{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:19:10Z","timestamp":1783419550255,"version":"3.54.6"},"reference-count":38,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"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>The local twitch response (LTR) elicited during ultrasound-guided fascial hydrorelease (FHR) is conventionally attributed to dysfunctional motor endplates. Recent observational data from a companion study suggest that LTR events may occur preferentially within stacking fascia\u2014a histologically defined multilayered, densified region of deep fascia\u2014at sites not directly attributable to motor endplate excitation. We propose the Fascial Capacitor Model: stacking fascia can be conceptually modeled as a multilayer biological capacitor in which collagen sublayers may act as electrodes and the interposed densified hyaluronic-acid (HA)-rich loose layer may act as the dielectric, with the LTR hypothesized to reflect a transient electrophysiological discharge when a needle bridges its layers. This biophysical model is grounded in the established molecular and histological architecture of human deep fascia, and the analogy is intended as one of structural isomorphism, rather than complete functional equivalence with engineered capacitor devices. Each premise is independently supported by the primary literature from at least eight research lines spanning roughly seventy years. The apparent gap between estimated bulk discharge voltages and motor neuron threshold is addressed by reconsidering needle-tip geometry and stimulation modality, anchored by the \u00b16 V triboelectric measurements. The pathological extension of the RC time constant in densified fascia\u2014lengthening by several orders of magnitude and estimated to reach the millisecond range\u2014is supported by empirical evidence from fibrotic extracellular matrices in other connective tissues, while tissue-specific in vivo measurements in fascia remain a future task. The model is positioned as the immediate-phase complement to the Fascial Memory Reset Hypothesis, provides a candidate mechanistic interpretation for intra-procedural symptom relief\u2014an as-yet unquantified clinical observation awaiting formal patient-reported outcome (PRO) measurement in a prospective trial\u2014and yields falsifiable predictions. A direct empirical validation program using insulating-needle recording of spontaneous electrical activity (SEA) is in preparation at the corresponding author\u2019s institution.<\/jats:p>","DOI":"10.3390\/ijms27135901","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:50:37Z","timestamp":1782867037000},"page":"5901","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Fascial Capacitor Model: A Biophysical Hypothesis for the Origin of the Local Twitch Response Within Stacking Fascia"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8959-5748","authenticated-orcid":false,"given":"Hiroaki","family":"Kimura","sequence":"first","affiliation":[{"name":"Kimura Pain Clinic, Maebashi 371-0013, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2001-4464","authenticated-orcid":false,"given":"Tadashi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","unstructured":"Travell, J.G., and Simons, D.G. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual, Williams & Wilkins. [2nd ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00002060-199407000-00006","article-title":"Lidocaine injection versus dry needling to myofascial trigger point: The importance of the local twitch response","volume":"73","author":"Hong","year":"1994","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/09645284211056346","article-title":"The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: A systematic review and meta-analysis","volume":"40","author":"Cleland","year":"2022","journal-title":"Acupunct. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/00002060-200203000-00010","article-title":"Endplate potentials are common to midfiber myofascial trigger points","volume":"81","author":"Simons","year":"2002","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kimura, H., Hiroki, T., Kobayashi, T., and Obata, H. (2026). Local Twitches During Ultrasound-Guided Fascial Hydrorelease Occur Within Stacking Fascia: A Retrospective Analysis of a Large Video Archive. Med. Sci., 14.","DOI":"10.20944\/preprints202606.0910.v1"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kimura, H., Kobayashi, T., and Obata, H. (2026). A Conceptual Fascial Memory Reset Hypothesis: Mechanobiological Insights into Stacking Fascia as an Ultrasound-Visible Structural Phenotype and the Potential Role of Fascial Hydrorelease. Int. J. Mol. Sci., 27.","DOI":"10.20944\/preprints202603.1500.v1"},{"key":"ref_7","unstructured":"Kimura, H. (2017). Spontaneous discharge of stacking fascia: A unified hypothesis for myofascial pain syndrome. Oral Presentation, 20th MPS Research Meeting, Fukuoka Prefecture Dental Association."},{"key":"ref_8","first-page":"105","article-title":"Histological characteristics of the deep fascia of the upper limb","volume":"111","author":"Stecco","year":"2006","journal-title":"Ital. J. Anat. Embryol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1143\/JPSJ.12.1158","article-title":"On the piezoelectric effect of bone","volume":"12","author":"Fukada","year":"1957","journal-title":"J. Phys. Soc. Jpn."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1143\/JJAP.3.117","article-title":"Piezoelectric effects in collagen","volume":"3","author":"Fukada","year":"1964","journal-title":"Jpn. J. Appl. Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"085706","DOI":"10.1088\/0957-4484\/20\/8\/085706","article-title":"Nanoscale characterization of isolated individual type I collagen fibrils: Polarization and piezoelectricity","volume":"20","author":"Yu","year":"2009","journal-title":"Nanotechnology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1021\/nn900472n","article-title":"Uncovering nanoscale electromechanical heterogeneity in the subfibrillar structure of collagen fibrils responsible for the piezoelectricity of bone","volume":"3","author":"Yu","year":"2009","journal-title":"ACS Nano"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s11916-014-0441-4","article-title":"Painful connections: Densification versus fibrosis of fascia","volume":"18","author":"Pavan","year":"2014","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"127","DOI":"10.36253\/ijae-1101","article-title":"The fascia: The forgotten structure","volume":"116","author":"Stecco","year":"2011","journal-title":"Ital. J. Anat. Embryol."},{"key":"ref_15","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_16","doi-asserted-by":"crossref","unstructured":"Fede, C., Petrelli, L., Pirri, C., Neuhuber, W., Tiengo, C., Biz, C., De Caro, R., Schleip, R., and Stecco, C. (2022). Innervation of human superficial fascia. Front. Neuroanat., 16.","DOI":"10.3389\/fnana.2022.981426"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1002\/ca.23072","article-title":"The fasciacytes: A new cell devoted to fascial gliding regulation","volume":"31","author":"Stecco","year":"2018","journal-title":"Clin. Anat."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s00276-011-0876-9","article-title":"Hyaluronan within fascia in the etiology of myofascial pain","volume":"33","author":"Stecco","year":"2011","journal-title":"Surg. Radiol. Anat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/nature10137","article-title":"Role of YAP\/TAZ in mechanotransduction","volume":"474","author":"Dupont","year":"2011","journal-title":"Nature"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"L344","DOI":"10.1152\/ajplung.00300.2014","article-title":"Mechanosignaling through YAP and TAZ drives fibroblast activation and fibrosis","volume":"308","author":"Liu","year":"2015","journal-title":"Am. J. Physiol.-Lung Cell. Mol. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pirri, C., Caroccia, B., Angelini, A., Piazza, M., Petrelli, L., Caputo, I., Montemurro, C., Ruggieri, P., De Caro, R., and Stecco, C. (2023). A New Player in the Mechanobiology of Deep Fascia: Yes-Associated Protein (YAP). Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242015389"},{"key":"ref_22","first-page":"133","article-title":"Electromechanical and physicochemical properties of connective tissue","volume":"9","author":"Grodzinsky","year":"1983","journal-title":"Crit. Rev. Biomed. Eng."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.medengphy.2009.02.006","article-title":"Relevance of collagen piezoelectricity to \u201cWolff\u2019s Law\u201d: A critical review","volume":"31","author":"Ahn","year":"2009","journal-title":"Med. Eng. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1088\/0031-9155\/41\/11\/001","article-title":"The dielectric properties of biological tissues: I. Literature survey","volume":"41","author":"Gabriel","year":"1996","journal-title":"Phys. Med. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fuentes-V\u00e9lez, S., Fagoonee, S., Sanginario, A., Pizzi, M., Altruda, F., and Demarchi, D. (2022). Electrical Impedance-Based Characterization of Hepatic Tissue with Early-Stage Fibrosis. Biosensors, 12.","DOI":"10.3390\/bios12020116"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.neuroscience.2011.07.066","article-title":"Sensory innervation of the thoracolumbar fascia in rats and humans","volume":"194","author":"Tesarz","year":"2011","journal-title":"Neuroscience"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1126\/science.1193270","article-title":"Piezo1 and Piezo2 are essential components of distinct mechanically activated cation channels","volume":"330","author":"Coste","year":"2010","journal-title":"Science"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1096\/fj.01-0015hyp","article-title":"Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture","volume":"15","author":"Langevin","year":"2001","journal-title":"FASEB J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"C747","DOI":"10.1152\/ajpcell.00420.2004","article-title":"Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo","volume":"288","author":"Langevin","year":"2005","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1089\/acm.2007.6351","article-title":"Connective tissue fibroblast response to acupuncture: Dose-dependent effect of bidirectional needle rotation","volume":"13","author":"Langevin","year":"2007","journal-title":"J. Altern. Complement. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"9765634","DOI":"10.34133\/2022\/9765634","article-title":"Surface Plasmon Effect Dominated High-Performance Triboelectric Nanogenerator for Traditional Chinese Medicine Acupuncture","volume":"2022","author":"Chen","year":"2022","journal-title":"Research"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2479","DOI":"10.1038\/s41467-023-38241-x","article-title":"Piezo2-expressing nociceptors mediate mechanical sensitization in experimental osteoarthritis","volume":"14","author":"Obeidat","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1038\/s41467-019-09461-x","article-title":"Quantifying the triboelectric series","volume":"10","author":"Zou","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00232-017-9962-1","article-title":"Asymmetric Patterns of Small Molecule Transport After Nanosecond and Microsecond Electropermeabilization","volume":"251","author":"Pocetti","year":"2018","journal-title":"J. Membr. Biol."},{"key":"ref_35","unstructured":"Kimura, H., Kobayashi, T., and Namiki, H. (2021). Fascia\u30ea\u30ea\u30fc\u30b9\u306e\u57fa\u672c\u3068\u81e8\u5e8a\u2014\u30cf\u30a4\u30c9\u30ed\u30ea\u30ea\u30fc\u30b9\u306e\u3059\u3079\u3066 [Fundamentals and Clinical Practice of Fascia Release: Everything About Hydrorelease], Bunkodo. [2nd ed.]. (In Japanese)."},{"key":"ref_36","unstructured":"Schleip, R., Stecco, C., Driscoll, M., and Huijing, P.A. (2022). Hydrorelease of Fascia. Fascia: The Tensional Network of the Human Body, Elsevier. [2nd ed.]."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/AAP.0b013e31819a2795","article-title":"Structural injury to the human sciatic nerve after intraneural needle insertion","volume":"34","author":"Ribalta","year":"2009","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"McDonnell, M.D., and Abbott, D. (2009). What is stochastic resonance? Definitions, misconceptions, debates, and its relevance to biology. PLoS Comput. Biol., 5.","DOI":"10.1371\/journal.pcbi.1000348"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5901\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:12:53Z","timestamp":1783419173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5901"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":38,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ijms27135901"],"URL":"https:\/\/doi.org\/10.3390\/ijms27135901","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]}}}