Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study / 中西医结合学报

OBJECTIVE@#This study aimed to investigate the feasibility of implementing a manual therapy technique (muscle energy technique, MET) protocol in a hospital pulmonary rehabilitation (PR) program for patients with moderate to severe chronic obstructive pulmonary disease (COPD). Please cite this article as: Baxter DA, Coyle ME, Hill CJ, Worsnop C, Shergis JL. Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study. J Integr Med. 2023; 21(3): 245-253.@*METHODS@#Participants aged 40 years and over, with moderate to severe COPD, were recruited into this 12-week study. The primary outcome measures were feasibility (acceptability of the intervention and attendance/adherence to the trial) and safety (adverse events, AEs). All participants received the MET and PR therapies. Participants and assessors were unblinded. Semi-standardized MET was delivered on 6 occasions (a maximum of once per week) at the hospital directly before a PR session. Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks. Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.@*RESULTS@#Thirty-three participants were enrolled, with a median age of 74 years (range 45-89 years). The median number of MET sessions that participants attended was 5 (range 0-6) out of a possible 6 sessions (83% attendance). At follow-up, participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing. There were no major AEs related to the intervention, with the majority of AEs classified as expected events related to COPD exacerbations.@*CONCLUSION@#It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting. Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.

The posture decoding technique can improve the pelvis carriage and lumbar motion of patients with lower crossed syndrome, relieving back pain and relaxing the back muscles / 中华物理医学与康复杂志

Objective:To observe the clinical effectiveness of manual therapy based on posture decoding for patients with lower crossed syndrome (LCS).Methods:Thirty-six LCS patients were randomly divided into an observation group and a control group, each of 18. The observation group received manual therapy based on posture decoding, while the control group was treated with proprioceptive neuromuscular facilitation (PNF), both in 20min sessions, once a week for 4 weeks. Before the experiment, after one, two and four weeks of treatment and followed-up 4 and 8 weeks later, both groups were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI) and finger-floor distance (FFD). Anterior pelvic tilt angles (ASIS-PSISs), sacral slopes (SS), lumbar curve index (LCI) and surface EMG flexion-relaxation ratios (FRRs) were also recorded from both groups before and after the treatment.Results:After one and four weeks of the treatment, the average VAS, ODI, and FFD had decreased significantly in both groups, with all significantly lower in the observation group, on average. At the final follow-up, the average VAS and ODI scores of both groups were significantly lower than before the treatment, with those of the observation group significantly lower than the control group′s averages. After 4 weeks of treatment significant differences were observed also in the group′s average ASIS-PSISs, SSs and LCIs compared with before the treatment. And right after the treatment the left and right surface electromyography FRRs of the observation group were significantly higher than those of the control group.Conclusion:Manual therapy based on posture decoding can significantly improve the pelvis forward angle and lumbar motion of LCS patients, relieving back pain and relaxing back muscles.

Aplicación de la técnica manual craneosacral en mujeres que laboran en la Educación Superior / Application of the craniosacral manual technique in women working in Higher Education / Aplicação da técnica manual craniossacral em mulheres que trabalham no Ensino Superior

En la actualidad la mayoría de las personas por lo menos una vez en el año presenta una molestia en la estructura del cuello, considerado como cervicalgia o dolor cervical, el mismo que está ocasionando un impacto considerable en la vida de las personas dentro del ámbito familiar, laboral y en la comunidad, provocando efectos negativos en la calidad de vida y en casos severos puede llegar a ocasionar discapacidad y limitación funcional de los movimientos. Por lo que este estudio presentó como objetivo determinar la efectividad de la aplicación de la técnica manual craneosacral en mujeres que laboran en la Universidad Católica de Santiago de Guayaquil. La metodología que se utilizó fue un enfoque cuantitativo- descriptivo con un diseño experimental del tipo pre experimental, con un corte longitudinal, se utilizó como muestra a 31 mujeres que laboran en diversas áreas de la Universidad Católica Santiago de Guayaquil, a su vez, se utilizó como técnica la encuesta, y el instrumento aplicado para la valoración del dolor cervical fue la escala visual analógica del dolor (EVA). Los resultados de esta técnica respecto a la escala visual analógica (EVA) mediante una valoración inicial y final, reflejaron mejoría en el dolor cervical donde el 68% de las pacientes no presentaron dolor, y el 32% reflejan un dolor leve. Se concluyó, que por medio de la técnica manual craneosacral el dolor disminuyo en un gran porcentaje restableciendo los procesos naturales del equilibrio del cuerpo a través de la terapia manual.

Currently, most people at least once a year have a discomfort in the structure of the neck, considered cervicalgia or cervical pain, which is causing a considerable impact on the lives of people within the family, work and in the community, causing negative effects on the quality of life and in severe cases can lead to disability and functional limitation of movements. Therefore, this study presented the objective of determining the effectiveness of the application of the craniosacral manual technique in women who work at the Catholic University of Santiago de Guayaquil. The methodology used was a quantitative-descriptive approach with an experimental design of the pre-experimental type, with a longitudinal cut, 31 women who work in various areas of the Santiago de Guayaquil Catholic University were used as a sample, in turn, used the survey as a technique, and the instrument applied for the assessment of neck pain was the visual analogue pain scale (VAS). The results of this technique with respect to the visual analog scale (VAS) through an initial and final evaluation, reflected improvement in cervical pain where 68% of the patients did not present pain, and 32% reflected mild pain. It was concluded that through the craniosacral manual technique, the pain decreased by a large percentage, restoring the natural processes of the body's balance through manual therapy.

Atualmente, a maioria das pessoas pelo menos uma vez ao ano apresenta um desconforto na estrutura do pescoço, considerado cervicalgia ou dor cervical, que está causando um impacto considerável na vida das pessoas dentro da família, no trabalho e na comunidade, causando efeitos negativos na qualidade de vida e em casos graves pode levar à incapacidade e limitação funcional dos movimentos. Portanto, este estudo apresentou o objetivo de determinar a eficácia da aplicação da técnica manual craniossacral em mulheres que trabalham na Universidade Católica de Santiago de Guayaquil. A metodologia utilizada foi uma abordagem quantitativo-descritiva com um desenho experimental do tipo pré-experimental, com corte longitudinal, 31 mulheres que trabalham em várias áreas da Universidade Católica de Santiago de Guayaquil foram usadas como amostra, por sua vez, utilizaram a pesquisa como técnica, e o instrumento aplicado para avaliação da cervicalgia foi a escala visual analógica de dor (EVA). Os resultados desta técnica com relação à escala visual analógica (EVA) através de uma avaliação inicial e final, refletiram melhora da dor cervical onde 68% dos pacientes não apresentavam dor, e 32% refletiam dor leve. Concluiu-se que através da técnica manual craniossacral, a dor diminuiu em grande porcentagem, restabelecendo os processos naturais de equilíbrio do corpo através da terapia manual.

Effects of unrestricted area soft tissue manipulation on pain severity in patients with chronic neck pain: a systematic review and Meta-analysis / 中国医师进修杂志

Objective:To systematically evaluate of the impact of non-specific soft tissue manipulation on pain severity in patients with chronic neck pain.Methods:Trials included in Meta-analysis were determined by searching PubMed, Embase, Cochrane Library, Web of Science and 5 English databases in the U.S. Clinical Trial Registry. The search terms include the subject terms of neck pain, soft tissue treatment, massage, and myofascial release. Two reviewers independently selected studies, extracted data and assessed the quality of the studies. The included trials were assessed by using the Cochrane risk-of-bias tool. STATA statistical software 16.0 was used for statistical analysis. Additionally, subgroup analysis and sensitivity analysis were performed to analyze the sources of heterogeneity and assess the stability of research results. Begg funnel plot and Egger′s publication bias plot were used to assess potential publication bias.Results:This systematic review included a total of 12 randomized controlled trials (566 patients in total). The participants were 18 to 85 years old. Most of the included studies were of medium quality. This Meta-analysis validated the effectiveness of soft tissue manual therapy on alleviating pain symptoms in patients with chronic neck pain ( ES =-0.83, 95% CI -1.15 to -0.51, P = 0.001). The Begg funnel plot indicated that there may be potential publication bias. Conclusions:This Meta-analysis found that soft tissue manual therapy has a significant effect on alleviating the pain of patients with chronic neck pain. However, different pain assessment tools could have a certain impact on the Meta-analysis results.

Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol / Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Abstract Introduction: Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice. Objective: To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors. Methods: Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%. Conclusion: We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Resumo Introdução: O câncer de mama é o tipo de câncer mais comum entre as mulheres. Os tratamentos podem levar a complicações, modificando os padrões de movimento dos membros superiores e gerando dor e perda de funcionalidade. A cinesioterapia e a reorganização miofascial (RM) têm demonstrado efeitos positivos na redução da dor crônica e na melhora da função dos membros superiores. A hipótese do presente estudo é que essas técnicas podem maximizar os resultados e reduzir o tempo de tratamento na prática clínica. Objetivo: Desenvolver um protocolo para verificar se a RM associada à cinesioterapia é mais eficaz do que a cinesioterapia isolada no tratamento da dor crônica e disfunção do membro superior em sobreviventes de câncer de mama. Métodos: As participantes serão divididas em dois grupos: grupo intervenção (reorganização miofascial + cinesioterapia) e grupo sham (massagem tradicional + cinesioterapia). Serão realizadas seis sessões de tratamento (uma vez por semana) e três avaliações. Os instrumentos de avaliação da dor e da funcionalidade serão a Escala Visual Analógica, o Diagrama de Dor Corporal, o Questionário de Deficiências do Braço, Ombro e Mão e a goniometria. A análise estatística será realizada com base na análise de intenção de tratar. Para analisar a diferença de médias entre os grupos, serão utilizados o teste T-Student ou U Mann-Whitney. ANOVA de medidas repetidas será utilizada para verificar os efeitos dos tratamentos. O nível de significância para todos os testes será de 5%. Conclusão: Espera-se que a RM associada à cinesioterapia melhore a dor crônica e a funcionalidade dos membros superiores de sobreviventes de câncer de mama.

A importância da intervenção fisioterapêutica no vaginismo: uma revisão sistemática / The importance of physiotherapeutic intervention in vaginism: a systematic review

Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)

Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)

Um teste clínico randomizado comparando o fortalecimento de abdutores do quadril e terapia manual em pacientes com fascite plantar: um protocolo de estudo / A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

| INTRODUÇÃO: A fascite plantar (FP) é uma causa comum de dor no calcanhar e deformidade da articulação do tornozelo. Mais de 11% -15% da população com sintomas nos pés precisa de cuidados de longo prazo. Foi comprovado que várias intervenções de fisioterapia com terapia convencional, que inclui terapia manual, ajudam nessa condição. OBJETIVO: Avaliar o efeito do fortalecimento do abdutor do quadril e da terapia manual (MT) em paciente com fascite plantar (FP). MÉTODOS: O desenho do estudo será um ensaio de controle randomizado de dois grupos, pré-teste e pós-teste. Um total de 30 participantes do sexo masculino e feminino com idade acima de 18-60 anos com dores provocadas pelos primeiros passos da manhã, dor na região plantar do calcanhar, serão alocados aleatoriamente em dois grupos - o Grupo A receberá terapia manual (TM) com fisioterapia convencional enquanto o Grupo B receberá fortalecimento dos abdutores do quadril com fisioterapia convencional. Ambos os grupos receberão 16 sessões de tratamento por 4 dias em cada semana durante 4 semanas. "Foot Function Index", "Podia scan", "Teste de queda do navicular" serão usados como medida de desfecho e serão avaliados na 1ª semana e na 4ª semana de tratamento em ambos os grupos. CONCLUSÃO: Os pacientes que recebem a intervenção de fortalecimento do abdutor do quadril podem ter resultados positivos quando comparados à intervenção de MT entre pacientes com FP. Este será o primeiro estudo a comparar o efeito do fortalecimento dos abdutores do quadril e da terapia manual. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos - Índia. (CTRI / 2020/04/024541)

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%- 15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group PretestPosttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. "Foot function index," "Podiascan," "Navicular drop test" will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. This will be the first study to compare the effect of hip abductors strengthening and manual therapy. TRIAL REGISTRATION: Clinical Trial Registry- India. (CTRI/2020/04/024541)

Rehabilitación física en pacientes con artropatía hemofílica: revisión sistemática y metaanálisis sobre dolor / Physical rehabilitation in haemophilic arthropathy: systematic review and pain-related meta-analysis

RESUMEN Introducción: La artropatía hemofílica (AH) cursa con diferentes manifestaciones clínicas importantes, como son las hemorragias articulares, el dolor, la disminución de la amplitud del movimiento y las alteraciones funcionales que pueden causar secuelas en la funciona lidad y movilidad. El ejercicio físico adaptado a los pacientes con hemofilia puede ser una adecuada estrategia terapéutica, que repercuta positivamente sobre la calidad de vida de dichos sujetos. Objetivos: Evaluar la eficacia de la rehabilitación física en el tratamiento de la artropatía hemofílica. Materiales y métodos: Se ha realizado una revisión sistemática y metaánálisis de ensayos clí nicos (seleccionados según criterios de elegibilidad). Para ello, se han utilizado las siguientes bases de datos: PEDro, Pubmed, Scopus y Web of Science. Se empleó la escala «PEDro¼ para evaluar la calidad metodológica de los estudios. Resultados: Tras aplicar los criterios de inclusión y exclusión, en la revisión final fueron incluidos siete artículos, los cuales aportaron resultados favorables sobre la fuerza y el diá metro muscular, el rango de movilidad, el estado articular y la calidad de vida. De ellos, dos estudios aportaron datos para metaanálisis, con resultados favorables sobre la variable dolor [Diferencia de medias estandarizada (DME) = -2,64; IC 95%: (-4,26; 1,03)]. Conclusiones: Se encontró evidencia sobre la eficacia de la rehabilitación física en el trata miento de la artropatía hemofílica. El ejercicio terapéutico (ET) es el principal tratamiento realizado; con este se obtuvieron mejoras significativas en distintas variables físicas.

ABSTRACT Introduction: Haemophilic arthropathy presents with different important clinical disorders, such as joint disease, pain, decreased range of motion, and functional alterations that can produce limitations in functionality and mobility. The physical exercise adapted to patients with haemophilia can be an adequate therapeutic strategy, having a positive impact on the quality of life of these subjects. Objectives: To identify the published clinical trials that evaluate the efficacy of physical rehabilitation in the treatment of haemophilic arthropathy. Materials and methods: A systematic review and meta-analysis of clinical trials was con ducted (using pre-defined eligibility criteria). The literature search was performed in the databases: PEDro, Pubmed, Scopus, and Web of Science. The quality of the methods used in the studies was evaluated using the PEDro scale. Results: After applying the inclusion and exclusion criteria, 7 studies were included in this review, providing favourable results on muscle strength and circumference, range of motion, joint disease, and quality of life. Moreover, 2 articles contributed information to the meta-analysis, showing favourable results on pain [Standardised mean difference (SMD) = -2.64; 95% CI: (-4.26; 1.03)]. Conclusions: This systematic review found evidence on the efficacy of physical rehabilitation in the treatment for haemophilic arthropathy. Therapeutic exercise is the main treatment carried out, obtaining significant improvements in the different physical outcomes.

Variação da resposta sintomática dolorosa na coluna lombar pela manipulação visceral / Variation of painful symptomatic response in the lumbar spine by visceral manipulation

Introdução: A manipulação visceral é atualmente um tratamento usado amplamente pelos osteopatas no mundo, contudo, sua base de mecanismos ainda é pouco esclarecida, havendo certa escassez de pesquisas publicadas sobre tais intervenções. O conceito para o tratamento se baseia na ação sobre aderências fáscias que supostamente afetam a hemodinâmica visceral, desregulação autonômica, fatores psicossomáticos e ptose visceral, repercutindo de maneira direta no bom funcionamento das demais estruturas do corpo. Objetivo: O estudo tem como objetivo mensurar as variações imediatas da resposta sintomática dolorosa por pressão na coluna lombar pela manipulação visceral. Métodos: Trata-se de um estudo experimental, com abordagem longitudinal e caráter quantitativo. Constituído por amostra de doze indivíduos divididos em G1 (uso de manipulação visceral), G2 (uso de placebo) e uso do algômetro de pressão nos músculos paravertebrais corresponde ao nível topográfico da quinta vértebra lombar. Para análise estatística dos dados obtidos, foi aplicado o teste t de Student para amostras pareadas no software Bioestat. Além disso, o nível de rejeição da hipótese de nulidade foi estabelecido em 0,05 ou 5%. Resultados: Obteve-se relevância em um ponto de vista estatístico na análise do grupo submetido a manipulação visceral. Quando comparado a outras evidências recentes, os resultados obtidos pelo estudo revelam dados condizentes. Conclusão: Os resultados deste estudo fornecem informações confiáveis que vão nortear a futura utilização da manipulação visceral na dor lombar crônica, mostrando bom prognóstico em curto prazo. (AU)

Introduction: Visceral manipulation is currently a treatment widely used by osteopaths worldwide, however, its basis of mechanisms is still poorly understood, and there is a lack of published research on such interventions. The concept for treatment is based on the action on fascia adhesions that supposedly affect visceral hemodynamics, autonomic dysregulation, psychosomatic factors, and visceral ptosis, directly affecting the proper functioning of other body structures. Objective: This study aimed to measure the immediate variations in the symptomatic painful response to pressure in the lumbar spine by visceral manipulation. Methods: This is an experimental study, with a longitudinal approach and quantitative character. Consisting of a sample of twelve individuals divided into G1 (use of visceral manipulation), G2 (use of placebo) and use of the pressure algometer in the paravertebral muscles corresponds to the topographic level of the fifth lumbar vertebra. For statistical analysis of the data obtained, the Student's t test was applied to paired samples using the Bioestat software. In addition, the level of rejection of the null hypothesis was set at 0.05 or 5%. Results: Relevance was obtained from a statistical point of view in the analysis of the groups submitted to visceral manipulation. When compared to other recent evidence, the results obtained by the study reveal consistent data. Conclusion: The results of this study provide reliable information that will guide the future use of visceral manipulation in chronic low back pain, showing a good prognosis in the short term. (AU)

Efectos de las Técnicas Manuales Orofaciales en la Disminución del Dolor Cervical. Una Revisión Bibliográfica / Effects of Orofacial Manual Techniques in the Reduction of Cervical Pain. A Bibliographic Review

Introducción: La prevalencia anual de dolor cervical oscila entre un 16,7% y un 75,1%, durando alrededor de 6 meses o más en el 14% de los casos, desencadenando en restricción del movimiento y dolor principalmente. Esto podría deberse a la relación entre la cabeza, columna cervical y estructuras relacionadas a la articulación temporomandibular (ATM). El objetivo de esta investigación es describir a través de la evidencia científica el efecto de las técnicas manuales orales en la disminución del dolor cervical. Métodos: Se incluyeron ensayos clínicos aleatorizados y revisiones sistemáticas encontrados en las bases de datos PubMed, Cochrane y PEDro. Realizando la extracción de datos a través de una tabla estructurada para cada tipo de estudio. Resultados: De 10 estudios seleccionados, 3 corresponden a revisiones sistemáticas y 7 a ensayos clínicos, donde la disminución del dolor cervical fue significativa al aplicar la terapia manual con ejercicios por sobre la terapia manual por sí sola. Por otro lado, las técnicas orofaciales fueron beneficiosas al combinarlas con terapia manual en comparación con un tratamiento habitual. No se encontraron diferencias significativas al aplicar ejercicios de Maitland y movilizaciones en comparación con ejercicios de flexibilidad, fortalecimiento, ejercicios de Mulligan y movilizaciones. Conclusión: Los resultados son debatibles, ya que la terapia manual por sí sola o combinada con ejercicios es la técnica más efectiva no solo en la disminución del dolor cervical, también en la mejoría de la calidad de vida.

Introduction: The annual prevalence of cervical pain ranges from 16.7% to 75.1%, lasting about 6 months or more in 14% of cases, triggering mainly movement restriction and pain. This could be due to the relationship between the head, cervical spine and structures related to the temporomandibular joint (TMJ). The objective of this research is to describe through scientific evidence the effect of oral techniques in reducing cervical pain. Methods: Randomized clinical trials and systematic reviews found in the PubMed, Cochrane and PEDro databases were included. Data extraction was done through a structured table for each type of study. Results: Out of 10 selected studies, 3 correspond to systematic reviews and 7 to clinical trials, where the decrease in neck pain was significant when applying manual therapy with exercises over manual therapy alone. On the other hand, orofacial techniques were beneficial when combined with manual therapy compared to an usual treatment. No significant differences were found when applying Maitland exercises and mobilizations compared to flexibility, strengthening, Mulligan exercises, and mobilizations (p<0.05). Conclusion: The results are debatable, as manual therapy alone or combined with exercises is the most effective technique not only in reducing neck pain, but also in improving quality of life.

The Potential Value Of Early Long-Term Use Of Memantine To Delay The Onset Of Alzheimers Dementia In Genetically Loaded High Risk Individuals To Develop Alzheimers Dementia With And Without Cardiovascular Risk Factors

@#Memantine is NMDA (N Methyl D Aspartate) antagonist used to manage dementia, it works by blocking the glutamate receptors that stimulate excite-toxic neuronal death that results from excessive calcium influx into the neurons which in turn causes mitochondrial suffocation and neuronal death. Memantine is an uncompetitive, low affinity, open-channel blocker that reduces the glutamate induced overstimulation of the receptors that results in neuronal damage. It is unlike potential neuroprotective agents that block virtually all NMDA receptor activity including blockade of those essential for normal neuronal functioning. On the other hand, the pathology of dementia we are tackling here appears several years and may be decades earlier in structural and functional MRI studies before the development of the full-blown clinical picture of Alzheimer’s Dementia. The use of Meantime in this paper is targeting the excite-toxic etiology mainly and the development of Alzheimer’s Dementia. We used the term and definitions of critical numbers in a synonymous way to talk about brain reserve and to hypothesize the potential mechanism of Memantine in delaying the onset of symptoms of Alzheimer’s Dementia if used as a monotherapy irrespective of other pathologies such as the neurofibrillary tangles and plaques formation. Meanwhile, in the same hypothesis we left a room for using memantine and other disease modifying agents to be combined and used to tackle more than one etiological factor in those individuals with genetic risk to develop Alzheimer’s Dementia with and without cardiovascular risk factors.

A Case of Cervical Radiculopathy Related to a Cervical Manual Therapy Course

ABSTRACT Neck pain is a common problem associated with considerable comorbidities, disability and cost to society. Spinal manual therapy is commonly used to treat this condition, and some countries recommend it as a treatment option in their clinical guidelines, since it is generally believed to be a safe and effective method for physicians to use to relieve neck pain. However, the non-invasive and frequently medication-free manipulation manoeuvres can potentially lead to severe adverse effects. This study presents a case of cervical radiculopathy related to cervical manual therapy applied during a training course.

Análise da terapia craniossacral na disfunção temporomandibular associada a cefaleia tensional / Analysis of craniosacral therapy in temporomandibular dysfunction associated with tensional headache

Resumo Introdução Ocorrendo de forma branda e não invasiva, a terapia craniossacral é uma técnica de manipulação na qual o terapeuta exerce leve pressão sobre estrutura óssea, sendo utilizada como tratamento para diversos problemas de saúde, como cefaleias e DTM. Objetivo Analisar os efeitos da terapia craniossacral em indivíduos com disfunção temporomandibular associada a cefaleia do tipo tensional. Material e método Estudo descritivo, intervencionista com abordagem quantitativa, realizado no núcleo de atenção médica integrado, no período de fevereiro a setembro de 2018. Foram inclusos no estudo indivíduos com disfunção temporomandibular e que apresentaram cefaleia dentre os sintomas. Foram exclusos aqueles que não compareceram ao atendimento ou não apresentaram a sintomatologia. Previamente, foi realizada uma avaliação para identificar a dor na crise de cefaleia, a mensuração da amplitude de movimento mandibular e a palpação dos músculos da mastigação, para classificar a dor em leve, moderada ou forte. Após oito atendimentos, sendo duas vezes por semana com duração de 15 minutos cada, todos foram reavaliados. Resultado Participaram do estudo 31 indivíduos, sendo 90,3% do sexo feminino. Na classificação do RDC/TMD, houve prevalência dos grupos G1 e G1G3. Quanto a mobilidade mandibular, houve ganho para os movimentos de abertura, com 45,6 mm (±7,5) antes da terapia e, na reavaliação, 47,4 mm (±8,4); desvios laterais antes da terapia (lado direito - 7,0 ±2,8) e (lado esquerdo - 7,7±3,0), e após a terapia (8,0±3,0) e (8,6±2,9), respectivamente; o movimento de protusão, antes com média 5,03 ±2,5 e, na reavaliação, com 4,8 ±1,9. Na palpação muscular, destacamos redução do quadro álgico no músculo pterigoideo medial com média 2,2 (±1,05) antes da terapia e 1,5 (±1,02) após a terapia. Conclusão Concluímos que a terapia se mostrou eficaz no tratamento de pacientes com disfunção temporomandibular associada a cefaleia do tipo tensional.

Abstract Introduction Occurring in a mild and non-invasive way, craniosacra therapy is a manipulation technique that the therapist exerts light pressure on the bone structure, being used as a treatment for several health problems, such as headaches and TMD. Objective To analyze the effects of craniosacra therapy in individuals with temporomandibular disorders associated with tension-type headache. Material and method Descriptive, interventional study with a quantitative approach, carried out in the integrated medical care center from February to September 2018. Individuals with temporomandibular disorder and who presented headache among the symptoms were included in the study. And those who did not attend the service or did not present symptoms were excluded. Previously, an assessment was carried out to identify pain during headache attacks, measurement of mandibular range of motion and palpation of mastication muscles, to quantify pain as mild, moderate and severe. After 8 consultations, twice a week lasting 15 minutes each, all were reassessed. Result 31 individuals participated in the study, being 90.3% female. In the classification of the RDC/TMD, there was a prevalence of groups G1 and G1G3. Regarding mandibular mobility, there was a gain for opening movements with 45.6mm (±7.5) before therapy and 47.4mm (±8.4) in the reassessment; lateral deviations before therapy (right side - 7.0 ±2.8) and (left side - 7.7±3.0) and after (8.0±3.0) and (8.6±2.9); and the protrusion movement before with an average of 5.03 ± 2.5 and in the reassessment with 4.8 ± 1.9. And in muscle palpation, we highlight a reduction in pain in the medial pterygoid muscle with a mean of 2.2 (±1.05) before therapy and 1.5 (±1.02) after. Conclusion We conclude that the therapy has been shown to be effective in treating patients with temporomandibular disorders associated with tension-type headache.

Efeito da massagem e pseudomassagem no desempenho agudo e recuperação autopercebida: um estudo controlado por placebo / Effect of massage and pseudo massage on acute performance and self-perceived recovery: a study placebo-controlled

RESUMO O objetivo deste estudo foi verificar o efeito da massagem ou pseudomassagem no desempenho do salto vertical. Quinze participantes foram submetidos aleatoriamente a três condições experimentais: massagem, pseudomassagem e repouso. A condição de massagem exigiu três saltos verticais unipodais seguidos de dois minutos de massagem manual nos músculos flexores plantares e, antes de executar outros três saltos, foi aplicada a Escala de Recuperação de Qualidade Total (TQR). As duas condições a seguir foram estruturadas com os mesmos procedimentos, no entanto, os participantes foram submetidos à pseudomassagem (simples-cego) ou a dois minutos de descanso. Os resultados não mostraram diferenças estatísticas na altura do salto entre as análises pré e pós, nem entre as condições experimentais (massagem 18,7 ± 4,1 vs. 18,2 ± 4,1; pseudomassagem 19,1 ± 4,0 vs. 18,3 ± 3,8; descanso 19,0 ± 4,0 vs. 18,7 ± 3,9 cm). Também não houve diferenças estatísticas no TQR entre as condições experimentais (massagem 16,2 ± 4,3; pseudomassagem 16,4 ± 3,9; descanso 15,9 ± 2,6 ua). Tanto a massagem quanto a pseudomassagem não afetaram o desempenho no salto vertical e na TQR.

ABSTRACT The aim of this study was to verify the effect of massage or pseudo massage on vertical jump performance. Fifteen participants were randomly subjected to three experimental conditions: massage, pseudo massage and rest. The massage condition required three unipodal vertical jumps followed by two minutes of manual massage on plantar flexor muscles and, before performing another three jumps, the Total Quality Recover Scale (TQR) was applied. The two following conditions were structured with the same procedures, although participants were submitted either at pseudo massage (single-blinded) or two minutes of rest. Results showed no statistical differences on jump height between pre and post analysis nor between experimental conditions (massage 18.7 ± 4.1 vs 18.2 ± 4.1; pseudo massage 19.1 ± 4.0 vs 8.3 ± 3.8; rest 19.0 ± 4.0 vs 18.7 ± 3.9 cm). There were also no statistical differences in the TQR results between experimental conditions (massage 16.2 ± 4.3; pseudo massage 16.4 ± 3.9; rest 15.9 ± 2.6 ua). Both massage and pseudo massage did not affect performance on vertical jump and TQR.

Effect Of Manual Therapy (MET) Vs Conventional Therapy For Improving Tendo-Achilles (TA) Flexibility And Foot Posture In Children With Autism Spectrum Disorder

Background: Autism Spectrum Disorder (ASD) is a disorder of neurodevelopment, which affects individuals across social, ethnic, and geographic groups. Autistic children have difficulty with gross motor and fine motor functioning difficulties, including a wide range of signs and symptoms. Toe walking due to TA tightness is commonly observed gait in autistic children altering foot posture in them. The knowledge about the abnormalities can be useful for the assessment and treatment planning of ASD children. We evaluated TA tightness, ROM of the ankle joint, and compare the effect of manual therapy (MET) and conventional therapy for improving TA flexibility and foot posture. Methods: An RCT included 20 diagnosed autistic children(13male,7female) as per inclusion criteria the subjects were divided into two groups, i.e., group A and B, the group A was given Conventional Therapy in the form of passive stretching whereas Group B was given Manual Therapy in the form Muscle Energy Technique. The participants were clinically examined and evaluate TA tightness in the form of Elastography, Range of motion, and foot posture. Data were taken as pre and after post-intervention. Results: There were significant changes in elastography readings, foot posture index, and range of motion in both groups post-intervention, but significant improvement was observed in group B as compared to group A, i.e., p>0.05. Conclusion: This has been concluded that there is a significant effect of Manual therapy in the form of muscle energy technique for improving TA flexibility and foot posture as compared to conventional treatment.

Effectiveness of Manual Physical Therapy and NSAIDs as a Combination Therapy in Arthritis Patient-A Case Series

Among various types of arthritis Osteoarthritis (OA), Psoriatic arthritis (PA) and Gouty arthritis (GA) are the major ones which have been studied and cause hindrance in movements in many patients. Here we have discussed the treatment modality, a combination of manual therapy and NSAIDs (Ibuprofen) for relieving the symptoms of arthritis. A total of six patients were included consisting of osteoarthritis, psoriatic arthritis and gouty arthritis who presented at the medical office of Dr. Barengolts (MD in USA) and Aybek Izzatov (MD in Uzbekistan) Tyan Anmo Massage School. The study was conducted from October 2019 to March 2020. The treatment consisted of 30 sessions performed for half a year, one week per month (5 days in a month). Significant improvement in symptoms was seen as after 6 months we saw there was reduction in morning stiffness and improved range of motion. The pain score shifted from 5-6 to 2-3 on VAS pain scale. The results signify that the combination therapy wherein manual therapy and NSAIDs worked in an effective way to reduce the level of severity of pain and other associated symptoms.

Liberação miofascial no ganho de potência muscular do quadríceps: um estudo controlado e randomizado / Myfascial release in quadriceps muscle power gain: a controlled and randomized study

A prescrição de exercícios para o ganho de força e potência muscular é utilizado com o objetivo de ajudar na reabilitação de lesões musculares e para o aprimoramento físico nas práticas esportivas. Dentre as técnicas que são apontadas como possíveis condutas que poderiam auxiliar no fortalecimento muscular e potência destaca-se a Liberação Miofascial. Deste m o do, o estudo buscou analisar e comparar um programa de treinamento para ganho de potência muscular com fortalecimento muscular resistido isolado e os resultados de sua combinação com a Liberação Miofascial. Trata-se de um estudo quantitativo, transversal, analítico, de caráter experimental, comparativo, controlado e randomizado. A amostra foi composta por 11 mulheres com idade de 18 a 40 anos subdivididas em dois grupos de intervenção. As intervenções ocorerram 3 vezes por semana durante 4 semanas. Os membros do Grupo controle realizaram apenas o fortalecimento muscular com exercício de agachamento a partir de 0 º de flexão de joelhos até o limite de 90º de flexão e retornando ao grau 0. As voluntárias do Grupo Liberação Miofascial associado ao treino de força inicialmente foram submetidas a intervenções de Liberação Miofascial dos músculos quadríceps bilateralmente e posteriormente ao treino de fortalecimento muscular descrito no grupo controle. Foram avaliadas as variáveis distância do salto vertical e carga suportada em 1 Repetição Máxima. A estatística inferencial utilizada foi através do t este T de Student emparelhado para verificar a diferença entre as médias do antes e depois dos tratamentos em cada grupo. Para verificar as diferenças em relação às técnicas utilizadas em grupos diferentes foi realizado o teste T de Student não compartilhado. Os resultados demonstraram não haver diferença estatisticamente significante entre os grupos no que se refere a carga máxima suportada em 1 Repetição Máxima (p=0,484), mesmo sendo essa diferença numericamente de 3,31kg a mais de ganho para o Grupo que utilizou a Liberação Miofascial associada ao treino de força, e não foi encontrada diferença significativa (p=0,068) entre a distância de salto vertical nos grupos, apesar desta distânicia ser 4,35 cm maior também no grupo Liberação Miofascial associada ao treino de força. Foi possível demonstrar, desta form a, que a liberação miofascial não otimiza o ganho da potencia muscular associado ao exercício resistido . Desta forma, através dos resultados deste estudo, não é possível recomendar a utilização da LM como um recurso para ser utilizado pré treino com objetivo de ganho de potência muscular...(AU)

The prescription of exercises to gain muscle strength and power is used to help in the rehabilitation of muscle injuries and for physical improvement in sport practices. Among the techniques that are pointed as possible ways that could help in muscle strengthening and power, Myofascial Release stands out. Thus, the study sought to analyze and compare a training program for muscle power gain with isolated resistance muscle strengthening and the results of its combination with myofascial release. It is a quantitative, cross-sectional, analytical, experimental, comparative, controlled and randomized study. Our sample consisted of 11 women aged 18 to 40 years old, subdivided into two interventio n gro ups. Th e interventions occurred 3 times a week for 4 weeks. Control Group members only perform muscle strengthening with squats from 0º of knee flexion up to the limit of 90º of flexion and return of grade 0. As volunteers of the Myofascial Release Group associated with strength training, t hey were subm it ted t o Myofascial Release of the quadriceps muscles bilaterally and after the muscle st rengt hening t raining described in the control group. The variables vertical jump distance and load supported in 1 Maximum Repetition were evaluated. The inferential statistics used was through the paired Student's T test to verify the difference between the means of before and after treatments in each group. To verify the differences in relation to the techniques used in different groups, the Student's t-test was not shared. T here was n o statistically significant difference between the groups regarding the maximum load supported in 1 Maximum Repeat (p=0.484), even though this difference was numerically 3 .3 1kg m o re gain fo r t he Myofascial Release Group.No significant difference (p=0.068) was found either between t he v ertical jump distance, which was 4.35 cm higher ­ also in the Myofascial Release group. Thus, it was demonstrated that myofascial release does not optimize the gain in muscle power associat ed with resistance exercises. Thus, through the results of this study, it is not possible to recommend the use of SCI as a resource to be used pre-training in order to gain muscle power...(AU)

The Impact Of Manual Therapy Techniques On Pain, Disability And Il-1b Levels In Patients With Chronic Cervical Pain

Background: Chronic neck pain is a common musculoskeletal dysfunction, and Manual Therapy is one of the effective treatment modalities, but underlying mechanisms of action are unclear. The study's purpose was to investigate the short-term effect of mobilization-manipulations on patient’s symptoms and to detect changes in the concentration of inflammatory biomarker interleukin-1b. Methods: Twenty-two patients aged 20-50 years with chronic neck pain, randomly assigned into two groups. The study group received nine sessions of a three-week Manual Therapy intervention. The control group received SHAM Manual Therapy of the same dosage. Pain and functionality measures conducted before and after the intervention via NPRS and NDI scales, respectively. Blood samples collected at baseline, after the first session and post-intervention, detecting IL-1β concentration, using the corresponding ELISA kit. Mixed ANOVA statistical analysis implemented for differences in the GROUP-TIME factors. Results: There was a significant statistical interaction between factors and significant main effects on pain, functionality, and IL-1β (p <.05). IL-1β was statistically significant reduced (p <.05) at second measurement for the study group, but not significantly reduced (p> .05) between second and final measurement. No statistical significance was found for the control group on any of the dependent variables across measures. Conclusion: Patients with chronic mechanical pain showed significant pain and functionality improvement after manual therapy application. The underlying mechanism of action seems to relate with a reduced IL-1b concentration of reinforcing future research at relevant pain biomarkers.

Comparison Of Kinesio Taping And Manual Therapy With Supervised Exercise Therapy For The Treatment Of Shoulder Impingement Syndrome

Background: Shoulder Impingement Syndrome (SIS) is a major contributing factor for shoulder pain. Although many therapists use Kinesio Taping (KT) and Manual Therapy (MT) for SIS, no such studies in combination with Supervised Exercise Therapy (SET) have been conducted in the context of Saudi Arabia. Thus, the purpose of this study is to compare the effectiveness of KT and MT with SET in patients with SIS. Methods: Randomized controlled trial. Thirty-two subjects were assigned into two groups (KT with SET and MT with SET). The following outcome measures were measured at baseline, three weeks and six weeks. The outcome measurements are pain intensity by a numerical pain rating scale (NPRS), Active range of motion in the shoulder (AROM) by goniometry, and the functions of the shoulder measured through Shoulder Pain and Disability Index (SPADI). A simple descriptive statistical analysis was adopted to describe the patient-specific demographic characteristics with respect to outcome parameters. Within-group and between groups comparison were analyzed using ANOVA, and Scheffes’ posthoc tests by using SPSS 21.0. Results: Sixteen subjects completed treatment in each group. No differences were identified between groups at baseline. In ANOVA, it was shown that both groups significantly (p<0.05) decreased pain intensity, improved function and increased shoulder AROM in the 3rd week, and 6th week. However, post hoc analysis results suggested that the KT, in conjunction with SET, had a higher proportion of change on 3rd week, of the pain intensity, SPADI, and AROM. Conclusion: KT with SET has been found to be more effective than the MT with SET in the 3rd week and had the same effect in the 6th week of the treatment. When an immediate effect is expected, KT may be a better choice of treatment in the management of SIS.

Terapia manual na recuperação funcional pós-entorse lateral de tornozelo: revisão sistemática / Manual therapy in the functional recovery after the ankle side entry: systematic review

INTRODUÇÃO: O tornozelo é considerado uma das regiões do corpo mais propensa às lesões esportivas, sendo 70% dessas lesões entorses de tornozelo. A recidiva de entorses pode provocar um prejuízo crônico na função proprioceptiva e sensório-motora. Não existe um tratamento específico para as entorses, sendo utilizados protocolos como o PRICE, abordagem passiva, imobilização da articulação e terapia manual. OBJETIVO: Trazer informações mais consistentes que elucidem os efeitos da terapia manual na recuperação da funcionalidade do paciente. MATERIAIS E MÉTODOS: Tratase de uma revisão sistemática baseada no PRISMA, com buscas realizadas nas bases de dados: PubMed, SciELO, LILACS e PEDro. Foram pesquisados apenas ensaios clínicos randomizados, com avaliação maior ou igual a 5/10 na escala PEDro, nos idioma português e inglês. Os estudos deveriam incluir população com idade entre 18 e 60 anos utilizando técnicas de terapia manual como: Mulligan, Maitland, mobilização neural, massoterapia, liberação miofascial, pompage e alongamento passivo. RESULTADOS: Foram incluídos 7 artigos com um total de 300 indivíduos. Os estudos incluídos investigaram a recuperação da funcionalidade de pacientes submetidos à terapia manual. Limitações: heterogeneidade no tempo de lesão. CONCLUSÃO: Os resultados evidenciaram melhora na capacidade física para correr, saltar, pousar e realizar movimentos de corte e laterais, melhora da cinemática, marcha, distribuição de descarga de peso e função global.

INTRODUCTION: The ankle is considered one of the regions of the body most prone to sports injuries, with 70% of these injuries ankle sprains. The recurrence of sprains can cause chronic impairment in proprioceptive and sensorymotor function. There is no specific treatment for sprains, using protocols such as PRICE, passive approach, immobilization of the joint and manual therapy. Manual therapy in patients who have undergone lateral ankle sprains can provide beneficial results by improving range of motion, subtalar joint slippage, speed and length of steps, distribution of gait forces, pain relief, and activities of daily living. OBJECTIVE: The objective of this study is to provide more consistent information that elucidates the effects of manual therapy on the recovery of the patient's functionality. MATERIALS AND METHODS: This is a systematic review that followed some PRISMA rules in the databases: PubMed, SciELO, LILACS and PEDro. The articles were searched in Portuguese and English. RESULTS: Seven articles with a total of 300 individuals were included. The included studies investigated the retrieval of the functionality of patients undergoing manual therapy. CONCLUSION: The results showed an improvement in physical ability to run, jump, land and perform lateral and lateral movements, improvement of kinematics, improvement of gait, better distribution of weight discharge and improvement of overall function.