ABSTRACT
The purpose of this focused review is to develop a consolidated hypothesis as to the causes and mechanisms of central sensitization and a related model for a treatment approach using Systemic Manual Therapy (SMT). The key to understanding central sensitization is a firm grasp on structure and function of the Locus-coeruleus noradrenaline system (LC-NA). This system uses an elaborate switching mechanism to control the level and rate of activation of multiple systems. This review evaluates the mechanisms and temporal relationships behind four components: salient stimuli, threat coding, aberrant afferent input, and oxidative stress. The five-stage temporal model for central sensitization includes phasic activation of the LC-NA system, salient stimuli, threat coding of salient stimuli, central sensitization, and neural degeneration. The three components of treatment include temporarily reducing afferent visceral input, shifting humoral inflammatory activity away from the brain and outside the body, and reducing oxidative stress by making oxygenated blood more available around the LC and other stressed areas in the brain. The SMT protocols that could help in reduction of visceral afferent input are GUOU, Barral and LAUG. Protocols that should shift humoral inflammatory activity away from the brain or completely out of the body include UD and DCS. One protocol that can potentially reduce oxidative stress by making oxygenated blood more available around the LC is CCCV. Future research and hypothesis-testing strategies as well as limitations are further discussed.
ABSTRACT
BACKGROUND: The emergence of the Coronavirus (COVID-19) pandemic increased the need for an effective treatment for respiratory conditions exponentially. To meet this challenge, we reevaluated the effectiveness of our physical therapy protocols for respiratory conditions. Protocols of interest were categorized as decongestive, neurogenic, mechanical, and immune modulating. OBJECTIVE: The objective of this study is to evaluate which of our existing treatment protocols or protocol combinations produce the best outcome. To do so, we analyzed which ones can meet the following criteria when compared to all other treatments: test statistic (>2.0) in parametric and non-parametric tests, [statistical significance (p < 0.05)], effect size larger than 0.2, difference in the Patient Identified Problem Scale (PIP) score above Minimal Clinically Important Difference (MCID), and sample size minimum 15 treatments. DESIGN: Retrospective multivariate analysis using a modified adaptive platform design. METHODS: A computerized sampling using respiratory related key words from a blinded dataset yielded 178 patients with respiratory complaints or pain in the chest area. Additional statistical analysis using parametric and non-parametric tests evaluated the difference between each treatment protocol and the rest of the treatments provided. RESULTS: Several protocol combinations and one individual protocol passed the study criteria. Cardiac vascular venous thoracic (CVVT) protocol was used most frequently within these combinations (7), followed by Urinary Drainage (UD) (4). Other protocols in this group were Cardiac Cervical Cranial Vascular (CCCV), Venous Thoracic Cardiopulmonary (VTCP), and Diaphragm Cranial Sinus (DCS). Among the respiratory specific protocols, CVVT was significantly better than VTCP (0.40, p < 0.001). DISCUSSION AND CONCLUSION: For the patient population studied, CVVT appears to be the primary protocol to consider, followed by UD, CCCV, VTCP, and DCS. Combining CVVT with Barral Abdominal Motility protocol (Barral) or VTCP with Lower Abdominal Urogenital (LAUG) on the same day might be required with acute patients.