Repouso eletromiográfico dos músculos mastigatórios de pacientes com disfunção temporomandibular antes e após intervenção fonoaudiológica com e sem bandagem elástica / Electromyographic rest of the masticatory muscles of patients with temporomandibular disorders before and after speech therapy with and without elastic bandage / Resto electromiográfico de los músculos masticatorios de pacientes con trastornos temporomandibulares antes y después de logopedia con y sin venda elástica

Objetivo: A pesquisa tem por objetivo verificar os limiares de repouso eletromiográfico dos músculos masseter e temporal em pacientes com disfunção temporomandibular (DTM) antes e após intervenção fonoaudiológica com e sem a utilização de bandagem elástica terapêutica. Métodos: A coleta contou com 14 participantes do sexo feminino, com idade entre 18 e 40 anos, com diagnóstico de DTM muscular ou mista. As pacientes foram divididas entre dois grupos classificados em: pacientes com bandagem associada à terapia tradicional (CB) e grupo de terapia tradicional (SB). As pacientes inicialmente foram avaliadas pelo exame de eletromiografia de superfície nas situações de contração voluntária máxima e repouso, e após quatro semanas de intervenção, foi realizada nova avaliação com os mesmos instrumentos. A análise dos dados ocorreu de forma quantitativa e qualitativa. Resultados:No grupo SB o músculo masseter direito apresentou aumento dos valores de repouso com significância, foi observado que o mesmo ocorreu para todos os músculos deste grupo, influenciando no equilíbrio da musculatura ipsilateral e contralateral, no entanto sem evidência estatística. O grupo CB não demonstrou valores estatísticos significativos, porém qualitativamente os valores de repouso muscular diminuíram e equilibraram-se de forma contralateral. Conclusão: Não foram observadas mudanças estatisticamente significantes nos limiares eletromiográficos durante repouso dos músculos masseter e temporal em ambos os grupos. Qualitativamente houve aumento dos valores eletromiográficos após terapia manual tradicional em todos os músculos do grupo SB. Com relação ao grupo CB, houve diminuição dos valores do repouso eletromiográfico após terapia, embora sem evidências estatísticas. (AU)

Purpose: Objective: The research aims to verify the electromyographic rest thresholds of the masseter and temporal muscles in patients with temporomandibular disorders (TMD) before and after speech therapy intervention with and without the use of therapeutic elastic bandage. Methods: The collection included 14 female participants, aged between 18 and 40 years, who had a diagnosis of muscular or mixed TMD. The patients were divided into two groups: with traditional therapy (CB) bandage and traditional therapy (SB) only group. The patients underwent initial evaluation, as well as surface electromyography in situations of maximum voluntary contraction and rest and at the end of the four weeks of intervention, a new evaluation was performed with the same instruments. Data analysis occurred quantitatively and qualitatively. Results: In the SB group, the right masseter muscle showed a significant increase in resting values. It was observed that the same occurred for all muscles in this group, influencing the balance of the ipsilateral and contralateral muscles, although without statistical evidence. The CB group did not show statistically significant values, but qualitatively the muscle rest values decreased and balanced in a contralateral way. Conclusion: No statistically significant changes were observed in the resting electromyographic thresholds of the masseter and temporalis muscles in both groups. Qualitatively, there was an increase in electromyographic values after traditional manual therapy in all muscles in the SB group. Regarding the CB group, there was a decrease in electromyographic resting values after therapy, although without statistical evidence. (AU)

Objetivo: La investigación tiene como objetivo verificar los umbrales electromiográficos de reposo de los músculos masetero y temporal en pacientes con trastornos temporomandibulares (TMD) antes y después de la terapia del habla con y sin el uso de venda elástica terapéutica. Métodos: La colección incluyó a 14 participantes mujeres, con edades entre 18 y 40 años, diagnosticadas con TTM muscular o mixta. Los pacientes fueron divididos en dos grupos clasificados en: pacientes con vendaje asociado a terapia tradicional (CB) y grupo de terapia tradicional (SB). Los pacientes fueron inicialmente evaluados mediante electromiografía de superficie en situaciones de máxima contracción voluntaria y reposo, luego de cuatro semanas de intervención se realizó una nueva evaluación con los mismos instrumentos. El análisis de datos se llevó a cabo cuantitativa y cualitativamente. Resultados: En el grupo SB, el músculo masetero derecho presentó un aumento significativo en los valores de reposo, se observó que lo mismo ocurrió para todos los músculos de este grupo, influyendo en el equilibrio de los músculos ipsilaterales y contralaterales, sin embargo, sin evidencia estadística. El grupo CB no mostró valores estadísticamente significativos, pero cualitativamente los valores de descanso muscular disminuyeron y se equilibraron contralateralmente. Conclusión: No se observaron cambios estadísticamente significativos en los umbrales electromiográficos en reposo de los músculos masetero y temporal en ambos grupos. Cualitativamente, hubo un aumento de los valores electromiográficos después de la terapia manual tradicional en todos los músculos del grupo SB. En cuanto al grupo CB, hubo una disminución de los valores electromiográficos de reposo después de la terapia, aunque sin evidencia estadística. (AU)

Efeito imediato da mobilização com movimento (MWM) em pacientes com dor lombar: um estudo randomizado controlado / Immediate effect of mobilization with movement (MWM) in patients with low back pain: a randomized controlled trial

Objective: To analyze the effect of the Mobilization With Movement (MWM) of the Mulligan's concept in the perception of nociceptive and neuropathic pain, range of motion (ROM) and joint mobility of individuals with low back pain. Method: This is a randomized and controlled clinical trial, with 30 volunteers with nonspecific low back pain, divided into: Intervention Group (INTG), that received sustained natural apophyseal glides (SNAG) type MWM of the Mulligan's concept; Control Group (CONTG), which received a similar intervention to INTG. Volunteers were assessed using the Numeric Rating Scale for Pain (NRS Pain); the Modified Schober Test (MST) and ROM by goniometry for lumbar spine mobility and Douleur Neuropatique 4 (DN4) questionnaire for assessment of neuropathic and nociceptive pain. Results: INTG showed an increase in lumbar flexion (pre-intervention= 81.21±15.23°; post-intervention= 90.00±19.62°, p< 0.05), mobility of the lumbar spine in MST (pre= 15.33±1.05 post= 16.08±1.02, p< 0.05) and reduction of pain perception by NRS Pain (pre= 5.33±2.26; post= 1.47±2.61 p< 0.05) and in CONTG (pre= 4.07±2.34; post= 2.20±1.93, p< 0.05). Conclusion: The intervention with MWM - SNAGs promoted improved ROM and mobility in flexion of the lumbar spine, associated with reduction from the nociceptive pain in INTG and CONTG.

Objetivo: Analisar o efeito da Mobilization Whith Movement (MWM) do conceito Mulligan na percepção de dor nociceptiva e neuropática, na amplitude e na mobilidade articular de indivíduos com dor lombar. Métodos: Trata-se de um ensaio clínico randomizado e controlado, de 30 voluntários com dor lombar inespecífica, divididos em: Grupo Intervenção (GINT) que recebeu a mobilização articular com deslizamentos apofisários naturais mantidos (MWM - SNAGs); Grupo Controle (GCONT), que recebeu uma mobilização articular placebo. Os voluntários foram avaliados pela escala numérica de dor (EVN); pelo teste modificado de Schober (TMS) para a mobilidade da coluna lombar e pelo DN4 para avaliação da dor neuropática e nociceptiva. Resultados: GINT apresentou aumento da flexão lombar (pré intervenção= 81,21±15,23°; pós-intervenção= 90,00±19,62°, p= <0,05), da mobilidade da coluna lombar no TMS (pré= 15,33±1,05 pós= 16,08±1,02, p= <0,05) e redução da percepção de dor pela EVN (pré= 5,33±2,26; pós= 1,47±2,61= p< 0,05) e no GCONT (pré= 4,07±2,34; pós= 2,20±1,93, p < 0,05). Conclusão: A intervenção com MWM - SNAGs promoveu melhora da ADM e da mobilidade na flexão da coluna lombar, associada com redução da dor nociceptiva no GINT e no GCONT.

Uma leitura psicanalítica sobre o consumo de manipulações corporais na contemporaneidade / Une lecture psychanalytique sur la consommation des manipulations corporelles à l'époque contemporaine / A psychoanalytical reading on the consumption of body manipulations in contemporary times

O presente artigo visa abordar o fenômeno contemporâneo do consumo de manipulações corporais do tipo estético a partir da teoria e da clínica psicanalíticas. Nossa hipótese de pesquisa é que a menor potência do ideal do eu em sua vertente de interdito afeta a consistência da imagem corporal, culminando em um sofrimento psíquico provocado pelo desregramento pulsional. Indagamos se a intervenção no corpo poderia apaziguar a relação imaginária através de uma idealização do corpo vendida como mercadoria

Cet article vise à aborder le phénomène contemporain de consommation de manipulations corporelles de type esthétique en s'appuyant sur la théorie et la clinique psychanalytiques. Notre hypothèse de recherche est que la puissance inférieure de l'Idéal du Moi dans son aspect d'interdit affecte la cohérence de l'imagecorporelle, culminant dans la souffrance psychique causée par le trouble instinctif. Nous nous sommes demandé si l'intervention sur le corps pouvait apaiser la relation imaginaire par une idéalisation du corps vendu comme une marchandise

This article aims to address the contemporary phenomenon of consumption of body manipulations of the aesthetic type based on psychoanalytic theory and clinics. Our research hypothesis is that the lower power of the ego ideal in its interdict aspect affects the consistency of the body image, culminating in psychic suffering caused by instinctual disorder. We asked whether intervention in the body could appease the imaginary relationship through an idealization of the body sold as a merchandise.

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism / 中华创伤杂志(英文版)

PURPOSE@#Static progressive stretch (SPS) can be applied to treat chronic joint stiffness. However, the impacts of subacute application of SPS to the distal lower limbs, where deep vein thrombosis (DVT) is common, on venous thromboembolism remain unclear. This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.@*METHODS@#A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022. Patients with unilateral lower limb comminuted para-articular fractures, transferred to rehabilitation ward for further treatment within 3 weeks after operation, followed up more than 12 weeks since initial manual physiotherapy, and diagnosed DVT by ultrasound before rehabilitation course were included in the study. Patients with polytrauma, without evidence of previous peripheral vascular disease or incompetence, had medication for thrombosis treatment or prophylaxis before the operation, detected with paralysis due to nervous system impairment, infected after operation during the regime, or with acute progression of DVT were excluded. The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation. Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups. SSPS 28.0 and GraphPad Prism 9 were used for data processing. A p < 0.05 was set significant difference.@*RESULTS@#In total of 154 patients with DVT participating in this study, 75 of them were treated with additional SPS for postoperative rehabilitation. The participants in the SPS group showed improved range of motion (12.3° ± 6.7°). However, in the SPS group, there was no difference in thrombosis volume between the start and termination (p = 0.106, p = 0.787, respectively), although difference was seen intra-therapy (p < 0.001). Contingency analysis revealed the pulmonary embolism incidence (OR = 0.703) in the SPS group compared to the mean physiotherapy.@*CONCLUSION@#The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.

Incentivos eleitorais e o gerenciamento de resultados orçamentários por meio de restos a pagar / Incentivos electorales y gestión de resultados presupuestarios a través de saldos a pagar / Electoral incentives and the management of budgetary results through unpaid commitment

Resumo O objetivo desta pesquisa é analisar o efeito dos ciclos políticos eleitorais sobre o gerenciamento de resultados orçamentários por meio de restos a pagar nos municípios brasileiros. Ao assinalar como lacuna empírico-teórica as incipientes métricas de qualidade da informação contábil no ambiente governamental, embasado na teoria da agência, da legitimidade e do gerenciamento de impressão, propõe-se um modelo de estimativa de accruals orçamentários discricionários, captados por meio do carry-over do tipo restos a pagar. Para isso, valemo-nos da teoria dos ciclos políticos para justificar o comportamento cíclico oportunista do gestor, em razão do calendário eleitoral. A partir de uma amostra contemplando 62,1% dos municípios brasileiros, foram testadas três hipóteses embasadas na literatura. Os resultados evidenciaram accruals orçamentários discricionários positivos nos anos imediatamente anteriores aos pleitos democráticos e sua reversão - accruals orçamentários discricionários negativos - em anos eleitorais, perfazendo o ciclo eleitoral orçamentário. Além disso, demonstra-se que os gestores em primeiro mandato estão mais inclinados a ingressar nesse tipo de prática, motivados pelas chances de sua recondução ao cargo, a despeito do sucesso no pleito, denotando que os prefeitos estão mais dispostos a adotar tais práticas durante o primeiro mandato. Essa evidência é ratificada, tendo em vista a não observância de níveis significativos dessa prática no segundo mandato. Em caráter incremental às pesquisas no setor público, esta propõe uma proxy de qualidade da informação contábil governamental e comprova que o gerenciamento de resultados, mensurados pelos accruals orçamentários discricionários, tem comportamentos cíclicos em razão do calendário eleitoral previamente estabelecido.

Resumen El objetivo de esta investigación es analizar el efecto de los ciclos políticos electorales en la gestión de los resultados presupuestarios a través de los saldos a pagar en los municipios brasileños. Al señalar como un vacío empírico-teórico las incipientes métricas de calidad de la información contable en el ámbito gubernamental, basadas en la teoría de agencia, legitimidad y gestión de impresiones, se propone un modelo de estimación de devengos presupuestarios discrecionales, capturados a través del arrastre del tipo remanentes a pagar. Para ello, utilizamos la teoría de los ciclos políticos para justificar el comportamiento cíclico oportunista del gestor, debido al calendario electoral. A partir de una muestra que cubre el 62,1% de los municipios brasileños, se probaron tres hipótesis basadas en la literatura. Los resultados mostraron devengos presupuestarios discrecionales positivos en los años inmediatamente anteriores a las elecciones democráticas y su reversión (devengos presupuestarios discrecionales negativos) en los años electorales, completando el ciclo electoral presupuestario. Asimismo, se demuestra que los gestores en su primer mandato son más proclives a incursionar en este tipo de práctica, motivados por las posibilidades de ser reelegidos en el cargo, a pesar de su éxito en las elecciones, denotando que los alcaldes están más dispuestos a adoptar este tipo de prácticas durante el primer mandato. Esta evidencia se ratifica al constatar la ausencia de niveles significativos de esta práctica en el segundo mandato. Además de la investigación en el sector público, propone una proxy de calidad de la información contable gubernamental y demuestra que la gestión de resultados, medida por los devengos presupuestarios discrecionales, tiene un comportamiento cíclico debido al calendario electoral previamente establecido.

Abstract This research aims to analyze the effect of electoral political cycles on the management of budgetary results by observing the unpaid commitments of Brazilian local governments. The study proposes a model to estimate discretionary budgetary accruals based on unpaid commitments, addressing an empirical-theoretical gap regarding incipient quality metrics of accounting information in public administration, considering the theory of agency, legitimacy, and impression management. The theory of political cycles was adopted to justify the managers' opportunistic cyclical behavior aligned with the electoral calendar. Three hypotheses based on the literature were tested from a sample covering 62.1% of Brazilian municipalities. The results showed positive discretionary budgetary accruals in the years immediately preceding the elections and the opposite in election years (i.e., negative discretionary budgetary accruals), completing the budgetary electoral cycle. Furthermore, it is demonstrated that managers in their first term are more inclined to enter into this type of practice, motivated by the chances of being re-elected. This evidence is ratified by the absence of this practice at significant levels during the managers' second term. This research incrementally contributes to public administration research, proposing a proxy for the quality of government accounting information. It proves that earnings management, measured by discretionary budgetary accruals, has cyclical behavior aligned with the electoral calendar.

Electromyography in muscle activation lumbar region in a comparison between manual therapy and photobiomodulation associated with kinesiotherapy in individuals with low back pain

INTRODUCTION: About 10 million people have low back pain (LBP) disability in Brazil. Several therapies are used to treat this condition, such as kinesiotherapy, manual therapy (MT), and photobiomodulation (PBM). Although the use of these methods in LBP has been investigated, studies evaluating the efficacy of the association between these techniques are still needed. OBJECTIVE: To evaluate the activation of the lumbar region muscles by PBM or MT associated with kinesiotherapy for the treatment of LBP. METHODS: Twenty individuals with chronic LBP were randomlydivided into two groups. The first group (MT) received vertebral mobilization associated with a kinesiotherapy exercise program. The second group (830nm-PBM) received PBM associated with the exercise program, twice a week for 8 weeks. Evaluation of pain perceived was performed by the visual analogic scale (VAS), lumbar disability by the Oswestry questionnaire, muscle strength by strain gauge, and activation through surface electromyography (EMG). Data were collected before and after the treatment. EMG data was analyzed by MatLab®. The ANOVA two-way test was used (degree of significance p≤0.05), and the size of the effect by the Hedge test. RESULTS: Considering pain, the two groups presented a significant result (p<0.05). In muscle activation, only the multifidus was different during the side bridge (p<0.05) when compared intragroup. None of the variables were different when evaluating intergroup. CONCLUSION: Both MT and PBM associated with kinesiotherapy for 8 weeks are effective in reducing pain, and improving motor control and stability of the lumbar spine in patients with chronic LBP.

Efectividad de la terapia manual en trastornos temporomandibulares. Revisión de literatura / Effectiveness of manual therapy in temporomandibular disorders. Literature review

Los trastornos temporomandibulares (TTM) tienen consecuencias funcionales importantes, que no distinguen edad ni sexo, los esquemas de tratamiento están enfocados al mejoramiento de la función y alivio de los síntomas, basándose principalmente en terapias conservadoras, evitando el sobretratamiento y atendiendo de forma oportuna a los casos que lo requieran, con la finalidad de evitar tratamientos invasivos. Los estudios controlados sobre la eficacia de la terapia manual para el tratamiento de los TTM son escasos, y la evidencia existente tiene claras limitaciones en su metodología, a pesar de ello, es la terapia más segura, aunque sus resultados son controversiales. Por tanto, el objetivo de este trabajo fue realizar una revisión de literatura sobre la eficacia de la terapia manual en el tratamiento de algunos de los trastornos temporomandibulares. En la mayoría de los estudios se observó la influencia que tiene el asesoramiento profesional y las charlas para el control de hábitos en el tratamiento con terapia manual. Así también, la constancia de los pacientes en sus citas, y la realización de los ejercicios en casa. La terapia demostró ser efectiva en algunos de los TTM, debido a que en casos crónicos no se evidenció mejora significativa.

TMDs have important functional consequences, which do not distinguish age or gender. Treatment schemes are focused on improving function and relieving symptoms, they are mainly based on conservative therapies, avoiding over-treatment and at the same time, opportunely treating cases that require it, hence, avoiding more invasive treatments. Controlled studies on the efficacy of manual therapy for the treatment of TMDs are scarce, and the existing evidence has clear limitations in its methodology, despite this, it is the safest therapy although its results are controversial. Therefore, the aim of this work was to perform a literature review on the efficacy of manual therapy in the treatment of some temporomandibular disorders. In most of the studies it was noticed, the influence of professional advice and habit control talks in the treatment with manual therapy, as well as the consistency of the patients with their appointments, and the practice of at home exercises. The therapy proved to be effective in some of the TMDs, since in chronic cases, no significant improvement was evidenced.

Effect of the maitland concept techniques on low back pain: a systematic review / Efeito das técnicas do conceito maitland na dor lombar: revisão sistemática / Efecto de las técnicas del concepto maitland en la lumbalgia: revisión sistemática

ABSTRACT Low back pain has a prevalence that reaches up to 70% of the population between 35-55 years of age and is the principal cause of occupational disability. The scientific evidence on the effect of manual therapy on low back pain is conflicting and there are no specific reviews on the Maitland concept of manual therapy. Therefore, the objective of this systematic review is to analyze the effect of the techniques of the Maitland concept of manual therapy in patients with low back pain and/or determine the level of scientific evidence.For this, a search was carried out in the Cinahl, Medline, Web of Science, PubMed and Scopus databases during the months of January and February 2021 and it was updated in August 2021. In the search, 894 records were obtained, of which 15 randomized clinical trials that obtained a minimum of 3 points out of 5 on the Jadad scale were included.The main results in the current scientific literature suggest that there is solid evidence that the manipulations and mobilizations described in the Maitland Concept, applied alone or in combination with other interventions, reduce pain and disability in subjects with low back pain.The effects on musculature are contradictory. Exercise and patient education increase the effect of manual therapy. Future research requires analyzing whether the effects are preserved in the long term and more homogeneous treatment protocols are needed to determine a prescriptive guideline for manual therapy. Level of evidence I; Systematic review.

RESUMO: A dor lombar tem uma prevalência que atinge até 70% da população entre 35-55 anos e é a principal causa de incapacidade ocupacional. As evidências científicas sobre o efeito da terapia manual na dor lombar são conflitantes e não há revisões específicas sobre o conceito de terapia manual de Maitland. Portanto, o objetivo desta revisão sistemática é analisar o efeito das técnicas do conceito Maitland de terapia manual em pacientes com lombalgia e/ou determinar o nível de evidência científica.Para isso, foi realizada uma busca nas bases de dados Cinahl, Medline, Web of Science, Pubmed e Scopus durante os meses de janeiro e fevereiro de 2021 e foi atualizada em agosto de 2021. Na busca foram obtidos 894 registros dos quais foram incluídos 15 ensaios clínicos randomizados que obtiveram um mínimo de 3 pontos em 5 na escala de Jadad. Os principais resultados na literatura científica atual sugerem que há evidências sólidas de que as manipulações e mobilizações descritas no conceito de Maitland, aplicadas isoladamente ou em combinação com outras intervenções, reduzem a dor e a incapacidade em indivíduos com dor lombar. Os efeitos nos músculos são contraditórios. O efeito da terapia manual é aumentado quando combinada com exercícios e educação do paciente. Pesquisas futuras requerem analisar se os efeitos são preservados em longo prazo e protocolos de tratamento mais homogêneos são necessários para determinar uma diretriz prescritiva para a terapia manual. Nível de evidência I; Revisão sistemática.

RESUMEN: La lumbalgia tiene una prevalencia que alcanza hasta el 70% de la población entre los 35-55 años y es la primera causa de discapacidad laboral. La evidencia científica sobre el efecto de la terapia manual en la lumbalgia es contradictoria y no existen revisiones específicas sobre el concepto Maitland de terapia manual. Por tanto, el objetivo de esta revisión sistemática consiste en analizar el efecto de las técnicas del concepto Maitland de terapia manual en pacientes con lumbalgia y o determinar el nivel de evidencia científica.Para ello se llevó a cabo una búsqueda en las bases de datos Cinahl, Medline, Web of Science, PubMed e Scopus durante los meses de enero y febrero de 2021 y se actualizó en agosto de 2021. En la búsqueda se obtuvieron un total de 894 registros de los cuales fueron incluidos 15 ensayos clínicos aleatorizados que obtuvieron un mínimo de 3 puntos sobre 5 en la escala de Jadad. Los principales resultadosen la literatura científica actual sugieren que existe evidencia sólida de que las manipulaciones y movilizaciones descritas en el concepto Maitland, aplicadas de forma aislada o en combinación con otras intervenciones, disminuyen el dolor y la discapacidad en sujetos con lumbalgia. Los efectos sobre la musculatura son contradictorios. El efecto de la terapia manual se ve incrementado cuando se combina con ejercicio y educación del paciente. Futuras investigaciones requieren analizar si los efectos se preservan largo plazo y se necesitan protocolos de tratamiento más homogéneos para determinar una pauta prescriptiva de terapia manual. Nivel de evidencia I; Revisión sistemática.

Effect of pompage on pain, disability and craniocervical position of female teachers - Randomized clinical trial / Efeito da pompage sobre a dor, incapacidade e postura craniocervical de professoras - Ensaio clínico randomizado

Abstract Introduction: Education professionals are one of the most important occupational groups and represents one of the main parts of the economy of modern society. The vocal demands most mentioned by the teachers are talking while standing up, talking a lot and in a closed environment, which corresponds to the most frequent situations encountered in teaching. In addition, remaining in the standing position for a prolonged period may have repercussions on other systems and generate postural deviations, pain and reduced functionality. Objective: To verify changes in pressure pain threshold, in disability index and in craniocervical posture of female teachers with vocal and musculoskeletal complaints, and with normal larynx, after myofascial release - pompage. Methods: This study was a controlled and randomized clinical trial. The following procedures were performed: anamnesis, videolaryngoscopy, hearing screening, clinical and photogrammetric postural assessment using the SAPo® protocol, completion of the neck pain self-assessment protocol Neck Disability Index, and pain threshold in the cervical muscles using the Pain Pressure Threshold. Myofascial therapy with pompage had a total of 24 sessions of 40 min each, three times a week, in 28 teachers assigned to the study group (SG), and 28 to the control group (CG). Afterwards, the groups were reassessed. Results: The SG presented a significant improvement in the pain threshold of all the muscles evaluated, in the posture of most of the body segments evaluated, and in the cervical disability. In the CG there was a significant improvement in angle A2 after therapy. Conclusion: After myofascial release therapy with pompage, the subjects presented a reduction in cervical pain and in functional disability, an increase in pain threshold, and posture improvement.

Resumo Introdução: Os profissionais da educação são um dos grupos ocupacionais mais importantes e representam uma das principais partes da economia da sociedade moderna. As demandas vocais mais citadas pelos professores são falar em pé, falar muito e em ambiente fechado, correspondendo às situações mais frequentes encontradas no ensino. Além disso, a permanência prolongada na posição ortostática pode repercutir em outros sistemas e gerar desvios posturais, dor e redução da funcionalidade. Objetivo: Verificar alterações no limiar de dor à pressão no índice de incapacidade e na postura craniocervical de professoras com queixas vocais e osteomusculares e com laringe normal, após liberação miofascial - pompage. Métodos: Ensaio clínico controlado e randomizado. Foram realizados anamnese, videolaringoscopia, triagem auditiva, avaliação postural clínica e fotogramétrica por meio do protocolo SAPo®, preenchimento do protocolo de autoavaliação de dor cervical Neck Disability Index e limiar de dor nos músculos cervicais por meio do Pain Pressure Threshold. A terapia miofascial com pompage teve um total de 24 sessões de 40 minutos cada, três vezes por semana, em 28 professoras do grupo estudo (GE) e 28 do grupo controle (GC). Em seguida, os grupos foram reavaliados. Resultados: O GE apresentou melhora significativa no limiar de dor de todos os músculos avaliados, na postura da maioria dos segmentos corporais avaliados e na incapacidade cervical. No GC houve melhora significativa no ângulo A2. Conclusão: Após terapia de liberação miofascial com pompage, os sujeitos apresentaram redução da dor cervical e da incapacidade funcional, aumento no limiar de dor e melhora da postura.

Standardized manipulations for pediatric Tuina in medical institutions / 国际中医中药杂志

The standardization of pediatric Tuina is beneficial to pediatric Tuina practitioners in a norm practices. The paper collects the content from teaching textbooks, TCM ancient books and database literature, and tries to develop the technical specifications of pediatric Tuina by four rounds Delphi surveys and expert consensus. This specification covers the manipulation of pediatric Tuina, the position of acupoints, the effects of acupoints and the diagnosis and treatment of pediatric Tuina, including indications, contraindications, cautious use, operation steps and methods.

Foot reflexology in painful conditions: systematic review / Reflexologia podal em condições dolorosas: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Because foot reflexology is commonly associated with other interventions, its benefits are difficult to establish. In addition, systematic reviews have been carried out many years ago, analyzing unspecific parameters and with controversial results. Thus, the objectives of this study were: to analyze the results of randomized controlled trials with a control group in painful conditions, using foot reflexology as a single intervention; describe the proposed application and methodological quality of the studies (PEDro scale). CONTENTS: The PEDro, Pubmed, Scielo and LILACS data bases were consulted, searching for clinical trials with the following keywords and Boolean index: Foot Reflexology AND pain; reflexology foot massage AND pain (English, Portuguese and Spanish). These keywords should have been present in the title or summary of the article for inclusion, directing to pain and moving away from other variables. 95 studies were found, 17 were selected and most of the results were favorable. The usual application varies from 2-30 minutes of stimulation on each foot, varying between massaging in general or using the somatotopic map stimulating the solar plexus, pain correspondence zone and accessory points related to the diagnosis. In short, the studies showed moderate to good methodological quality according to the PEDro scale. CONCLUSION: Foot reflexology has shown promise for pain relief as an isolated therapy in neuromusculoskeletal cases in hospital and outpatient settings. The hope is that studies of excellent methodological quality can support this statement in the near future.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os benefícios da reflexologia podal são difíceis de serem estabelecidos, pois revisões sistemáticas foram realizadas há muitos anos, analisando parâmetros inespecíficos com resultados controversos. Os objetivos deste estudo foram analisar os resultados de ensaios clínicos randomizados com grupo controle frente a quadros dolorosos, com a reflexologia podal como intervenção única; registrar sua aplicação e a qualidade metodológica dos estudos (escala PEDro). CONTEÚDO: Foram consultadas as bases de dados PEDro, Pubmed, Scielo e LILACS, buscando por ensaios clínicos com as seguintes palavras-chave e índice booleano: Foot Reflexology AND pain; reflexology foot massage AND pain (inglês, português e espanhol). Essas palavras-chave deveriam estar presentes nos tópicos de título ou resumo do artigo para sua inclusão, direcionando para quadro álgico e afastando-se de outras variáveis. Foram encontrados 95 estudos, 17 foram selecionados e em sua maioria os resultados foram favoráveis. A aplicação usual varia de 2-30 minutos de estimulação em cada pé, alterando massagear de maneira geral ou pelo mapa somatotópico estimulando o plexo solar, zona de correspondência de dor e pontos acessórios relacionados ao diagnóstico. Os estudos apresentaram qualidade metodológica de moderada a boa segundo a escala PEDro. CONCLUSÃO: A reflexologia podal mostrou-se promissora para alívio da dor como terapia isolada em casos de dor neuromusculoesquelética em ambiente hospitalar e ambulatorial. Estudos de melhor qualidade metodológica devem ser realizados para comprovar a importância da reflexologia podal na dor neuromusculoesquelética.

Observation on analgesic effect of acupuncture combined with manipulation on cervicogenic headache / 中国骨伤

OBJECTIVE@#To compare therapeutic effects between nape acupuncture combined with manipulation and simple manipulation in treating cervicogenic headache, and to verify the synergistic effect of manipulation and nape acupuncture.@*METHODS@#Total 60 patients with cervicogenic headache were divided into two groups:nape acupuncture combined with manipulation group (group A) and manipulation group(group B). There were 30 patients in group A, including 12 males and 18 females with an average age of (41.37±12.09) years old, and an average course of disease of (23.73±15.54) months;there were 30 patients in the manipulation group (group B), including 14 males and 16 females with an average age of (42.40±12.05) years old, and an average course of disease of (25.53±14.33) months. In the group A, acupuncture therapy was performed firstly at the bilateral @*RESULTS@#There was no significant difference in the onset time of analgesia between the two groups[(5.97±3.21) min vs(7.30±3.97) min, @*CONCLUSION@#Nape needling can prolong the analgesic time of manipulation and improve the analgesic effect of manipulation.

Desfechos da terapia manual sobre a biomecânica da deglutição em indivíduos com DPOC / Outcomes of manual therapy on the biomechanics of swallowing in individuals with COPD

RESUMO Objetivo Diversos comprometimentos da deglutição têm sido relatados em indivíduos com doença pulmonar obstrutiva crônica (DPOC), tendo como causa a desvantagem mecânica da musculatura respiratória devido à hiperinsuflação. Dentre as estratégias terapêuticas, até o momento, não foram encontrados relatos na literatura sobre o uso da terapia manual (TM) no manejo dos transtornos da deglutição nesta população. O objetivo do estudo foi verificar os desfechos de um programa de TM sobre a biomecânica da deglutição de indivíduos com DPOC. Método Foram avaliados 18 indivíduos com idade média 66,06±8,86 anos, 61,1% (11) homens e VEF1%médio 40,28±16,73 antes e após-programa de TM. As medidas analisadas foram: tempo de trânsito oral, tempo de trânsito faríngeo (TTF), número de deglutições, resíduos em valéculas (VL) e seios piriformes, penetração/aspiração e excursão hiolaríngea na deglutição das consistências líquida e pastosa. Resultados Houve diferença significativa no TTF (p=0,04), resíduos em VL (p=0,03), elevação máxima do hioide (p=0,003) e deslocamento do hioide (p=0,02) na deglutição da consistência pastosa. Na consistência líquida apenas redução de resíduos em VL (p=0,001). Conclusão O programa de TM interferiu na biomecânica da deglutição de indivíduos DPOC demonstrada pela redução do TTF, resíduos em VL e maior elevação e deslocamento do hioide na consistência pastosa. Na consistência líquida houve redução de resíduos em VL.

ABSTRACT Purpose Several swallowing disorders have been reported in chronic obstructive pulmonary disease (COPD) patients due to the mechanical disadvantage of the respiratory muscles caused by hyperinflation. To date, no reports have been found in the literature among the therapeutic strategies on the use of manual therapy (MT) to manage swallowing disorders in COPD. The aim of the study was to verify the outcomes of a TM program on the biomechanics of swallowing of individuals with COPD. Methods 18 individuals with a mean age of 66.06 ± 8.86 years, 61.1% (11) men, and a FEV1% mean of 40.28 ± 16.73 were evaluated before and after TM. The measures analyzed were: oral transit time, pharyngeal transit time (PTT), number of swallows, vallecular (VL) residue and pyriform sinuses, penetration/aspiration and hyolaryngeal excursion in liquid and pasty consistencies. Results A significant difference was found in PTT (p=0.04), VL residue (p=0.03), maximal hyoid elevation (p=0.003), and displacement of hyoid (p=0.02) in the pasty consistency. In the liquid consistency, we found a decrease in VL residue (p=0.001). Conclusion The MT program influenced the swallowing biomechanics of COPD patients demonstrated by a reduction in PTT and VL residue and increased hyoid elevation and displacement in the pasty consistency. In the liquid consistency, a decrease in VL residue was found.

A autoliberação miofascial sobre o desempenho de potência muscular em atletas de futebol sub-13 / The myofascial self-liberation on muscular power performance in sub-13 soccer athletes

Este estudo investiga o efeito da autoliberação miofascial sobre o desempenho de potência muscular no salto vertical, salto horizontal e agilidade uniplanar em atletas de futebol sub-13, cuja amostra foi composta por 22 adolescentes do sexo masculino, praticantes de uma escolinha de futebol da cidade de Juiz de Fora, MG. Ao todo, realizaram-se três dias de testes de cada variável, assim como o protocolo de autoliberação, com intervalo de 48 horas entre as sessões. Para o protocolo controle, os participantes foram orientados a realizar três tentativas de salto horizontal, vertical e agilidade uniplanar, com intervalo de dois minutos para cada tentativa e uma pausa de cinco minutos entre os testes. Os mesmos procedimentos foram repetidos para a realização do protocolo experimental de autoliberação, porém executou-se, nos pré-testes de membros inferiores, um minuto de autoliberação miofascial, com ordem aleatória dos grupos musculares (quadríceps, isquiostibiais e gastrocnêmio), com o total de seis minutos de autoliberação, validando-se os melhores resultados de cada teste dos protocolos controle e experimental, em que utilizou-se o Foam Rolling. Observou-se uma média de 2,8 (±0,8) para os estágios de desenvolvimento dos participantes, considerando a Escala de Tanner. Quanto ao protocolo de autoliberação, o desempenho no salto vertical foi significativamente superior após a utilização do Foam Rolling, comparado ao controle. Não houve diferença significativa no desempenho de salto horizontal e agilidade uniplanar ao comparar o protocolo controle com o experimental, todavia, efeitos adversos não foram observados na utilização deste método.(AU)

This study investigates the effect of myofascial self-liberation on the performance of muscle power in the variables of vertical jump, horizontal jump and uniplanar agility in under-13 soccer athletes, whose sample was composed of 22 male adolescents, practitioners of a soccer school from the city of Juiz de Fora, MG. In all, three days of tests were performed for each variable, as well as the self-release protocol, with an interval of 48 hours between sessions. For the control protocol, participants were instructed to make three attempts to jump horizontally, vertically and uniplanar agility, with an interval of two minutes for each attempt and a five-minute pause between tests. The same procedures were repeated for the experimental self-liberation protocol, however, in the lower limb pre-tests, a minute of myofascial self-liberation was performed, with a random order of the muscle groups (quadriceps, hamstrings and gastrocnemius), with the total of six minutes of self-liberation, validating the best results of each test of the control and experimental protocols, in which Foam Rolling was used. An average of 2.8 (± 0.8) was observed for the participants' developmental stages, considering the Tanner Scale. As for the selfliberation protocol, the performance in the vertical jump was significantly higher after using Foam Rolling, compared to the control. There was no significant difference in the performance of horizontal jump and uniplanar agility when comparing the control protocol with the experimental one, however, adverse effects were not observed in the use of this method.(AU)

Eficácia da terapia manual nos fatores modulatórios duais do zumbido somático: um protocolo de estudo / Efficacy of manual therapy on somatic tinnitus dual modulatory factors: a study protocol

A literatura tem demonstrado efeito promissor da terapia manual na melhora da gravidade do zumbido somático. No entanto, não há nenhum estudo anterior que tenha demonstrado o efeito da terapia manual nos fatores modulatórios duplos (disfunções temporomandibulares e músculos da coluna cervical). O objetivo do estudo é avaliar a eficácia da terapia manual nos fatores modulatórios duais do zumbido somático (TMD e coluna cervical). MÉTODOS / PROJETO: Trinta e nove pacientes com zumbido somático serão aleatoriamente designados para um dos três grupos, ou seja, A (zumbido somático cervicogênico), B (zumbido somático induzido pela TMD) e C (fatores modulatórios duplos induzidos ao zumbido somático), respectivamente. Este ensaio clínico randomizado de vários grupos, braços paralelos, pré-teste pós-teste, centro único, com três grupos paralelos receberá seis sessões de tratamento de terapia manual integrada em dias alternados durante duas semanas. Os exercícios de reeducação postural serão aconselhados aos pacientes como exercícios em casa. O desfecho primário será o Tinnitus Handicap Inventory (THI) e os desfechos secundários incluem Escala Visual Analógica (VAS) e Algômetro Calibrado Digitalizado (DCA) para medir pré e pós efeito de intervenção dos tratamentos. DISCUSSÃO: A eficácia da terapia manual em pacientes com zumbido somático em cada grupo será estabelecida com este estudo.

The literature has shown promising effect of manual therapy in improving the severity of somatic tinnitus. However, no previous study which has demonstrated the effect of manual therapy on dual modulatory factors (Temporomandibular disorders and cervical spine muscles). The purpose of the study is to evaluate the efficacy of manual therapy on somatic tinnitus dual modulatory factors (TMD and cervical spine). METHODS/DESIGN: Thirty nine patients with somatic tinnitus will be randomly assigned to one of the three groups i.e., A(Cervicogenic somatic tinnitus),B(TMD induced somatic tinnitus) and C(Dual modulatory factors induced somatic tinnitus) respectively. This multi group, parallel arms, pre-test post-test, single centre, randomized clinical trial with three parallel groups will receive six treatment sessions of integrated manual therapy on alternate days for two weeks. Postural re-education exercises will be advised to the patients as home exercises.The primary outcome measure will be Tinnitus Handicap Inventory (THI) and secondary outcome measures include Visual Analogue Scale (VAS) and Digitalized Calibrated Algometer (DCA) to measure pre and post intervention effect of the treatments. DISCUSSION: The efficacy of manual therapy in patients with somatic tinnitus in each group will be established with this study.

Evaluation of short-term effectiveness of orthopedic manual therapy in signs and symptoms of myofascial pain: a controlled clinical trial / Evaluación de la eficacia a corto plazo de la terapia manual ortopédica en signos y síntomas de dolor miofascial: un ensayo clínico controlado

To evaluate the short-term effectiveness of orthopedic manual therapy (OMT) in signs and symptoms of myofascial pain (MFP) in young adults. Materials and Methods: An experimental controlled clinical study was performed in young adults between 19 and 24 years old. Thirty-one patients with MFP according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were divided into two groups. Group A: Orthopedic Manual Therapy (n=16; 10 females, 6 males; 21.6 ± 1.70 years old), and Group B: Control group (n=15; 10 females, 5 males; 20.9 ± 2.00 years old). The participants of group A were treated for a period of 6 weeks; Six therapeutic interventions were performed. Degree of dysfunction (Helkimo index), pain level (VAS scale), and range of mandibular movements (opening and lateral movements) were taken at baseline (T0) and immediately at post-treatment (T1). The data were analyzed with chi-square test and t-test; p<0.05 was considered significant. Result: After the OMT, there were no significant changes in diagnosis of MFP according to RDC/TMD (p=0.41); however, there was a statistically significant improvement in the Helkimo index (p=0.0083) and the level of pain according to the VAS scale (p=0.0004). Mandibular movements did not show significant differences (p>0.05). Conclusion: This study suggested that a 6-week period of OMT treatment has a clinically significant effect in pain level and degree of dysfunction in patients with MFP. A longer follow-up study is required to better assess the effects of manual therapy.

Evaluar la efectividad a corto plazo de la terapia manual ortopédica (TMO) en los signos y síntomas del dolor miofascial (DMF) en adultos jóvenes. Materiales and Métodos: Se realizó un estudio clínico controlado en adultos jóvenes entre 19 y 24 años. Treinta y un pacientes fueron diagnosticados con DMF según los criterios de diagnóstico para trastornos tempo-romandibulares (CDI/TTM) y se dividieron en dos grupos. Grupo A: Terapia manual ortopédica (n = 16; 10 mujeres, 6 hombres; 21,6 ± 1,70 años), y Grupo B: grupo de control (n = 15; 10 mujeres, 5 hombres; 20,9 ± 2,00 años). Los participantes del grupo A fueron tratados por un período de 6 semanas. Se realizaron seis intervenciones terapéuticas. El grado de disfunción (índice Helkimo), el nivel de dolor (escala EVA) y el rango de movimientos mandibulares (movimientos de apertura y laterales) se evaluaron al inicio del estudio (T0) e inmediatamente después del tratamiento (T1). Los datos se analizaron con la prueba de chi-cuadrado y la prueba t de student; se consideró significativo cuando p fue menor a 0.05. Resultados: Después de la TMO, no hubo cambios significativos en el diagnóstico de DMF según CDI /TTM (p=0,41); sin embargo, hubo una mejora estadísticamente significativa en el índice Helkimo (p=0.0083) y el nivel de dolor según la escala EVA (p= 0.0004). Los movimientos mandibulares no mostraron diferencias significativas (p>0.05). Conclusión: Este estudio sugirió que un período de 6 semanas de tratamiento con TMO tiene un efecto clínicamente significativo en el nivel de dolor y el grado de disfunción en pacientes con DMF. Se requiere un estudio de largo plazo para evaluar de mejor forma el efecto de la terapia manual ortopédica.

Joint mobilization associated or not to other therapies reduces chronic musculoskeletal pain: a systematic review

ABSTRACT BACKGROUND AND OBJECTIVES: Joint mobilization is a non-pharmacological technique used to treat chronic musculoskeletal pain. However, it is controversial due to a lack of studies comparing its effects on this painful condition. The objective of this study was to assess the risk of bias in clinical trials investigating the effect of joint mobilization on chronic musculoskeletal pain. CONTENTS: A systematic search on Pubmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science, and Scopus was performed on September 2019 from the combination of three keywords: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Randomized controlled clinical trials that evaluated the use of joint mobilization associated or not to other therapies in chronic musculoskeletal pain treatment were included. Five thousand five hundred eighty-seven articles were screened, and 14 studies were analyzed, including 812 participants, with a mean age of 54 years, and female being the most affected. According to these articles, joint mobilization promoted the reduction of pain intensity in short and long terms, increase in range of motion, strength and function when used alone or in association with conventional physiotherapy. Regarding methodological quality, most of the studies were classified with low risk for selection, performance, detection and reporting bias. In the "other bias" item, which considered therapists experience time and types of treatment applied, only one study presented low risk and other study presented an unclear risk. CONCLUSION: Joint mobilization seems to be an effective technique for the treatment of chronic musculoskeletal pain. However, it is still necessary to investigate and compile studies with greater methodological quality, thus promoting greater support to evidence-based practice.

RESUMO JUSTIFICATIVA E OBJETIVOS: Mobilização articular é uma técnica não farmacológica usada no tratamento da dor musculoesquelética crônica. No entanto, é controverso devido à falta de estudos que comparem seus efeitos sobre essa condição de dor. O objetivo deste estudo foi avaliar o risco de viés em ensaios clínicos que investigam o efeito da mobilização articular na dor musculoesquelética crônica. CONTEÚDO: Foi realizada uma busca sistematizada no Pu-bmed, Cochrane Library, ScienceDirect, Scielo, PEDro, CINAHL, SPORTDiscus, LILACS, BVS, PsycINFO, Web of Science e Scopus em setembro de 2019 com a combinação de três palavras-chave: Musculoskeletal Manipulations AND Chronic Pain AND Musculoskeletal Pain. Ensaios clínicos controlados e aleatorizados que avaliaram o uso de mobilização articular associada ou não a outras terapias no tratamento da dor muscu-loesquelética crônica foram incluídos. Foram encontrados 5587 artigos e analisados 14 estudos, incluindo 812 participantes, com idade média de 54 anos, sendo o sexo feminino o mais afetado. Nestes, a mobilização articular promoveu redução da dor em curto e longo prazo, amplitude de movimento, força e melhora da função quando utilizado isoladamente ou em associação à fisioterapia convencional. Em relação à qualidade metodológica, a maioria dos estudos foi classificada com baixo risco para seleção, desempenho, detecção e viés de relato. No item "other bias", que considerou terapeutas com tempo de experiência e tipos de tratamento aplicados, apenas um estudo apresentou baixo risco e outro estudo apresentou risco incerto. CONCLUSÃO: Mobilizaç ão articular parece ser uma técnica eficaz para o tratamento da dor musculoesquelética crônica. No entanto, é necessário realizar estudos com maior qualidade metodológica, promovendo maior apoio à prática baseada em evidências.

Zheng's massage combined with electroacupuncture in the treatment of reflex sympathetic dystrophy syndrome of the wrist / 中国骨伤

OBJECTIVE@#To observe the clinical effects of zheng's massage combined with electroacupuncture in the treatment ofreflex sensory dystrophy syndrome of the wrist.@*METHODS@#From October 2016 to September 2018, 48 cases of reflex sensory dystrophy syndrome of the wrist were divided into the observation group and the control group. In the observation group, there were 24 cases, including 10 males and 14 females, ranging in age from 54 to 76 years old, with an average age of (61.41 ±7.90) years old. The patients in the observation group were treated with massage combined with electroacupuncture. The control group consisted of 24 patients, including 9 males and 15 females, ranging in age from 52 to 75 years old, with an averageage of (58.71±8.11 ) years old. The patients in the control group were treated with electroacupuncture alone. All the patients in both groups were treated for 6 weeks. The clinical symptoms and signs, visual anglogue scale (VAS), Cooney wrist score and clinical efficacy evaluation were compared between the two groups before and after treatment, and statistical analysis was conducted.@*RESULTS@#After 6 weeks of treatment, VAS in the control group was 4.9±1.8, and Cooney wrist score was 74.63±1.72; VAS in the observation group was 2.2±1.4, and Cooney wrist score was 86.31±2.53. The comprehensive scores of VAS and Cooney wrist joint between two groups were improved after treatment, and the observation group was better than control group(<0.05). The curative effect of the observation group was better than that of the control group.@*CONCLUSION@#Zheng's massage combined with electroacupuncture has the following advantages in the treatment of reflex sympathetic dystrophy syndrome of the wrist, such as small trauma, patients' willingness promoting functional rehabilitation, which is worthy of clinical promotion.

Clinical observation on acupuncture plus subtle adjustment manipulation of the cervical spine for peripheral facial paralysis / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of acupuncture plus subtle adjustment manipulation of the cervical spine for peripheral facial paralysis.Methods: A total of 60 patients with peripheral facial paralysis who met the screening criteria were selected and divided into two groups according to the method of random number table, with 30 cases in each group. The patients in the acupuncture plus tuina group received routine treatment of acupuncture and subtle adjustment manipulation of the cervical spine, while the patients in the acupuncture group only received the same acupuncture treatment. Assessment of peripheral facial paralysis with integrated traditional Chinese and Western medicine was adopted for rehabilitation assessment. Results: The total effective rate of the acupuncture plus tuina group was 93.3％, while that of the acupuncture group was 70.0％, and there was a significant between-group difference (P<0.05). After treatment, the total scores of rehabilitation assessment in both groups were significantly higher than those before treatment (both P<0.05), and the score of the acupuncture plus tuina group was significantly higher than that of the acupuncture group (P<0.05). Conclusion: The treatment of acupuncture plus subtle adjustment manipulation of the cervical spine can improve the function of facial muscles in patients with peripheral facial paralysis, and its clinical efficacy is better than that of the acupuncture treatment alone.

Protocolo de mobilização associada à manipulação vertebral diminui dor lombar crônica. Um estudo preliminar clínico randomizado / Mobilization associated with vertebral manipulation protocol reduces chronic lumbar pain. A preliminary randomized clinical study

A dor lombar crônica é um problema osteomuscular de causa multifatorial, que afeta as atividades de vida diária, podendo levar a perda de capacidade funcional e qualidade de vida. Ainda com resultados pouco conclusivos de mobilização e manipulação sobre a dor e ADM em indivíduos com dor lombar, o objetivo deste estudo foi verificar os efeitos destas técnicas manuais na dor e mobilidade de indivíduos com dor lombar crônica. Foi realizado um estudo preliminar clínico, transversal, paralelo, controlado randomizado e cego. Os voluntários (n=16) foram divididos de maneira aleatória por envelopes, em dois grupos: grupo intervenção (G-INT), que receberam o tratamento de mobilização e manipulação vertebral e grupo placebo (G-PLA) sem o tratamento. Os voluntários realizaram avaliação dos desfechos de dor e mobilidade. Foram realizadas três sessões em cada paciente com um intervalo de um dia. As reavaliações foram realizadas após a última intervenção. Houve diferença estatisticamente significativa na END no grupo G-INT (pré - 5,33 ± 1,32, pós - 2,77 ± 1,85, p=0,03), com D de Cohen = 1,59, na comparação intragrupo. Para comparações intergrupos considerando o Δ pré e pós-intervenção foi observada diferença estatisticamente significativa na END (G-INT = -2,55 ± 1,13, G2 = -1,00 ± 0,81, com p=0,01), com D de Cohen = 1,58. A mobilização associada à manipulação mostrou-se significativamente eficaz no tratamento de dor lombar crônica.

Chronic low back pain is a multi-factorial musculoskeletal problem that affects activities of daily living, which can lead to loss of functional capacity and quality of life. Still with inconclusive results of mobilization and manipulation on pain and ROM in individuals with low back pain, the objective of this study was to verify the effects of these manual techniques on the pain and mobility of individuals with chronic low back pain. A preliminary clinical, cross-sectional, parallel, randomized controlled and blind study was carried out. The volunteers (n = 16) were randomly divided into envelopes, into two groups: intervention group (G-INT), who received spinal mobilization and manipulation treatment and placebo group (G-PLA) without treatment. The volunteers evaluated pain and mobility outcomes. Three sessions were performed on each patient with an interval of one day. Reassessments were carried out after the last intervention. There was a statistically significant difference in the END in the G-INT group (pre - 5.33 ± 1.32, post - 2.77 ± 1.85, p = 0.03), with Cohen's D = 1.59, in the comparison intragroup. For intergroup comparisons considering the Δ pre- and postintervention, a statistically significant difference was observed in the END (G-INT = -2.55 ± 1.13, G2 = -1.00 ± 0.81, with p = 0.01), with Cohen's D = 1.58. Mobilization associated with manipulation was shown to be significantly effective in treating chronic low back pain.