Myofascial continuity: Review of anatomical and functional evidence

Background: Myofascial continuity, the structural and functional linkage of muscles via fascial networks, is pivotal for musculoskeletal mechanics, sensory feedback, and clinical practice. Objective: This review assesses anatomical and functional evidence for myofascial chains, evaluating their structural validity, biomechanical role in force transmission, sensory integration, and therapeutic applications in physiotherapy and manual therapy. Methods: A narrative review synthesizes systematic reviews of cadaveric dissections, in vivo biomechanical studies, and primary research. Studies were selected for methodological rigor, relevance to myofascial continuity, and contributions to force transmission models. Results: Anatomical evidence strongly supports the Superficial Back Line, Back Functional Line, and Front Functional Line, with moderate evidence for the Spiral and Lateral Lines. The Superficial Front Line lacks validation. The ArthroMyoFascial complex demonstrates joint-level fascial integration, and the neck-eye myofascial continuum suggests links to oculomotor control. In vivo studies partially confirm epimuscular myofascial force transmission (EMFT), with in vitro data indicating fascia transmits up to 30 % of mechanical forces, though human evidence is limited. Fascia's contractile myofibroblasts and innervation contribute to tension regulation, proprioception, and pain modulation. Conclusion: Myofascial continuity is anatomically robust, with emerging functional significance via EMFT and sensory mechanisms. Clinical applications include targeted rehabilitation, manual therapy, and pain management, leveraging fascial and joint-level interactions. Further research using advanced imaging, controlled biomechanical trials, and standardized methods is needed to refine force transmission models and validate myofascial chains.