Table 1.

Currently used diagnostic methods to examine fascial tissue structure and function

Method	Assessment target	Advantages	Disadvantages	References
Biopsy	Histological properties including molecular analysis.	Permits analysis of tissue damage, infiltration of inflammatory cells, cytokines and others.	Invasiveness.	66 75 77
Bioimpedance	Hydration changes.	High sensitivity.	Lacking data on reliability and validity for smaller regions.	78
Manual palpation	Stiffness, elasticity and shearing mobility of tissue.	Cost-effectiveness. Psychosocial factors.	Limited reliability.	79 80 82
Indentometry	Stiffness and elasticity.	Established reproducibility.	Limited depth.	) 81 83–85
Ultrasound (US) imaging	Thickness of layers, tendon elongation.	Permits diagnosis of a fibrotic thickening (eg, of a particular endomysium) or of tendon strain response during loading.	Difficulty in standardising the exact viewing angle.	86 88
US with correlation software	Relative shearing motion of adjacent layers.	Permits diagnosis of adhesive tissue connections, such as in chronic low back pain.	Lacking standards for selection of regions of interest.	89
Compression-based US elastography	Stiffness.	Measurements possible at further depth than, for example, with indentometry.	Lack of standardisation. Frequent appearance of artefacts.	87
Shear-wave US elastography	Stiffness.	Enhancement by propagation analysis permits morphological analysis.	Lack of standardisation.	90 91
B-mode ultrasonography	Tendon structure and mechanical/material properties.	In vivo methodology. Application in perspective studies. Relatively inexpensive.	Accuracy is user-dependent. Applicability is limited to superficial tendons mainly. Limited control of any mediolateral deviation of the tendon line of pull off the scanning plane. Tendon slack length (ie, at 0% strain) and tendon force cannot be directly measured and need to be estimated. Scanning frame rate is currently limited.	90 96–98 103