
  • Muscle, Skeletal / anatomy & histology*
  • Myofascial Pain Syndromes / physiopathology*