The “motor unit” or the “muscle” has long been considered the quantal element in the control of movement. However, in recent years new research has proved the strong interaction between muscle fibers and intramuscular connective tissue, and between muscles and fasciae, suggesting that the muscles can no longer be considered the only elements that organize movement. In addition, innervation and vascularization of muscle is strongly connected with intramuscular connective tissue. This awareness induced Luigi Stecco, in 2002, to create a new term, the “myofascial unit”, to describe the bilateral dependent relationship, both anatomical and functional, that occurs between fascia, muscle and accessory elements. The aim of this narrative review is to understand the scientific support for this new term, and whether it is actually correct to consider the myofascial unit the physiological basic element for peripheral motor control.

Article: Myofascial points treatment with focused extracorporeal shock waves (f-ESW) for plantar fasciitis: an open label randomized clinical trial - European Journal of Physical and Rehabilitation Medicine 2021 Nov 17 - Minerva Medica - Journals

Extracorporeal Shockwaves Treatment is considered an effective therapeutic option for plantar fasciitis, but the standard application in the medial insertion of the plantar fascia on the calcaneus has provided ambiguous evidences. In this case, a 63-year man with plantar fasciitis was treated in a 3-session program and Foot and Ankle Outcome Scale and Foot Functional Index questionnaires were chosen for the clinical outcome evaluation. The therapy was focused on the active trigger or myofascial points of the leg, thigh and pelvis in order to return the correct equilibrium of the myofascial system of the whole limb. The patient has already reported an improvement after the second session (FAOS: 76 vs 33, FFI: 85%) which was confirmed in the third one and in the 1-month follow up (FAOS: 79, FFI: 6%) Results suggest that plantar fasciitis may be due to proximal rigidity or tension of the fascia and a global approach using ESWT may have a similar or better outcome respect to the standard application.

Background: Extracorporeal Shockwave Therapy (ESWT) for targeting myofascial tissues is gaining increasing interest for the treatment of musculoskeletal disorders. This review evaluates the mechanisms, applications, and effectiveness of ESWT in managing myofascial pain syndrome (MPS) while identifying methodological gaps in existing research. Methods: A systematic search of PubMed, PEDro, and Cochrane Central Library was conducted up to August 2025, focusing on studies from existing meta-analyses, particularly randomized controlled trials. Eligible studies were selected based on predefined criteria, including the use of ESWT for MPS treatment, methodological rigor, and adherence to standardized protocols. Data were extracted on diagnostic criteria for MPS and myofascial trigger points (MTrPs), shockwave application parameters, adherence to International Society for Medical Shockwave Treatment (ISMST) guidelines, follow-up periods, and treatment efficacy. Results: significant inconsistencies were identified in MPS diagnosis, shockwave application technique, and study follow-up periods. Many studies did not adhere to ISMST guidelines, with variations in energy levels, impulses, and differentiation between radial pressure wave (RPW) and focused ESWT (fESWT). One-third of the studies had follow-up periods of two weeks or less, limiting the assessment of long-term outcomes. Despite these limitations, ESWT demonstrated moderate to good efficacy compared with controls. Conclusions: While ESWT appears effective for MPS, methodological inconsistencies prevent definitive conclusions. Future research should standardize protocols, differentiate RPW from fESWT, and include longer follow-up periods to optimize therapeutic potential and validate ESWT as a treatment for MPS.