title: Deformations experienced in the human skin, adipose tissue, and fascia in osteopathic manipulative medicine.
abstract: BACKGROUND
  Osteopathic manipulative medicine techniques involve compressive and tangential forces to target the fascia. These forces are transmitted to the skin and adipose tissue before the fascia is encountered. Knowing the extent of deformation of these 2 tissue layers relative to the fascia will assist osteopathic physicians in evaluating techniques for manual therapies and adjusting these therapies to reduce patient discomfort and improve results.
  
  
  OBJECTIVE
  To determine the magnitude of the forces transmitted to the skin, adipose tissue, and fascia, and to determine the magnitude of deformation produced in the skin and adipose tissue relative to the fascia using a mathematical model.
  
  
  METHODS
  The large deformation theory of elasticity, valid for 3-dimensional deformations, was used to evaluate the forces that need to be applied such that a specified deformation is produced in any region of the skin, adipose tissue, or fascia layers. Similarly, if the forces are specified, then the deformation produced can be determined.
  
  
  RESULTS
  The normal and tangential forces required to produce a deformation of 9% compression and 4% shear for the skin were 50 N and 11 N, respectively. Normal and tangential forces of about 100 N and 22 N were found for a similar deformation of fascia. For adipose tissue, these forces were 36 N and 8 N, respectively. In addition, the skin experienced more compression and shear-about 1.5 times as much as the fascia, and the adipose tissue experienced about 2.5 to 3.5 times the deformation of the fascia and 50% more than the skin when a given force was applied to the skin.
  
  
  CONCLUSIONS
  The forces applied to the surface of the skin were transmitted through this layer and the adipose layer entirely to the fascia. Therefore, the skin and adipose tissue experienced the same magnitude of force as the fascia. However, the skin and adipose tissue experienced more compression and shear than the fascia.
authors.affiliation: From the departments of biomedical engineering (Dr Chaudhry), mathematical sciences, center for applied mathematics and statistics (Dr Bukiet), and mechanical engineering (Dr Zhiming) at the New Jersey Institute of Technology in Newark; the Sport Medicine Unit of the Department of Internal Medicine at the University of Padua in Padua, Italy (Dr Stecco); and the Research Service at Veterans Affairs (VA) Medical Center in East Orange and Rowan University School of Osteopathic Medicine in Stratford, New Jersey (Dr Findley).
authors.forename: Hans
authors.initials: H
authors.lastname: Chaudhry
authors.affiliation: From the departments of biomedical engineering (Dr Chaudhry), mathematical sciences, center for applied mathematics and statistics (Dr Bukiet), and mechanical engineering (Dr Zhiming) at the New Jersey Institute of Technology in Newark; the Sport Medicine Unit of the Department of Internal Medicine at the University of Padua in Padua, Italy (Dr Stecco); and the Research Service at Veterans Affairs (VA) Medical Center in East Orange and Rowan University School of Osteopathic Medicine in Stratford, New Jersey (Dr Findley) bukiet@njit.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bukiet
authors.affiliation: From the departments of biomedical engineering (Dr Chaudhry), mathematical sciences, center for applied mathematics and statistics (Dr Bukiet), and mechanical engineering (Dr Zhiming) at the New Jersey Institute of Technology in Newark; the Sport Medicine Unit of the Department of Internal Medicine at the University of Padua in Padua, Italy (Dr Stecco); and the Research Service at Veterans Affairs (VA) Medical Center in East Orange and Rowan University School of Osteopathic Medicine in Stratford, New Jersey (Dr Findley).
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Ji
authors.affiliation: From the departments of biomedical engineering (Dr Chaudhry), mathematical sciences, center for applied mathematics and statistics (Dr Bukiet), and mechanical engineering (Dr Zhiming) at the New Jersey Institute of Technology in Newark; the Sport Medicine Unit of the Department of Internal Medicine at the University of Padua in Padua, Italy (Dr Stecco); and the Research Service at Veterans Affairs (VA) Medical Center in East Orange and Rowan University School of Osteopathic Medicine in Stratford, New Jersey (Dr Findley).
authors.forename: Antonio
authors.initials: A
authors.lastname: Stecco
authors.affiliation: From the departments of biomedical engineering (Dr Chaudhry), mathematical sciences, center for applied mathematics and statistics (Dr Bukiet), and mechanical engineering (Dr Zhiming) at the New Jersey Institute of Technology in Newark; the Sport Medicine Unit of the Department of Internal Medicine at the University of Padua in Padua, Italy (Dr Stecco); and the Research Service at Veterans Affairs (VA) Medical Center in East Orange and Rowan University School of Osteopathic Medicine in Stratford, New Jersey (Dr Findley).
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Findley
mesh_terms: D000273:Adipose Tissue / Q000502:physiology*; D001696:Biomechanical Phenomena; D004548:Elasticity; D005205:Fascia / Q000502:physiology*; D006801:Humans; D026301:Manipulation, Osteopathic; D008962:Models, Theoretical; D012879:Skin Physiological Phenomena; D013314:Stress, Mechanical