SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Integrative Physiology
This article is part of the Research TopicMechanical Forces in Health and Disease: A Mechanobiological PerspectiveView all 19 articles
Alterations in Intramuscular Connective Tissue in Hypertonic Muscle: A Scoping Review
Provisionally accepted
Xiaoxiao Zhao1,2*
Yunfeng Sun1,2
Caterina Fede1*
Carmelo Pirri1
Wei Gong3
Alessandra Del Felice2,4
Carla Stecco1- 1Institute of Human Anatomy, Department of Neurosciences, University of Padova, 35121 Padova, Italy, Padova, Italy
- 2Padova Neuroscience Center, University of Padova, 35129 Padova, Italy, Padova, Italy
- 3Rehabilitation Medicine Department, Dongguan Kanghua Hospital, No. 1000Dongguan Avenue, Nancheng Subdistrict, Dongguan 523ooo,Guangdong, P.R. China, Dongguan, China
- 4Section of Neurology, Department of Neuroscience, University of Padova, 35122 Padova, Italy, Padova, Italy
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Introduction: Muscle hypertonia is a common symptom in patients with upper motor neuron disorders. To date, the role of intramuscular connective tissue (IMCT) alterations in hypertonic muscle has not been fully explored. This review aimed to identify and characterize alterations in IMCT components in hypertonic muscle in central neurological disorders. Methods: This scoping review included studies investigating IMCT alterations in hypertonic muscles resulting from central neurological disorders. Four electronic databases, including PubMed/Medline, CINAHL, Web of Science, and Scopus, were searched to identify relevant studies published prior to July 20, 2025. The review followed the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The risk of bias was evaluated using ROBINS-E. Data were extracted and narratively synthesized according to IMCT categories. Results: Twelve studies were included. Among the included studies, increased collagen, glycosaminoglycan content, fascia thickness, and fibroblasts, as well as altered IMCT structural properties, were found in hypertonic muscles. The collagen content was found to be positively correlated with spasticity and stiffness. A key limitation of these studies is that all participants were in the chronic stage of the neurological disease. Conclusion: This scoping review provides evidence that alterations in IMCT components in muscle with hypertonia occur across different neurological conditions. Targeting these changes may provide a new intervention strategy to reduce muscle stiffness and improve the muscle function of patients with hypertonia secondary to neurological disease.
Keywords: Hypertonia, Intramuscular connective tissue, Fascia, Extracellular Matrix, Collagen
Received: 08 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Zhao, Sun, Fede, Pirri, Gong, Del Felice and Stecco. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoxiao Zhao
Caterina Fede
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