{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:39:59Z","timestamp":1792046399893,"version":"4.4.0"},"reference-count":95,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Among the leading etiologies of limb amputations are diabetes mellitus, alongside trauma and peripheral vascular disease conditions, whose complications are major indications for surgery, which can subsequently elicit chronic refractory postamputation pain. \u2018Phantom limb pain\u2019 (PLP) denotes pain that is perceived as occurring in an absent part of the limb following amputation. Even though it is a relatively common complication among amputees\u2014with an estimated prevalence as high as ~80 percent\u2014the underlying mechanisms of this puzzling condition remain poorly understood. Current theories predominantly emphasize the role of the nervous system and neuropsychopathology in the development of PLP. However, these neurocentric explanations are disputed and have not yet been translated into effective treatments or a definitive cure for the condition, nor have several notable anomalies been settled, which has prompted researchers to call for the exploration of alternative theories. The aim of this paper is to offer an alternative mechanical mechanism for explaining PLP and spontaneous phantom sensations. This work introduces a theoretical model for the mechanism of PLP, drawing on a recent study that proposed this model to explain fibromyalgia-type psychosomatic syndromes as disorders driven by overactive soft tissue myofibroblasts. The manuscript proposes a shift from purely neurocentric models of PLP to a framework where the extracellular matrix and connective tissue, specifically myofascial tissue and inflammatory myofibroblasts\u2014which are often overlooked in research\u2014take part in its pathogenesis. In this suggested model, surgical interventions disrupt the biomechanical stability of the fascio-musculoskeletal biotensegrity-like system, thus acting as a contributing factor in the chronic pain manifestation. The term \u2018biotensegrity\u2019 refers to the dynamic biomechanical behavior of a living system that is stabilized by compressive and tensile force elements, a characteristic quality of myofascial tissue. In this framework, abnormal extracellular matrix remodeling, driven by overactive peripheral myofibroblasts, and the concomitant mechanical effects exerted on sensory nerves embedded within the fascia and reaching the neuroma microenvironment contribute to the generation and perception of spontaneous PLP and phantom sensations. The interplay between abnormal extracellular matrix, the neuroma\u2019s intrinsic excitability, as well as peripheral and central neurophysiological mechanisms, collectively provide a biophysical neuropathophysiological basis to help explain PLP. This offers a different unexplored perspective on a condition with poorly understood mechanisms.<\/jats:p>","DOI":"10.3390\/ijms26178161","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T13:47:49Z","timestamp":1755870469000},"page":"8161","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Disrupted Biotensegrity in the Fiber Cellular Fascial Network and Neuroma Microenvironment: A Conceptual Framework for \u201cPhantom Limb Pain\u201d"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5823-3390","authenticated-orcid":false,"given":"Shiloh","family":"Plaut","sequence":"first","affiliation":[{"name":"Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2408, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S1474-4422(02)00074-1","article-title":"Phantom-limb pain: Characteristics, causes, and treatment","volume":"1","author":"Flor","year":"2002","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.apmr.2005.03.031","article-title":"Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey","volume":"86","author":"Ephraim","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Limakatso, K., Bedwell, G.J., Madden, V.J., and Parker, R. (2020). The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0240431"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1046\/j.1526-4637.2000.00012.x","article-title":"Phantom tooth pain: A new look at an old dilemma","volume":"1","author":"Marbach","year":"2000","journal-title":"Pain Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0304-3959(03)00241-0","article-title":"Neuropathic pain following breast cancer surgery: Proposed classification and research update","volume":"104","author":"Jung","year":"2003","journal-title":"Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1172\/JCI94003","article-title":"A review of current theories and treatments for phantom limb pain","volume":"128","author":"Collins","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Plaut, S. (2022). Scoping review and interpretation of myofascial pain\/fibromyalgia syndrome: An attempt to assemble a medical puzzle. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263087"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"598","DOI":"10.3899\/jrheum.191068","article-title":"Erratum in: Intramuscular Pressure Is Almost Three Times Higher in Fibromyalgia Patients: A Possible Mechanism for Understanding the Muscle Pain and Tenderness","volume":"48","author":"Katz","year":"2021","journal-title":"J. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e144201","DOI":"10.1172\/JCI144201","article-title":"Passive transfer of fibromyalgia symptoms from patients to mice","volume":"131","author":"Goebel","year":"2021","journal-title":"J. Clin. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.surg.2014.08.063","article-title":"Fibromyalgia symptoms and medication requirements respond to parathyroidectomy","volume":"156","author":"Adkisson","year":"2014","journal-title":"Surgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s11695-008-9505-z","article-title":"The effect of laparoscopic Roux-en-Y gastric bypass on fibromyalgia","volume":"18","author":"Saber","year":"2008","journal-title":"Obes. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.bbi.2016.05.021","article-title":"Spinal versus brain microglial and macrophage activation traits determine the differential neuroinflammatory responses and analgesic effect of minocycline in chronic neuropathic pain","volume":"58","author":"Li","year":"2016","journal-title":"Brain Behav. Immun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1038\/nrn1991","article-title":"Phantom limb pain: A case of maladaptive CNS plasticity?","volume":"7","author":"Flor","year":"2006","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1093\/pm\/pnab319","article-title":"Can Central Sensitization After Injury Persist as an Autonomous Pain Generator? A Comprehensive Search for Evidence","volume":"23","author":"Brazenor","year":"2022","journal-title":"Pain Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Velasco, E., Flores-Cort\u00e9s, M., Guerra-Armas, J., Flix-D\u00edez, L., Gurdiel-\u00c1lvarez, F., Donado-Bermejo, A., van den Broeke, E.N., P\u00e9rez-Cervera, L., and Delicado-Miralles, M. (2024). Is chronic pain caused by central sensitization? A review and critical point of view. Neurosci. Biobehav. Rev., 167.","DOI":"10.1016\/j.neubiorev.2024.105886"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1093\/brain\/awv161","article-title":"Reassessing cortical reorganization in the primary sensorimotor cortex following arm amputation","volume":"138","author":"Makin","year":"2015","journal-title":"Brain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1152\/jn.00482.2020","article-title":"Aberrant activity in an intact residual muscle is associated with phantom limb pain in above-knee amputees","volume":"125","author":"Therrien","year":"2021","journal-title":"J. Neurophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1227\/01.NEU.0000093424.71086.8F","article-title":"Cortical areas involved in virtual movement of phantom limbs: Comparison with normal subjects","volume":"53","author":"Roux","year":"2003","journal-title":"Neurosurgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1038\/ncomms2571","article-title":"Phantom pain is associated with preserved structure and function in the former hand area","volume":"4","author":"Makin","year":"2013","journal-title":"Nat. Commun."},{"key":"ref_20","unstructured":"Wall, P.D., and Melzack, R.A. (1999). Phantom pain and other phenomena after amputation. Textbook of Pain, Churchill Livingstone. [4th ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.tins.2006.02.003","article-title":"Fire and phantoms after spinal cord injury: Na+ channels and central pain","volume":"29","author":"Waxman","year":"2006","journal-title":"Trends Neurosci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.brainres.2014.07.022","article-title":"Forelimb amputation-induced reorganization in the ventral posterior lateral nucleus (VPL) provides a substrate for large-scale cortical reorganization in rat forepaw barrel subfield (FBS)","volume":"1583","author":"Li","year":"2014","journal-title":"Brain Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/0304-3959(90)90029-D","article-title":"Pain \u2018memories\u2019 in phantom limbs: Review and clinical observations","volume":"43","author":"Katz","year":"1990","journal-title":"Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1002\/acn3.89","article-title":"Observation of limb movements reduces phantom limb pain in bilateral amputees","volume":"1","author":"Tung","year":"2014","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/0304-3959(87)90064-9","article-title":"Psychological factors influencing chronic phantom limb pain: An analysis of the literature","volume":"28","author":"Sherman","year":"1987","journal-title":"Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/0304-3959(84)90128-3","article-title":"Chronic phantom and stump pain among American veterans: Results of a survey","volume":"18","author":"Sherman","year":"1984","journal-title":"Pain"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tadeo, I., Berbegall, A.P., Escudero, L.M., Alvaro, T., and Noguera, R. (2014). Biotensegrity of the extracellular matrix: Physiology, dynamic mechanical balance, and implications in oncology and mechanotherapy. Front. Oncol., 4.","DOI":"10.3389\/fonc.2014.00039"},{"key":"ref_28","unstructured":"Chaitow, L., Schleip, R., Huijing, P., and Findley, T.W. (2012). Fascia: The Tensional Network of the Human Body\u2014The Science and Clinical Applications in Manual and Movement Therapy, Churchill Livingstone\/Elsevier. [2nd ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1007\/s00419-022-02192-4","article-title":"Seventy years of tensegrities (and counting)","volume":"92","author":"Micheletti","year":"2022","journal-title":"Arch. Appl. Mech."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jbmt.2019.09.006","article-title":"Biotensegrity: What is the big deal?","volume":"24","author":"Scarr","year":"2020","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.apmr.2015.07.023","article-title":"What Is Evidence-Based About Myofascial Chains: A Systematic Review","volume":"97","author":"Wilke","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1111\/joa.12464","article-title":"Intermuscular force transmission along myofascial chains: A systematic review","volume":"228","author":"Krause","year":"2016","journal-title":"J. Anat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1007\/s11916-013-0352-9","article-title":"Fascial components of the myofascial pain syndrome","volume":"17","author":"Stecco","year":"2013","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1002\/ca.23388","article-title":"Fascial entrapment neuropathy","volume":"32","author":"Stecco","year":"2019","journal-title":"Clin. Anat."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/ca.23882","article-title":"The deep fascia and its role in chronic pain and pathological conditions: A review","volume":"35","author":"Kondrup","year":"2022","journal-title":"Clin. Anat."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Fede, C., Pirri, C., Fan, C., Petrelli, L., Guidolin, D., De Caro, R., and Stecco, C. (2021). A Closer Look at the Cellular and Molecular Components of the Deep\/Muscular Fasciae. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22031411"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1002\/jor.24665","article-title":"Fascia and soft tissues innervation in the human hip and their possible role in post-surgical pain","volume":"38","author":"Fede","year":"2020","journal-title":"J. Orthop. Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Fede, C., Petrelli, L., Guidolin, D., Porzionato, A., Pirri, C., Fan, C., De Caro, R., and Stecco, C. (2021). Evidence of a new hidden neural network into deep fasciae. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-92194-z"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Suarez-Rodriguez, V., Fede, C., Pirri, C., Petrelli, L., Loro-Ferrer, J.F., Rodriguez-Ruiz, D., De Caro, R., and Stecco, C. (2022). Fascial Innervation: A Systematic Review of the Literature. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23105674"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e1901036","DOI":"10.1002\/adhm.201901036","article-title":"Mechanical Response of Neural Cells to Physiologically Relevant Stiffness Gradients","volume":"9","author":"Kayal","year":"2020","journal-title":"Adv. Healthc. Mater."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.biomaterials.2016.02.041","article-title":"Matrix stiffness modulates formation and activity of neuronal networks of controlled architectures","volume":"89","author":"Lantoine","year":"2016","journal-title":"Biomaterials"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6672","DOI":"10.1016\/j.biomaterials.2012.06.006","article-title":"The influence of substrate stiffness on the behavior and functions of Schwann cells in culture","volume":"33","author":"Gu","year":"2012","journal-title":"Biomaterials"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1038\/nrm809","article-title":"Myofibroblasts and mechano-regulation of connective tissue remodelling","volume":"3","author":"Tomasek","year":"2002","journal-title":"Nat. Rev. Mol. Cell Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1038\/s41586-020-2938-9","article-title":"Fibrosis: From mechanisms to medicines","volume":"587","author":"Henderson","year":"2020","journal-title":"Nature"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hu, D., Jiang, J., Ding, B., Xue, K., Sun, X., and Qian, S. (2021). Mechanical Strain Regulates Myofibroblast Differentiation of Human Scleral Fibroblasts by YAP. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.712509"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"12502","DOI":"10.1038\/ncomms12502","article-title":"PAK Proteins and YAP-1 Signalling Downstream of Integrin Beta-1 in Myofibroblasts Promote Liver Fibrosis","volume":"7","author":"Martin","year":"2016","journal-title":"Nat. Commun."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Tarbit, E., Singh, I., Peart, J.N., Bivol, S., and Rose\u2019Meyer, R.B. (2021). Increased release of serotonin from rat primary isolated adult cardiac myofibroblasts. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-99632-y"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1126\/science.173.3996.548","article-title":"Contraction of granulation tissue in vitro: Similarity to smooth muscle","volume":"173","author":"Majno","year":"1971","journal-title":"Science"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3625","DOI":"10.1016\/j.celrep.2018.03.010","article-title":"Single-Cell Deconvolution of Fibroblast Heterogeneity in Mouse Pulmonary Fibrosis","volume":"22","author":"Xie","year":"2018","journal-title":"Cell Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"L824","DOI":"10.1152\/ajplung.00350.2015","article-title":"\u03b1-Smooth muscle actin is an inconsistent marker of fibroblasts responsible for force-dependent TGF\u03b2 activation or collagen production across multiple models of organ fibrosis","volume":"310","author":"Sun","year":"2016","journal-title":"Am. J. Physiol. Lung Cell Mol. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s00418-004-0667-z","article-title":"Fibroblasts form a body-wide cellular network","volume":"122","author":"Langevin","year":"2004","journal-title":"Histochem. Cell Biol."},{"key":"ref_52","first-page":"195","article-title":"Variability of fibroblast morphology in vivo: A silver impregnation study on human digital dermis and subcutis","volume":"177","author":"Novotny","year":"1991","journal-title":"J. Anat."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"C147","DOI":"10.1152\/ajpcell.2000.279.1.C147","article-title":"Biochemical and functional characterization of intercellular adhesion and gap junctions in fibroblasts","volume":"279","author":"Ko","year":"2000","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"20150140","DOI":"10.1098\/rsif.2015.0140","article-title":"Mechanics regulates ATP-stimulated collective calcium response in fibroblast cells","volume":"12","author":"Lembong","year":"2015","journal-title":"J. R. Soc. Interface"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1038\/s41392-023-01501-9","article-title":"Cellular mechanotransduction in health and diseases: From molecular mechanism to therapeutic targets","volume":"8","author":"Di","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1111\/joa.13124","article-title":"Role of fasciae around the median nerve in pathogenesis of carpal tunnel syndrome: Microscopic and ultrasound study","volume":"236","author":"Stecco","year":"2020","journal-title":"J. Anat."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1177\/107110079401500706","article-title":"Plantar fascia rupture associated with corticosteroid injection","volume":"15","author":"Sellman","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1177\/107110079801900207","article-title":"Complications of plantar fascia rupture associated with corticosteroid injection","volume":"19","author":"Acevedo","year":"1998","journal-title":"Foot Ankle Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jse.2016.01.012","article-title":"The effect of myofibroblasts and corticosteroid injections in adhesive capsulitis","volume":"25","author":"Hettrich","year":"2016","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s40259-017-0211-z","article-title":"Adverse Effects of Collagenase in the Treatment of Dupuytren Disease: A Systematic Review","volume":"31","year":"2017","journal-title":"BioDrugs"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e7355","DOI":"10.1097\/MD.0000000000007355","article-title":"Incidence of trigger digits following carpal tunnel release: A nationwide, population-based retrospective cohort study","volume":"96","author":"Lin","year":"2017","journal-title":"Medicine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1177\/0363546513494359","article-title":"Efficacy of platelet-rich plasma for chronic tennis elbow: A double-blind, prospective, multicenter, randomized controlled trial of 230 patients","volume":"42","author":"Mishra","year":"2014","journal-title":"Am. J. Sports Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"E118","DOI":"10.1097\/01.BRS.0000051703.90769.71","article-title":"Medial compartment syndrome of the foot: An unusual complication of spine surgery","volume":"28","author":"Stotts","year":"2003","journal-title":"Spine"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2340\/16501977-0353","article-title":"Phantom limb pain relief by contralateral myofascial injection with local anaesthetic in a placebo-controlled study: Preliminary results","volume":"41","author":"Casale","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Guo, Q., Di, Z., Tian, H.F., and Zhang, Q.A. (2021). Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report. Front. Neurosci., 15.","DOI":"10.3389\/fnins.2021.713548"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1080\/02640414.2016.1251606","article-title":"Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial","volume":"35","author":"Wilke","year":"2017","journal-title":"J. Sports Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s40279-017-0703-5","article-title":"Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching","volume":"47","author":"Nordez","year":"2017","journal-title":"Sports Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s00421-015-3270-1","article-title":"Acute bouts of upper and lower body static and dynamic stretching increase non-local joint range of motion","volume":"116","author":"Behm","year":"2016","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Chen, B., Cui, S., Xu, M., Zhang, Z., and Liu, C. (2022). Effects of Isometric Plantar-Flexion on the Lower Limb Muscle and Lumbar Tissue Stiffness. Front. Bioeng. Biotechnol., 9.","DOI":"10.3389\/fbioe.2021.810250"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1002\/ca.23835","article-title":"The anatomical myofascial continuum between the neck and eyes","volume":"35","author":"Prabhu","year":"2022","journal-title":"Clin. Anat."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1096\/fj.05-5424rev","article-title":"Cellular mechanotransduction: Putting all the pieces together again","volume":"20","author":"Ingber","year":"2006","journal-title":"FASEB J."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0266-7681(85)80015-2","article-title":"The pathobiology of human neuromas: An electron microscopic and biochemical study","volume":"10","author":"Badalamente","year":"1985","journal-title":"J. Hand Surg. Br."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Akbar, M., McLean, M., Garcia-Melchor, E., Crowe, L.A., McMillan, P., Fazzi, U.G., Martin, D., Arthur, A., Reilly, J.H., and McInnes, I.B. (2019). Fibroblast activation and inflammation in frozen shoulder. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215301"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e20191430","DOI":"10.1084\/jem.20191430","article-title":"Neuronal interleukin-1 receptors mediate pain in chronic inflammatory diseases","volume":"217","author":"Mailhot","year":"2020","journal-title":"J. Exp. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.pain.2010.07.018","article-title":"Mechanisms involved in IL-6-induced muscular mechanical hyperalgesia in mice","volume":"151","author":"Manjavachi","year":"2010","journal-title":"Pain"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1097\/00007632-199609150-00006","article-title":"The effects of mechanical compression and hypoxia on nerve root and dorsal root ganglia. An analysis of ectopic firing using an in vitro model","volume":"21","author":"Sugawara","year":"1996","journal-title":"Spine"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1227\/NEU.0000000000001313","article-title":"Prevention of Painful Neuroma and Phantom Limb Pain After Transfemoral Amputations Through Concomitant Nerve Coaptation and Collagen Nerve Wrapping","volume":"79","author":"Economides","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/0309364612447807","article-title":"Role of myofascial trigger points in post-amputation pain: Causation and management","volume":"37","author":"Reiestad","year":"2013","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1080\/09638280010029930","article-title":"Contractures in orthopaedic and neurological conditions: A review of causes and treatment","volume":"23","author":"Farmer","year":"2001","journal-title":"Disabil. Rehabil."},{"key":"ref_80","first-page":"76","article-title":"Changes in hip muscles after above-knee amputation","volume":"312","author":"Jaegers","year":"1995","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"3749","DOI":"10.1080\/09638288.2021.1893393","article-title":"Fitting transtibial and transfemoral prostheses in persons with a severe flexion contracture: Problems and solutions\u2014A systematic review","volume":"44","author":"Poonsiri","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1302\/0301-620X.94B11.30512","article-title":"Fixed flexion deformity and total knee arthroplasty","volume":"94","author":"Su","year":"2012","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1002\/jor.23498","article-title":"Effects of joint immobilization on changes in myofibroblasts and collagen in the rat knee contracture model","volume":"35","author":"Sasabe","year":"2017","journal-title":"J. Orthop. Res."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0363-5023(78)80090-2","article-title":"Digital contracture deformity after implantation of a silicone prosthesis: Light and electron microscopic study","volume":"3","author":"Chamay","year":"1978","journal-title":"J. Hand Surg. Am."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ca.23391","article-title":"Active contractile properties of fascia","volume":"32","author":"Schleip","year":"2019","journal-title":"Clin. Anat."},{"key":"ref_86","first-page":"508","article-title":"Chronic pain and the search for alternative treatments","volume":"145","author":"Goldman","year":"1991","journal-title":"CMAJ Can. Med. Assoc. J."},{"key":"ref_87","first-page":"70","article-title":"Psychosomatic aspects of peptic ulcer","volume":"36","author":"Milton","year":"1962","journal-title":"Q. Bull. Northwest Univ. Med. Sch."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/0167-8760(92)90022-4","article-title":"Temporal relationships between changes in phantom limb pain intensity and changes in surface electromyogram of the residual limb","volume":"13","author":"Sherman","year":"1992","journal-title":"Int. J. Psychophysiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1038\/s41523-021-00321-w","article-title":"Trigger point injection for post-mastectomy pain: A simple intervention with high rate of long-term relief","volume":"7","author":"Khoury","year":"2021","journal-title":"NPJ Breast Cancer"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1002\/rnj.142","article-title":"Application of Tensegrity Massage to Relive Complications After Mastectomy\u2014Case Report","volume":"40","author":"Wilk","year":"2015","journal-title":"Rehabil. Nurs."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.jmpt.2013.06.004","article-title":"Comparison of massage based on the tensegrity principle and classic massage in treating chronic shoulder pain","volume":"36","author":"Kassolik","year":"2013","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jbmt.2007.11.002","article-title":"Tensegrity principle in massage demonstrated by electro- and mechanomyography","volume":"13","author":"Kassolik","year":"2009","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Chiu, P.E., Fu, Z., Sun, J., Jian, G.W., Li, T.M., and Chou, L.W. (2022). Efficacy of Fu\u2019s Subcutaneous Needling in Treating Soft Tissue Pain of Knee Osteoarthritis: A Randomized Clinical Trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237184"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.apmr.2021.07.810","article-title":"Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysis","volume":"103","author":"Xie","year":"2022","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1136\/jnnp-2021-328428","article-title":"Making sense of phantom limb pain","volume":"93","author":"Schone","year":"2022","journal-title":"J. Neurol. Neurosurg. Psychiatry"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/17\/8161\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:04Z","timestamp":1760034844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/17\/8161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":95,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijms26178161"],"URL":"https:\/\/doi.org\/10.3390\/ijms26178161","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}